Educational exposure and sustainability-related outcomes among pharmacy students in Bulgaria: a cross-sectional study

Abstract

Introduction Pharmaceutical sustainability is important for environmentally responsible health care, yet evidence regarding pharmacy students’ preparedness remains limited. This cross-sectional study assessed sustainability-related awareness, educational exposure, attitudes, knowledge of medication disposal, and behavior among pharmacy students in Bulgaria. Methods An anonymous questionnaire was completed by 74 students from the Medical Universities of Plovdiv, Pleven, and Varna between April and December 2025. Descriptive statistics, chi-square tests, non-parametric tests, effect sizes, and exploratory binary logistic regression were applied. Results Among 73 participants with valid data, 23 (31.5%) were familiar with sustainable pharmacy, 28 (38.4%) were partially familiar, and 22 (30.1%) were unfamiliar. Only 14 participants (18.9%) reported sustainability training, whereas 57 (77.0%) supported mandatory sustainability education. Thirty-two participants (43.2%) knew unused medicines could be handed over safely. Familiarity was associated with previous training (p < 0.001; Cramér’s V = 0.532) and year of study (p = 0.010; Cramér’s V = 0.371). Trained participants reported higher attitude scores (p = 0.030; r = 0.25). In the adjusted model, year of study was associated with safe-handover knowledge (p = 0.013), although estimates were imprecise. Conclusion These findings identify gaps between positive attitudes, limited educational exposure, and knowledge. Structured sustainability education warrants further development and evaluation.