The research, published in the journal Discover Sustainability, examined the influence of three factors on household food-wasting behaviour among urban households in Enugu State: environmental awareness, household income and family size. Led by Eunice Ifenyinwa Ugwu of the Department of Home Economics and Hospitality Management Education at the University of Nigeria, Nsukka, the team set out to fill a stubborn evidence gap. While household food waste has been studied extensively in Europe, North America and parts of Asia, comparable data from sub-Saharan Africa remain scarce, even though the region’s rapidly urbanising cities are expected to become major drivers of global food demand and waste in the coming decades.

To build their dataset, the researchers conducted a cross-sectional survey of 239 urban households, selected using the Krejcie and Morgan procedure, a widely used statistical formula for determining sample size from a known population. The study was guided by the Theory of Planned Behaviour, a psychological framework that explains human action through attitudes, subjective norms and perceived behavioural control. In this context, the theory predicts that a household’s intention to avoid or engage in food waste flows from what its members believe about the environment, what they perceive others around them to be doing, and how much control they feel they have over their food management practices.

The analysis combined three statistical techniques. Descriptive statistics painted the initial picture of food-wasting patterns across the surveyed households. Pearson product-moment correlation analysis then measured the strength and direction of the linear relationships between each predictor and food-wasting behaviour. Finally, partial least squares structural equation modelling, a technique well suited to testing complex networks of relationships between observed variables and latent constructs, allowed the team to test all three predictors simultaneously within a single structural model.

The results were striking in their symmetry. Environmental awareness significantly reduced household food-wasting behaviour: households whose members understood the environmental consequences of waste threw away measurably less food. Household income and family size, by contrast, both significantly increased food-wasting behaviour. Of the three predictors, household income emerged as the strongest, suggesting that the ability to buy more food than a household needs is a more powerful driver of waste than any attitudinal factor the study measured.

This pattern makes intuitive sense once the mechanics of household food management are considered. Wealthier households buy in larger quantities, purchase more perishable items, and can afford to discard food without a painful sense of loss. Larger families generate more leftovers, cook bigger meals with greater margins of error, and face more complex logistics in matching purchases to consumption. Awareness, meanwhile, acts as a brake: when household members grasp that wasted food means wasted water, energy and emissions, they appear to manage their kitchens more carefully.

The structural model explained a meaningful proportion of the variance in household food-wasting behaviour and demonstrated acceptable predictive relevance, the statistical benchmarks that indicate the model captures real relationships rather than noise. The authors argue that this finding carries a theoretical punch: behavioural and structural determinants operate simultaneously in shaping household food waste in rapidly urbanising settings. Attitudes alone do not explain waste, and neither do demographics alone; the two pathways interact.

Indeed, the study’s most significant theoretical contribution may be its extension of the Theory of Planned Behaviour itself. The classic framework traces behaviour through an attitudinal pathway, but the Enugu researchers explicitly incorporated structural household variables, income and family size, alongside that pathway. This hybrid model acknowledges that in developing economies, where food budgets are tight and household structures vary widely, purely psychological models of consumption may miss the material conditions that constrain or enable sustainable behaviour.

The practical recommendations that flow from the findings are correspondingly layered. The authors call for targeted environmental education that reaches households through channels they actually use, income-sensitive food management strategies that recognise wealthier households as priority targets for waste-reduction campaigns, and household-size-responsive interventions that help larger families plan purchases and meals more precisely. Improved food storage, redistribution programmes that channel surplus food to those who need it, and stronger policy support for Sustainable Development Goal 12.3, which targets halving global food waste by 2030, complete the package.

For Nigeria and comparable developing economies, the study offers a template for designing sustainable food systems and behavioural transition initiatives grounded in local evidence rather than imported assumptions. As urbanisation accelerates across Africa, the households of cities like Enugu will shape the continent’s food footprint. The message of this research is that changing that footprint will require both minds and structures to move together: raising awareness where it is low, and building food systems that make the sustainable choice the affordable one for every income level and family size.

Subject of Research: Predictors of household food-wasting behaviour among urban households in Enugu State, Nigeria

Article Title: Environmental awareness, household income and family size as predictors of household food-wasting behaviour among urban households in Enugu State, Nigeria

Article References: Ugwu, E. I., Attah, B. I., Ifeanyichukwu, I. O., Ezeaku, M. N., Madu, M. A., & Emeka, C. E. (2026). Environmental awareness, household income and family size as predictors of household food-wasting behaviour among urban households in Enugu State, Nigeria. Discover Sustainability. https://doi.org/10.1007/s43621-026-04955-3

Image Credits: AI Generated

DOI: 10.1007/s43621-026-04955-3

Keywords: household food waste, environmental awareness, household income, family size, Enugu State, Nigeria, Theory of Planned Behaviour, structural equation modelling, sustainable consumption, SDG 12.3, food security, urbanisation

The research team, led by Bei Dong and corresponding author Carmen Wing Han Chan, set out to answer a deceptively simple question: among Chinese first-degree relatives of colorectal cancer patients, what shapes the formation of colonoscopy screening intention, and what determines whether that intention ever becomes a booked appointment? To explore this, the investigators conducted a qualitative descriptive study guided by the theory of planned behaviour, a widely used psychological framework that models human action as the product of attitudes toward the behaviour, perceived social pressure, and perceived control over performing it. Between May and June 2025, the team carried out semistructured interviews, conducted either face to face or by video call, with participants recruited from one specialised cancer hospital and two comprehensive hospitals in China.

The methodological design reflects a deliberate effort to capture the full spectrum of experience. Using maximum variation sampling, the researchers deliberately selected thirty-two first-degree relatives differing in gender, age, education level, occupation, place of residence, and — critically — their actual colonoscopy screening behaviour. This heterogeneity matters because it guards against the common pitfall of qualitative studies that interview only the willing or the accessible. The interviews were then subjected to content analysis, with the team attending to established criteria of rigour: credibility, transferability, dependability, and confirmability. Ethics approval was secured from the Ethics Committee of the Chinese University of Hong Kong, Soochow University, and Shandong Cancer Hospital, and written informed consent was obtained from every participant in accordance with the Declaration of Helsinki.

What emerged from the analysis was a two-stage architecture of decision-making. The researchers identified three categories of factors influencing whether an intention to undergo colonoscopy screening forms in the first place: perceived colorectal cancer risk, perceived health value of colonoscopy, and advice from others. In the language of the theory of planned behaviour, these map onto the attitude dimension — how a person evaluates the screening itself — and the subjective norm dimension, the perceived social expectation from family, friends, and clinicians. The study concludes that these attitude- and norm-related factors play a decisive role in intention formation, meaning that a relative who does not personally feel at risk, who doubts the value of the procedure, or who receives no encouragement from others may never even reach the point of saying yes.

But intention, the study shows, is only half the battle. Four separate categories of factors govern whether a formed intention translates into action: the priority of colonoscopy, information preparation, psychological preparation, and practical conditions. Priority, the researchers found, is shaped by the perceived urgency of the procedure and by conflict with role responsibilities — the competing demands of work, caregiving, and family obligations that push a discretionary medical appointment down the list. Information preparation involves the knowledge a relative needs about screening procedures themselves, while psychological preparation concerns two of the most feared elements of the colonoscopy experience: bowel preparation and anaesthesia. These intention-to-action factors, the analysis indicates, align with the perceived behavioural control dimension of the theoretical framework — the sense that one can actually carry the behaviour out.

The practical conditions category deserves particular scrutiny because it exposes barriers that no amount of personal motivation can overcome. The study identifies personal financial capacity, accessibility to caregiving support, and organisational support as the concrete enablers — or obstacles — standing between a willing relative and a completed colonoscopy. A person may genuinely want to undergo the procedure, as the article’s evocative title suggests with its trailing ellipsis, yet find the cost prohibitive, lack someone to accompany them or care for dependants during the recovery period, or face services that are simply inaccessible or inconveniently organised. These are structural problems, and the authors argue that structural support should be further optimised to improve the accessibility and convenience of colonoscopy screening services.

The theoretical payoff of the study lies in its stratification of the behavioural pathway. Because attitude- and norm-related factors dominate intention formation while control-related factors dominate the transition to action, the authors propose that interventions can be stratified according to whether first-degree relatives have already formed an intention to undergo colonoscopy screening. For those who have not, efforts should concentrate on risk perception, the perceived health value of the procedure, and social advice — essentially, on changing minds. For those who have formed an intention but remain stuck, the levers are different: information about procedures, reassurance about bowel preparation and anaesthesia, help with scheduling around role responsibilities, and practical support with finances, caregiving, and organisational logistics. A one-size-fits-all campaign, the findings imply, would miss one group or the other.

The clinical context amplifies the significance of these results. Colorectal cancer remains one of the most common malignancies worldwide, and screening by colonoscopy can detect precursor lesions and early-stage disease when treatment is most effective. First-degree relatives of patients occupy a uniquely high-risk tier, which is why interventions targeting both intention formation and action implementation are expected to further increase colonoscopy uptake in this population. The study’s authors frame their work as directly informing the development of precise and efficient interventions — a goal that matters enormously in health systems where screening resources are finite and where the relatives of newly diagnosed patients represent a captive, identifiable, and highly motivated audience for preventive care.

From a health services research perspective, the study also illustrates the value of qualitative methods in behavioural science. Quantitative surveys can measure how many relatives intend to undergo screening and how many actually do, but they cannot reveal why the numbers diverge. By interviewing thirty-two relatives across different hospitals, ages, and backgrounds, the researchers surfaced the texture of the decision: the anxiety about anaesthesia that never gets voiced in a clinic, the parent who cannot leave a sick family member to attend an appointment, the worker who cannot afford the days off, the relative who has heard conflicting advice about whether the procedure is truly necessary. Content analysis of these accounts converted anecdote into a structured, theory-anchored map of the behavioural terrain.

The broader lesson for screening programmes everywhere — not only in China — is that the phrase I want to undergo colonoscopy, but… contains a complete research agenda in four words. The word want points to attitudes and social norms; the word but points to control, logistics, and fear. The study’s conclusion that stratified interventions should be implemented according to whether relatives have formed an intention offers programme designers a practical decision rule, while its call to optimise structural support reminds policymakers that individual resolve cannot substitute for accessible, affordable, and convenient services. As colonoscopy screening expands to reach the first-degree relatives who need it most, the difference between a good intention and a completed procedure may come down to whether the health system treats the ellipsis as seriously as the affirmation that precedes it.

Subject of Research: Factors influencing colonoscopy screening intention and uptake among first-degree relatives of colorectal cancer patients

Article Title: “I want to undergo colonoscopy, but…”: qualitative study of colonoscopy screening intentions and actions amongst first-degree relatives of patients with colorectal cancer

Article References: Dong, B., Yang, Y., Chen, Y., Lam, T. Y. T., & Chan, C. W. H. (2026). “I want to undergo colonoscopy, but…”: qualitative study of colonoscopy screening intentions and actions amongst first-degree relatives of patients with colorectal cancer. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15603-x

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15603-x

Keywords: colorectal cancer, colonoscopy, first-degree relatives, cancer screening, theory of planned behaviour, qualitative study, health services research, intention-action gap, bowel preparation, anaesthesia, screening barriers, China

The psychological weight of a cancer diagnosis creates conditions that researchers have long recognised as fertile ground for misinformation to take root. When patients and their families receive life-altering news, their cognitive resources are often stretched to breaking point. The study under discussion, conducted at King Fahad Specialist Hospital in Dammam, Saudi Arabia, captures this dynamic in striking detail through semi-structured interviews with nineteen cancer patients and six caregivers. By grounding their analysis in two well-established psychological frameworks, the theory of planned behaviour and the health belief model, the researchers moved beyond simply cataloguing what participants searched for online and instead examined the underlying beliefs that shaped how they searched, what they trusted, and why they sometimes fell prey to false or misleading claims.

The theory of planned behaviour posits that human actions are guided by three kinds of beliefs: behavioural beliefs about the consequences of an action, normative beliefs about the expectations of others, and control beliefs about one’s own capacity to perform the behaviour. Applied to information seeking, this framework helps explain why a patient might type symptoms into a search engine late at night despite knowing that clinicians discourage it. If the patient believes that searching will bring relief from uncertainty, senses that family members expect them to be proactive, and feels confident in their ability to navigate the web, the intention to search online becomes powerful, regardless of the quality of what they find.

The health belief model adds another layer by focusing on perceptions of threat and benefit. A patient who perceives their cancer as severe and themselves as highly susceptible to progression may be more motivated to seek information aggressively, but that same heightened perception of threat can make dramatic, unverified claims about miracle cures or hidden causes feel plausible. Perceived barriers and self-efficacy, two further constructs of the model, determine whether patients verify what they read or accept it at face value. The interview study suggests that many participants possessed low self-efficacy when it came to evaluating sources, and this deficit became a critical vulnerability.

One of the most consequential findings is that participants relied on superficial methods to search for and evaluate online cancer information, largely to reduce cognitive effort. This behaviour has a rational core. Information search is fundamentally a problem-solving task involving inference and decision-making, and these are precisely the cognitive processes that cancer and its treatments can impair. Chemotherapy-related cognitive changes, often described by patients as difficulty concentrating or remembering, compound the challenge of parsing dense, technical, and sometimes contradictory web content. Under such conditions, shortcuts become attractive: judging a website by its professional appearance, trusting the first result a search engine returns, or accepting information because it appears repeatedly across multiple pages.

These heuristics, while efficient, are unreliable proxies for accuracy. Search engine rankings reflect popularity and optimisation rather than medical validity, and polished design is no guarantee of sound science. The study’s participants were not careless; they were conserving limited mental energy during an exhausting period of their lives. Recognising this distinction matters for anyone designing interventions, because simply urging patients to be more careful ignores the cognitive realities that make carefulness difficult. Practical tools that lower the effort required for evaluation, such as checklists that prompt a few key questions about a source, may succeed where exhortations to vigilance fail.

Equally revealing is the finding that peer experiences were regarded as a trustworthy source of cancer information. This trust is not irrational. Fellow patients offer lived experience, emotional resonance, and practical advice that clinical materials often lack. Hearing that another person tolerated a treatment regimen or managed a side effect can provide hope and a sense of community that no pamphlet can replicate. The difficulty arises when anecdotal experience is generalised into medical truth. A single patient’s response to an unproven remedy says nothing about its efficacy or safety for others, yet within online communities such stories circulate with persuasive force, particularly when they align with what an anxious reader hopes to hear.

The consequences of misinformation documented in the study extended beyond confusion. Participants reported impacts on both psychological and physical health outcomes. Psychologically, exposure to false or alarming claims fuelled anxiety, eroded hope, and sometimes created conflict between what patients read and what their clinicians told them. Physically, misinformation could lead to delayed treatment decisions, abandonment of prescribed therapies, or adoption of unverified interventions with real risks. These outcomes echo broader findings in the literature: systematic reviews of social media health information quality have identified cancer as one of the topics generating the most quality concerns, and reviews of misinformation prevalence report moderate rates of false content for noncommunicable diseases including cancer.

Against these risks, participants described mitigation strategies centred on trustworthy healthcare communication. Some verified online findings by bringing them to their physicians or nurses; others defaulted to information sources recommended by their care teams. These strategies transformed the clinical encounter into a verification checkpoint, a role that many clinicians already perform informally. The study suggests that this function could be made explicit and systematic. Directing patients to well-known national and international cancer information repositories, and introducing simple evaluation checklists during consultations, would give patients reliable starting points and reduce their dependence on whatever a general search engine surfaces first.

Yet the study also uncovered significant barriers to this kind of open dialogue. Fear of confronting physicians and reluctance to interfere with the consultation process prevented many participants from raising what they had read online. This hesitancy is understandable in contexts where medical authority carries substantial cultural weight and consultation time is limited. Patients may worry that questioning a doctor’s guidance with internet-sourced material will appear disrespectful, or that doing so will consume time needed for pressing clinical matters. The result is a silent gap: misinformation circulates unchallenged in patients’ lives while clinicians remain unaware of it, losing opportunities to correct false beliefs before they influence decisions.

Closing this gap requires deliberate effort on both sides. Clinicians can normalise the conversation by asking patients what they have read online, framing the question as routine rather than accusatory. Health systems can train staff to respond to online findings with curiosity rather than dismissal, since a dismissive reaction may push patients toward secrecy and further reliance on unreliable sources. Patients and caregivers, for their part, benefit from explicit permission and encouragement to bring questions arising from internet searches into their appointments. The study’s participants themselves recommended guidance on searching and evaluating credible information, indicating appetite for exactly this kind of support.

The unmet information needs documented in the study sit within a larger pattern. Integrative reviews of supportive care needs have found that cancer patients and caregivers are frequently dissatisfied with existing options for acquiring information, a finding consistent with international research on unmet information needs across cancer populations. Digital health tools have been proposed as a complement to conventional care precisely to address gaps such as coping support and cancer education, and surveys have identified information and education as the most needed digital health function for this group. The internet’s appeal is amplified for stigmatised conditions, where barriers to traditional information sources make anonymous online searching especially attractive.

The scale of the underlying challenge is considerable. Global cancer incidence is projected to reach 27.5 million new cases by 2040, with deaths rising to 16.3 million, which means the population of information-seeking patients and caregivers will grow substantially in the coming decades. A recent systematic review of information-seeking behaviour among cancer patients identified twenty quantitative studies but only four qualitative ones since 2002, and none of the qualitative work had applied a behavioural theory. The present study fills that methodological gap, and its theoretical grounding offers a template for future research seeking to understand not just what patients do online but why.

For caregivers, the findings carry particular weight. Family members often conduct searches on behalf of patients, filter information before sharing it, and shoulder the emotional labour of translating frightening content into reassurance. Because caregivers were interviewed separately in this study, their perspectives emerge distinctly, underscoring that safeguarding against misinformation is a family-level concern rather than an individual one. Interventions that equip caregivers with evaluation skills may therefore yield benefits that ripple outward to the patients they support.

Ultimately, the study reframes susceptibility to misinformation not as a failure of intelligence or diligence but as a predictable consequence of cognitive strain, emotional urgency, and unmet informational needs converging on a digital environment where credible and false content appear side by side. Solutions that acknowledge this reality, by lowering the effort of verification, strengthening the clinical relationship as a trusted channel, and providing authoritative repositories as default destinations, offer a realistic path forward. As digital health continues to expand its role in cancer care, ensuring that patients and caregivers can navigate it safely becomes not an optional enhancement but a core component of supportive care itself.

Subject of Research: Susceptibility of cancer patients and caregivers to online cancer misinformation

Article Title: Susceptibility of cancer patients and caregivers to online cancer misinformation: a qualitative interview study

Article References: Mohamed, H., Salsberg, J., Alanzi, T., Mohamed, M., & Kelly, D. (2026). Susceptibility of cancer patients and caregivers to online cancer misinformation: a qualitative interview study. Supportive Care in Cancer, 34(10), Article 987. https://doi.org/10.1007/s00520-026-11236-2

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11236-2

Keywords: cancer, misinformation, caregivers, digital health literacy, health belief model, theory of planned behaviour, information-seeking, health communication, oncology, qualitative research, social media, patient safety

The study, led by Rajan Shrestha of Aarhus University and the Nepal Development Society, forms part of a growing effort to correct a stubborn imbalance in global health evidence. Physical inactivity and prolonged sedentary behaviour are rising public health concerns across low- and middle-income countries, where non-communicable diseases such as diabetes, cardiovascular disease and cancer are climbing steeply. Yet most of what researchers know about the environmental and psychological drivers of activity comes from high-income countries, and much of it rests on questionnaires that ask people to recall and report their own behaviour, a method notoriously prone to bias and error.

To sidestep those limitations, the researchers turned to objective measurement. They analysed data from 421 adults who had taken part in the Community-Based Promotion of Physical Activity trial in Pokhara Metropolitan City. Each participant wore an Axivity AX3 accelerometer on the wrist continuously for seven days, providing minute-by-minute records of movement and stillness. The device captures acceleration in three dimensions, from which researchers derive measures such as the Euclidean Norm Minus One, a standard metric for quantifying overall body movement intensity. From these raw signals, the team calculated daily moderate-to-vigorous physical activity, the intensity level most strongly linked to health benefits, as well as total sedentary time.

Alongside the sensor data, participants completed structured questionnaires covering two distinct categories of environmental opportunity. The first, described as recreational or built opportunities, captures features familiar from urban planning literature in wealthy countries: parks, playgrounds, walking paths, gyms and other purpose-built facilities for leisure-time exercise. The second, productive or utilitarian opportunities, reflects a different reality: whether the surrounding environment supports movement as a by-product of daily life, such as walking to markets, shops, workplaces or services. The team also measured psychosocial factors drawn from the Theory of Planned Behaviour, a widely used psychological framework, including intention to be active and perceived behavioural control, the confidence a person feels in their own ability to act.

Because participants were recruited through community clusters, the researchers used multilevel linear mixed-effects models with random intercepts for clusters, a statistical approach that accounts for the fact that people living in the same neighbourhood share characteristics and cannot be treated as fully independent observations. This matters enormously in studies of built environments: ignoring clustering can produce misleadingly confident estimates. The models estimated associations between environmental and psychosocial factors and two outcomes, daily moderate-to-vigorous physical activity and sedentary time, and the team added interaction terms to test whether perceived behavioural control modified the environmental effects.

The headline result is striking for what it reveals about the geography of movement. Productive and utilitarian environmental opportunities, the everyday infrastructure that lets people accomplish necessary tasks on foot, showed stronger associations with device-measured moderate-to-vigorous activity than recreational or built features did. In the model that considered the environment alone, higher productive or utilitarian opportunity was linked to more daily moderate-to-vigorous activity. However, when the researchers added psychosocial factors into a combined model, these environmental associations were attenuated, suggesting that part of the apparent environmental effect travels through, or overlaps with, psychological and motivational characteristics of individuals.

One psychological factor refused to fade. Perceived behavioural control remained positively and robustly associated with moderate-to-vigorous physical activity even after adjustment, with an estimated coefficient of 34.35 and a 95 percent confidence interval running from 6.98 to 61.72. In practical terms, adults who felt more capable of being active accumulated meaningfully more device-measured activity each day. Intention, by contrast, showed no clear association with measured behaviour, a finding that will resonate with anyone who has resolved to exercise and then not done so. The gap between intending and acting is a central puzzle of behavioural science, and this dataset from Nepal adds a low- and middle-income country data point to a debate dominated by Western samples.

Sedentary time told a subtler story. Environmental associations with sitting and stillness were weaker and less consistent than those with activity, but the interaction analysis produced one notable result: among people in the highest tertile of productive or utilitarian environmental opportunity, higher perceived behavioural control was associated with less sedentary time, with an interaction coefficient of −35.26 minutes and a confidence interval from −64.92 to −5.61. The interpretation is intriguing. Environments rich in utilitarian movement opportunities may only translate into less sitting for people who feel confident in their ability to act on those opportunities, hinting that environmental and psychological levers work together rather than independently.

The authors caution, appropriately, that this is a cross-sectional analysis. It captures a single moment in time and cannot establish whether environments shape behaviour, whether active people choose more supportive environments, or whether some third factor drives both. Reverse causation is a live possibility: someone who already enjoys walking may perceive their neighbourhood as more walkable. The sample, drawn from participants in an existing physical activity promotion trial in one metropolitan area, may also not represent all of semi-urban Nepal. Still, the use of objective accelerometry over a full week, the multilevel design and the explicit separation of recreational from productive environmental opportunity make this one of the more methodologically careful studies of its kind in South Asia.

The implications stretch well beyond Pokhara. Cities across Asia and Africa are urbanising at unprecedented speed, and the design choices made in the next two decades will lock in patterns of movement or stillness for generations. If the findings hold, they suggest that in rapidly urbanising low- and middle-income countries, promoting physical activity may depend less on importing the gym-and-park model of wealthy nations and more on preserving and strengthening the everyday, utilitarian movement woven into daily life, while simultaneously building residents’ confidence that they can act. Interventions that pair walkable markets, services and workplaces with behavioural support targeting perceived control could do double duty. As non-communicable diseases rise across the Global South, this study offers a timely reminder that the most powerful exercise prescription may already be written into the streets people walk every day, provided they believe they can follow it.

Subject of Research: Environmental and psychosocial determinants of device-measured physical activity and sedentary behaviour among adults in semi-urban Nepal

Article Title: Environmental and psychosocial contexts of device-measured physical activity and sedentary behaviour in semi-urban Nepal: a multilevel analysis

Article References: Shrestha, R., Paudel, S., Rijal, A., Adhikari, T. B., Khatri, B., Neupane, D., Vaidya, A., Nielsen, R. Ø., & Kallestrup, P. (2026). Environmental and psychosocial contexts of device-measured physical activity and sedentary behaviour in semi-urban Nepal: a multilevel analysis. BMC Public Health. https://doi.org/10.1186/s12889-026-29793-w

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29793-w

Keywords: physical activity, sedentary behaviour, accelerometry, Nepal, low- and middle-income countries, built environment, perceived behavioural control, Theory of Planned Behaviour, multilevel analysis, public health, urbanisation, non-communicable diseases

The research, led by Prabhakar Sharma and Gyanendra Nath Tiwari, surveyed 226 residents across three Nagaland districts, Kohima, Dimapur, and Chümoukedima, spanning urban, semi-urban, and rural settings. The team anchored their work in the Theory of Planned Behaviour, a widely used psychological framework holding that behaviour flows from three conscious drivers: attitude toward the act, perceived social pressure from others, and perceived behavioural control, the sense that one is able to carry out the behaviour. To this classic trio the researchers added measures of cultural values and perceptions of policy and governance, and they paired the survey with open-ended questions and ten in-depth interviews to capture what residents themselves saw as the real obstacles.

The quantitative results were striking in their asymmetry. Respondents scored highest on items measuring environmental concern and personal responsibility: agreement that plastic waste harms the environment averaged 4.77 on a five-point scale, that reducing plastic use is necessary averaged 4.58, and that one feels personally responsible for proper disposal averaged 4.38. Yet the subscale measuring perceived behavioural control, covering access to disposal points, confidence in segregating waste at home, and the availability of affordable alternatives, was the weakest of all, averaging just 2.97. In other words, people knew the problem was real and felt it was theirs to solve, but they did not feel equipped to act.

When the researchers ran a hierarchical multiple regression to see which constructs actually predicted self-reported waste-management behaviour, the pattern upended expectations. Subjective norms, the perception of what neighbours, friends, and the community expect and practice, emerged as by far the strongest predictor, with a standardized coefficient of 0.485. Cultural values contributed next, at 0.251, followed by attitude at 0.186. Perceived behavioural control, the variable that classical theory often casts as decisive, contributed essentially nothing once the other factors were accounted for, with a coefficient of negative 0.023 and a p-value of 0.661. Although control showed a small bivariate correlation with behaviour, that association was entirely absorbed by its overlap with subjective norms. The final model explained 44.5 percent of the variance in self-reported practice.

Just as telling was what did not matter. Adding residents’ perceptions of policy and governance, whether the plastic ban was enforced, whether government was managing waste efficiently, whether public information was adequate, improved the model by exactly nothing, a change in explained variance of zero with a p-value of 0.908. Residents clearly viewed enforcement as weak: agreement that the plastic ban was strictly enforced averaged only 2.85, and belief in efficient government management averaged 2.88. But those dim views of the state did not independently predict what people actually did with their plastic. The machinery of governance, in this setting, appears to shape behaviour only indirectly, if at all.

The qualitative strand of the study filled in the human texture behind these numbers. Among roughly 131 open-ended survey responses, the most frequently cited barrier to proper disposal was lack of awareness and education, named by 67 percent, followed by inadequate infrastructure and facilities at 58 percent and weak enforcement at 32 percent. In the separate interview sample, infrastructure deficits and the absence of plastic-specific traditional beliefs were rated as very high intensity themes, raised unprompted by eight or more of the ten participants. One interviewee captured a widespread mindset bluntly: people consider all waste equal, so everything belongs in the same bin. Traditional Naga practices, built around biodegradable materials and low-waste living, simply never developed categories for a plastic-dominated waste stream.

When the researchers integrated the two strands of evidence, the most revealing result was a divergence rather than an agreement. Infrastructure was overwhelmingly salient in how residents talked about the problem, yet individually perceived control carried no unique statistical weight in the regression. The authors propose, cautiously, that infrastructure may operate less as a direct constraint on individual action and more as a structural condition that shapes community norms and expectations, so that where collection points are absent, responsible disposal simply never becomes a shared local standard. That mediational hypothesis could not be tested with the study’s cross-sectional design, but it offers a concrete target for future longitudinal research.

The theoretical implications extend beyond Nagaland. The Theory of Planned Behaviour is a deliberative-reasoning model, assuming that people weigh attitudes and consequences before acting. A growing literature argues that everyday waste disposal is often habitual, cued by routine and context rather than conscious reflection, and the survey instrument used here was not designed to detect such automatic processes. The authors also flag social-desirability bias as a risk, since normatively loaded items about responsibility and cleanliness may inflate self-reports, and they acknowledge that the attitude and cultural values subscales showed weak internal consistency, with Cronbach’s alpha values of 0.35 and 0.46 respectively, well below conventional thresholds. The cultural values finding, they stress, should be read as a promising but tentative extension rather than an established determinant, particularly because exploratory factor analysis showed some of its items blending into the subjective norms factor.

For policy, the practical message is unambiguous. Awareness campaigns alone are unlikely to close the gap between what people believe and what they do, because belief is not the binding constraint. Instead, the authors argue, interventions should centre community-based and norm-oriented strategies, enlisting the village councils, religious organisations, and youth groups that already function as trusted arbiters of local expectation. Respondents themselves pointed in the same direction: awareness and education campaigns were the most frequently proposed solution, cited by 72 percent of open-ended respondents and 90 percent of interviewees, followed by better infrastructure at 53 and 70 percent respectively, and stricter enforcement at 38 and 60 percent. Ideas such as plastic buy-back schemes, subsidies for reusable alternatives, and regular community clean-up days surfaced repeatedly.

The study has clear limits. Its sample, recruited through stratified quotas combined with convenience sampling, skewed young and male, with roughly half of respondents under 25, and all behaviour measures were self-reported rather than validated against observed practice or objective infrastructure audits. The cross-sectional design forbids causal claims, and two exploratory moderation tests, whether residential area or cultural values changed the strength of other predictors, failed to reach significance. Still, the core result stands as a genuinely useful contribution: in a collectivist, community-governed society, the strongest lever for changing plastic behaviour is not the individual conscience but the collective gaze. If Nagaland’s village councils and youth groups begin treating segregation as a shared expectation rather than a private virtue, the plastic choking its urban slopes may finally have somewhere to go other than the open fire.

Subject of Research: Psychosocial and cultural determinants of plastic waste management behaviour in Nagaland, India

Article Title: Psychosocial, cultural, and structural determinants of plastic waste management practices in Nagaland, India: A mixed-methods study using the theory of planned behaviour

Article References: Sharma, P., & Tiwari, G. N. (2026). Psychosocial, cultural, and structural determinants of plastic waste management practices in Nagaland, India: A mixed-methods study using the theory of planned behaviour. Environmental and Sustainability Indicators, 32, Article 101539. https://doi.org/10.1016/j.indic.2026.101539

Image Credits: AI Generated

DOI: 10.1016/j.indic.2026.101539

Keywords: plastic waste, Nagaland, theory of planned behaviour, subjective norms, waste management, mixed methods, environmental psychology, cultural values, India, recycling, community governance, developing countries

The research, published in the journal Discover Sustainability, was conducted by Yi Huan Tan, Lai Ti Gew, Raja Affendi Raja Ali and Pei Boon Ooi, drawing on teams from Sunway University’s Jeffrey Cheah Sunway Medical School and School of Psychology, together with the Gut Research Group at Universiti Kebangsaan Malaysia. The team set out to identify the determinants of sustainable single-use plastic waste management behaviour among active laboratory users in Malaysia. Rather than simply cataloguing what people throw away, the researchers wanted to understand the mental machinery behind the decision: the attitudes, social pressures, sense of control and environmental awareness that combine to shape whether a scientist sorts, reuses or properly disposes of plastic consumables.

To do this, the study leaned on one of the most widely used frameworks in behavioural science: the Theory of Planned Behaviour, or TPB. Developed originally to explain how human actions flow from intention, the theory proposes that the single best predictor of a behaviour is the intention to perform it, and that intention itself is driven by three factors. The first is attitude, meaning the individual’s evaluation of the behaviour as beneficial or harmful. The second is subjective norms, the perceived social pressure from colleagues, supervisors and peers to behave in a certain way. The third is perceived behavioural control, the person’s belief that they are actually capable of carrying out the behaviour given the resources, opportunities and obstacles they face.

The Malaysian team extended this classic model by adding a fourth psychological ingredient: environmental awareness, the depth of a person’s understanding of environmental problems and the consequences of their own actions. They also included a practical control variable, namely whether a sustainable waste management protocol was present in the respondent’s workplace, to test whether formal institutional rules shape outcomes independently of psychology. This combination allowed the researchers to weigh the relative power of internal beliefs against external structures, a question that matters enormously for anyone designing sustainability policies for research institutions.

Data came from a cross-sectional survey of 245 active laboratory users, recruited through an online questionnaire. The sample captured people who work at the bench day to day and therefore generate and handle laboratory plastic waste directly. The researchers then analysed the responses using Partial Least Squares Structural Equation Modelling, a statistical technique known as PLS-SEM that is well suited to testing complex networks of relationships between psychological constructs. Rather than examining each factor in isolation, PLS-SEM allows scientists to build a model in which attitudes, norms, control beliefs and awareness feed into intention, and intention and control in turn feed into actual reported behaviour, with the strength of each pathway estimated simultaneously.

The results were striking in several respects. Attitude, perceived behavioural control and environmental awareness all significantly predicted behavioural intention, confirming that laboratory users who view sustainable plastic management as worthwhile, who feel capable of doing it, and who understand the environmental stakes are more likely to intend to act. But the single strongest predictor was perceived behavioural control. In other words, what mattered most was not whether scientists cared, and not even whether they felt social pressure from those around them, but whether they believed they had the practical ability, time, facilities and institutional support to manage their plastic waste sustainably.

Just as telling was what failed to predict intention. Subjective norms, the social pressure component of the Theory of Planned Behaviour, showed no significant relationship with behavioural intention in this sample. This is a genuinely counterintuitive result, because in many environmental behaviour studies the expectations of peers and colleagues are a powerful lever. The finding suggests that in laboratory settings, simply encouraging a culture of sustainability, or relying on colleagues to nudge one another, may not be enough on its own. Scientists, the study implies, may respond less to what everyone around them says and more to what the workplace actually enables them to do.

The model’s downstream pathways reinforced this control-centred picture. Both behavioural intention and perceived behavioural control positively predicted sustainable waste management behaviours, meaning that good intentions do translate into action, but only when people also feel empowered to act. The practical implication is hard to overstate: institutions that want greener laboratories should focus less on persuasion and more on infrastructure. Accessible recycling streams, clear protocols, adequate bins, training and time built into workflows may accomplish what awareness campaigns alone cannot, because they directly strengthen the sense of control that the data identify as the dominant driver.

The presence of a sustainable waste management protocol as a control variable adds an organisational dimension to the findings. Formal protocols represent the institutional scaffolding within which individual psychology operates, and their inclusion acknowledges that laboratory behaviour is never purely a matter of personal choice. Sterility requirements, biosafety rules and experimental demands constrain what is possible at the bench, and a written, enforced protocol can either widen or narrow the space for sustainable action. By testing this factor alongside the psychological variables, the study offers a template for future research that treats individual motivation and organisational structure as interacting forces rather than competing explanations.

The broader context makes the study timely. Scientific research generates an enormous and growing stream of single-use plastic waste, and the sector’s reliance on disposable consumables has proven difficult to reconcile with sustainability goals. Yet laboratories are also places of unusually high expertise and, often, strong environmental values, which makes the gap between attitude and action especially frustrating. By showing that perceived behavioural control outweighs both attitude and social norms in this population, the Malaysian findings point toward a specific, actionable strategy: give laboratory users real options, clear procedures and genuine capability, and sustainable behaviour is likely to follow. The authors present their work as a contribution to the growing discourse on sustainable laboratory practices, offering recommendations for policy and organisational initiatives aimed at reducing single-use plastic waste in research settings. If the message spreads, the humble pipette tip box may finally get the recycling infrastructure its users have long intended to give it.

Subject of Research: Psychological determinants of sustainable single-use plastic waste management behaviour among laboratory users

Article Title: Sustainable single-use plastic waste management among laboratory users using theory of planned behaviour

Article References: Tan, Y. H., Gew, L. T., Raja Ali, R. A., & Ooi, P. B. (2026). Sustainable single-use plastic waste management among laboratory users using theory of planned behaviour. Discover Sustainability. https://doi.org/10.1007/s43621-026-04891-2

Image Credits: AI Generated

DOI: 10.1007/s43621-026-04891-2

Keywords: theory of planned behaviour, single-use plastic, laboratory waste, sustainable waste management, PLS-SEM, environmental awareness, perceived behavioural control, behavioural intention, Malaysia, environmental psychology, laboratory sustainability, waste management protocol

The research, published in Discover Psychology, was led by Riketa Parmar and Vipul Patel of Ganpat University’s V. M. Patel College of Management Studies, together with Mruga H. Mehta and Jigneshkumar P. Desai of Parul University. The team set out to build and test what they call the Green Banking Consumer Adoption Model for India, or GB-CAM-India. Rather than relying on a single behavioural theory, the model deliberately stitches together three of the most widely used frameworks in consumer and environmental psychology: the Technology Acceptance Model, the Theory of Planned Behaviour, and the Value-Belief-Norm theory. To these it adds constructs tailored to the Indian market, including perceived trust, perceived risk and customer satisfaction.

The logic behind the integration is worth unpacking. The Technology Acceptance Model, developed originally to explain how people come to use new technologies, focuses on two perceptions: that a system is useful and that it is easy to use. The Theory of Planned Behaviour adds the role of attitudes, subjective norms, meaning the social pressure we feel from people around us, and perceived behavioural control, our sense that we are capable of performing the behaviour. The Value-Belief-Norm theory, rooted in environmental sociology, traces pro-environmental action back through a chain of personal values, ecological beliefs and the activation of moral norms. Green banking sits at the intersection of all three: it is a technology, a planned consumer behaviour and an environmentally significant act at once, which is precisely why the authors argued that no single theory could capture the whole picture.

To test the model empirically, the researchers collected primary survey data from 760 respondents spread across five regions of Gujarat, a western Indian state with a large and diverse banking population. For each theoretical construct, they computed composite, or summed, scale scores and then subjected the data to a battery of statistical checks. Exploratory factor analysis was used to confirm that the survey items clustered into the intended dimensions, and reliability analysis confirmed internal consistency. The psychometric credentials of the measures were strong: the Kaiser-Meyer-Olkin measure of sampling adequacy reached 0.906, a value well above the conventional 0.6 threshold, every composite reliability value was at least 0.829, and all average variance extracted values were at least 0.545, calculated from the standardised loadings produced by the factor analysis. In plain terms, the survey instruments measured what they claimed to measure, and they did so consistently.

With the constructs validated, the team turned to multiple regression to test eight hypotheses linking the predictors to green banking adoption behaviour. The model performed respectably, explaining 46.8 percent of the variance in adoption behaviour, with an F-statistic of 82.51 on 8 and 751 degrees of freedom and a p-value below 0.001. Customer satisfaction dominated the results, with a standardised beta of 0.464, far ahead of any other predictor. Perceived ease of use came second at 0.193, followed by social influence at 0.083, both also significant at the 0.001 level. Perceived risk worked in the opposite direction, exerting a significant negative effect with a beta of minus 0.085 and a p-value of 0.002. The message for banks is that making green services feel safe, simple and satisfying matters more than preaching their environmental virtues.

One of the most technically interesting parts of the study concerns how satisfaction connects upstream perceptions to downstream behaviour. Using bootstrapped indirect-effect tests with 5,000 resamples and bias-corrected 95 percent confidence intervals, the researchers found that customer satisfaction carries significant indirect effects from perceived usefulness, perceived trust and environmental attitude through to adoption behaviour. Crucially, the corresponding direct paths from those three constructs to adoption were statistically nonsignificant. That pattern means satisfaction does not merely supplement these influences; it is the channel through which they operate. The authors are careful with terminology here, characterising these as indirect-only effects rather than partial mediation, a distinction that matters for how future researchers model the pathway.

The study also probed how the satisfaction-adoption relationship varies across the population. Income level emerged as a significant moderator of that path: higher-income consumers showed reduced sensitivity to satisfaction signals when deciding whether to adopt green banking. In other words, for wealthier customers, a pleasant service experience moves the adoption needle less than it does for lower-income consumers, a finding with clear implications for how banks segment their green marketing. The researchers additionally observed that mean adoption scores differed significantly across Gujarat’s five regions, with an F-statistic of 9.88 on 4 and 755 degrees of freedom and a p-value below 0.001. They are careful to note, however, that this is a group-difference finding rather than a formally tested regional moderation effect, an honest caveat that reflects the exploratory, composite-score design of the analysis.

The practical implications ripple outward from these statistics. For banks, the results suggest that investments in service quality, complaint resolution and overall customer experience may do more to accelerate green banking uptake than awareness campaigns alone, because satisfaction is the conduit through which usefulness, trust and environmental attitudes are converted into action. Reducing perceived risk, whether fear of fraud in digital channels or uncertainty about green products, should also pay dividends, given its significant negative coefficient. For policymakers working under the Reserve Bank of India’s Green Finance Framework, the regional differences in adoption scores across Gujarat hint that a one-size-fits-all national rollout may underperform, and that income-sensitive design could matter, since wealthier consumers respond differently to satisfaction cues than lower-income ones.

The authors are equally candid about the limits of their approach. Because the analysis relied on composite scores, exploratory factor analysis and multiple regression rather than a full structural equation model, the causal architecture of GB-CAM-India remains a proposal awaiting confirmatory testing. They explicitly flag directions for future SEM-based research that could estimate the full path model with latent variables, test the regional moderation hypothesis formally, and extend the sample beyond Gujarat to other Indian states. The survey design is also cross-sectional, so the direction of influence, while theoretically motivated, is inferred rather than observed over time.

Even with those caveats, the study lands at a propitious moment. As India’s financial sector aligns itself with sustainable development goals, understanding the psychology of the consumer becomes as important as the engineering of the green products themselves. What this research demonstrates is that the road to sustainable finance in India runs through the everyday experience of the bank customer: a useful app that is trusted, a service that satisfies, and a social environment that quietly nudges people toward greener choices. If satisfaction is the engine of green banking adoption, then the banks that win India’s sustainable finance transition may be those that treat environmental ambition and customer experience as a single, inseparable project.

Subject of Research: Consumer adoption of green banking services in India, modelled through an integrated TAM-TPB-VBN framework

Article Title: An integrated TAM–TPB–VBN framework with empirical validation from Gujarat for green banking consumer adoption in the Indian market

Article References: Parmar, R., Patel, V., Mehta, M. H., & Desai, J. P. (2026). An integrated TAM–TPB–VBN framework with empirical validation from Gujarat for green banking consumer adoption in the Indian market. Discover Psychology. https://doi.org/10.1007/s44202-026-00883-5

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00883-5

Keywords: green banking, consumer adoption, Technology Acceptance Model, Theory of Planned Behaviour, Value-Belief-Norm theory, India, Gujarat, customer satisfaction, sustainable finance, perceived risk, social influence, survey research

The research, conducted by Luigina Canova, Andrea Bobbio and Anna Maria Manganelli of the University of Padua, rests on the Theory of Planned Behaviour, one of the most widely used frameworks in social psychology for explaining voluntary human actions. The theory holds that a behaviour is driven by the intention to perform it, and that intention is in turn shaped by three forces: attitude, the person’s evaluative judgment of the behaviour; subjective norm, the perceived expectations of family and friends; and perceived behavioural control, the sense that one has the means and ability to act. Crucially, the theory also allows for background factors, deeper values and dispositions that feed into these beliefs without acting on behaviour directly.

The Padua team selected two such background factors for scrutiny: the perceived environmental value and the perceived health value of green products. Green personal care products in the study included shampoo, soap and deodorants made from organic farming components free of synthetic pesticides, fertilisers and genetically modified organisms, while green home care products covered laundry detergents, floor and glass cleaners and dishwashing liquids. The market context is striking. The global green personal care market is forecast to grow by 12.37 billion US dollars between 2024 and 2029, and trade in household green cleaning products rose from 5.14 billion dollars in 2023 to 5.49 billion in 2024, with further growth expected to reach 8.49 billion by 2030.

To test their extended model, the researchers ran two parallel two-wave surveys between October and December 2023, distributed through the Qualtrics platform. Roughly one hundred master’s students in psychology at the University of Padua recruited friends, relatives and acquaintances, with each participant assigned to only one of the two studies. In the first wave, respondents answered questions measuring perceived environmental and health values, attitudes, subjective norm, perceived behavioural control and intention. One month later they reported their intention again and, crucially, whether they had actually purchased green products during the intervening weeks. After attrition, the final combined sample comprised 766 adults, 68 percent of them women, with a mean age of 37 years.

The statistical machinery behind the study was rigorous. Confirmatory factor analyses of six latent constructs and twenty indicators produced good fit indices in both studies, and tests for common method variance suggested it did not distort the results. Regression analyses conducted with the PROCESS macro, using bias-corrected bootstrap confidence intervals based on five thousand resamples, tested the direct and indirect pathways of the model, with gender and age included as covariates. The measurement work paid off: the models explained roughly half of the variance in purchase intention in both studies, and between 24 and 28 percent of the variance in self-reported future purchasing behaviour, respectable figures for a psychological prediction of real-world action.

The results were consistent across both product categories in their broad outlines. Perceived environmental and health values each explained about a third of the variance in attitudes toward buying green products, and both fed indirectly into intention and behaviour through the classic Theory of Planned Behaviour constructs. Attitude emerged as the strongest single predictor of intention, followed by perceived behavioural control and subjective norm. But one value clearly outshone the other: perceived health value showed a stronger association with attitude, and in the personal care study it also maintained a direct link to intention, suggesting that consumers who believe green products enhance well-being are especially primed to buy them, partly independent of their general evaluation of the behaviour.

The most theoretically interesting finding concerned the notorious intention-behaviour gap. Meta-analyses across pro-environmental and health behaviours consistently show that intentions explain far more variance in themselves, around 50 percent, than behaviours do, around 30 percent. The Padua team examined whether the temporal stability of intention, measured by comparing intention scores at the two waves one month apart, moderated this gap. It did, and dramatically. For green personal care products, the effect of intention on behaviour was strongest among people whose intentions remained stable over the month, with a standardised coefficient of 0.65, compared with 0.32 among those with unstable intentions. For household products the pattern was even starker: among low-stability participants the intention-behaviour relationship was not statistically significant at all.

Not every result was symmetrical across the two product categories. Perceived behavioural control directly predicted future purchasing only for green home care products, which the authors attribute to the difficulty consumers may face in finding and recognising these items in retail settings, a market that remains smaller than that for green personal care. Demographic patterns also emerged: women expressed more favourable attitudes and stronger intentions toward green personal care products, while women and older participants reported greater perceived control over buying green household products, a pattern the researchers link to gender roles and greater familiarity with household shopping. The authors caution, however, that some indirect effects were statistically significant but small, and should be interpreted carefully.

The study is not without limitations, which the authors acknowledge candidly. The samples were convenience samples dominated by young adult women with medium-high education and income in a culturally homogeneous region of north-eastern Italy, the design was correlational, all measures were self-reported and vulnerable to social desirability bias, and the analyses were not preregistered. Still, the practical implications are concrete. Marketers should emphasise both environmental and health benefits, with certified toxicity and dermatological standards bolstering perceived health value; campaigns should engage family and friendship networks, given the weight of subjective norms; and retailers should improve availability, placement and pricing to strengthen perceived control. Above all, the findings suggest that fostering stable, protected intentions, rather than fleeting enthusiasm, may be the key to converting green goodwill into green purchases, a small but measurable step toward sustainable development goals.

Subject of Research: Psychosocial determinants, including perceived environmental and health values and intention stability, of purchasing green personal and household care products under the Theory of Planned Behaviour.

Article Title: The Purchase of Green Personal and Household Care Products: The Predictive Contribution of Perceived Environmental and Health Values and Intention Stability in the Theory of Planned Behaviour

Article References: Canova, L., Bobbio, A., & Manganelli, A. M. (2026). The Purchase of Green Personal and Household Care Products: The Predictive Contribution of Perceived Environmental and Health Values and Intention Stability in the Theory of Planned Behaviour. Trends in Psychology. https://doi.org/10.1007/s43076-026-00524-9

Image Credits: AI Generated

DOI: 10.1007/s43076-026-00524-9

Keywords: green products, Theory of Planned Behaviour, consumer behaviour, intention-behaviour gap, intention stability, perceived health value, perceived environmental value, sustainable consumption, household care products, personal care products, environmental psychology, Italy

Menstrual cups are bell-shaped devices, typically made of medical-grade silicone, that are inserted into the vagina to collect rather than absorb menstrual blood. A single cup can be worn for up to twelve hours, then emptied, cleaned and reinserted, and with proper care a cup can last for as long as a decade. Compared with disposable pads and tampons, the economics are striking. One systematic review cited in the study calculated that if a woman used twelve pads per cycle, switching to a cup would represent roughly 0.4 percent of the waste and 5 percent of the cost; against twelve tampons per cycle, the cup would account for about 7 percent of the cost and 6 percent of the plastic waste. Research in Gujarat found that the average annual cost of sanitary pads is roughly twenty times that of a menstrual cup. Yet despite these advantages, usage among reproductive-age women in India has been reported at only around 5 percent.

The research team, led by Melisa Rudolph Menezes of Manipal Health Enterprises Limited, together with Swathi K S and Brayal D Souza of the Prasanna School of Public Health at Manipal Academy of Higher Education and Pallavi Upadhyaya of T A Pai Management Institute, grounded their investigation in three established behavioural frameworks: the Theory of Planned Behaviour, the Technology Acceptance Model and the Health Belief Model. This integrated approach allowed them to capture social influence, usability perceptions and health-related beliefs within a single model. The Theory of Planned Behaviour contributes the roles of attitude and subjective norms; the Technology Acceptance Model contributes perceived ease of use; and the Health Belief Model contributes safety perceptions, cost considerations and awareness as a cue to action. Because menstrual cups are inserted rather than worn externally, the researchers also hypothesised that safety perception would mediate the relationship between attitude and behavioural intention.

Data were collected through a cross-sectional online survey distributed via Google Forms and social media platforms, with voluntary participation and informed consent. The questionnaire contained 28 items measuring seven constructs: awareness, perceived ease of use, price value, attitude, safety perception, subjective norms and behavioural intention, all rated on five-point Likert scales. A priori power analysis using G*Power indicated a minimum sample of 103 for a medium effect size, so the achieved sample of 282 was comfortably adequate. Analyses were performed in SPSS for descriptive statistics and SmartPLS version 4 for structural equation modelling, following a two-step procedure that first validated the measurement model and then tested the structural paths.

The measurement model passed standard checks. Outer loadings exceeded the 0.7 threshold, Cronbach’s alpha and composite reliability met internal consistency criteria, average variance extracted surpassed 0.5 for convergent validity, and all heterotrait-monotrait ratios fell below 0.90, confirming discriminant validity. Variance inflation factors were all below 5, ruling out problematic multicollinearity. Most respondents were aged 18 to 30, about 91 percent had education at or above the 12th-standard level, roughly 30 percent were employed, and 73.4 percent were single, reflecting a largely young, educated, digitally connected sample.

The structural model delivered clear and statistically significant findings. Awareness, perceived ease of use and price value all significantly shaped attitudes towards menstrual cups, with price value showing the strongest path coefficient into attitude at 0.312. In turn, attitude, safety perception and subjective norms all significantly predicted behavioural intention. The coefficient of determination for behavioural intention was 0.424, indicating moderate predictive validity. Most strikingly, safety perception carried the highest path coefficient of any construct at 0.411, making it the single most powerful driver of intention in the model. All seven hypotheses were supported at the 5 percent significance level.

The mediation analysis added a crucial nuance. Without safety perception in the model, the direct effect of attitude on intention was 0.505; with the mediator included, it dropped to 0.246, an absorption of 0.259. The indirect effect through safety perception was 0.2558, and the variance accounted for statistic came to 0.5097, falling within the 20 to 80 percent range that indicates partial mediation. In practical terms, this means that even women who hold favourable attitudes towards menstrual cups may hesitate to adopt them unless they also believe the product is safe for their bodies. Safety beliefs about hygiene, insertion, sterilisation and leakage act as a cognitive filter through which positive attitudes must pass before converting into intention.

These findings align with, and help reconcile, a mixed international literature. Studies in Taiwan using the Theory of Planned Behaviour found attitude to be the largest predictor of cup intention, while research in the Philippines reported that subjective norms did not significantly influence intention, and work in Nepal suggested that positive peer exposure could increase adoption. The Indian results suggest that in a context where menstruation remains stigmatised and misconceptions about internal products persist, social endorsement matters, but it cannot fully override personal safety and comfort concerns. Prior Indian studies have reported that more than 80 percent of women in some populations are aware of menstrual cups and nearly half would be willing to try one if available, yet actual use remains low, evidence that knowledge alone is insufficient to change behaviour.

The authors argue that their results point to targeted, actionable interventions rather than generic promotion. To address safety perceptions and ease of use, policymakers and marketers could develop instructional workshops and video demonstrations on proper cup use and hygiene. Given the influence of subjective norms, peer-led campaigns and community ambassadors could normalise the product, while digital campaigns on popular social media platforms highlighting health benefits and cost-effectiveness could raise awareness. The study is not without limitations: its cross-sectional design cannot establish causality, convenience sampling through online channels may introduce self-selection bias and limit generalisability to women with less internet access or digital literacy, and measured intentions may not translate into actual behaviour where product availability, peer influence or personal comfort intervene. Even so, the research provides public health experts, policymakers and marketers with an evidence-based map of the psychological levers, above all safety, that must be pulled to make sustainable menstrual health choices genuinely accessible in India.

Subject of Research: Behavioral intentions of Indian women to adopt menstrual cups as sustainable menstrual hygiene products

Article Title: Shifting Preferences: Assessing Women’s Behavioral Intentions to Adopt Menstrual Cups

Article References: Menezes, M. R., K S, S., Upadhyaya, P., & Souza, B. D. (2026). Shifting Preferences: Assessing Women’s Behavioral Intentions to Adopt Menstrual Cups. Trends in Psychology. https://doi.org/10.1007/s43076-026-00533-8

Image Credits: AI Generated

DOI: 10.1007/s43076-026-00533-8

Keywords: menstrual cups, menstrual hygiene management, behavioral intentions, Theory of Planned Behaviour, Technology Acceptance Model, Health Belief Model, safety perception, PLS-SEM, India, sustainable menstrual products, consumer behavior, women's health