Original Article

Survey of Knowledge, Attitude, and Performance of Students at Hamadan University of Medical Sciences Regarding Solid Wastes Recycling

1. Introduction

Waste management is currently among the most complex issues of human life and an essential source of environmental pollutions, challenging policymakers, planners, and implementers across the world (1). A significant cause of this issue is daily human population growth and the increasing rate of waste production. Therefore, the management of exposure to these pollutants becomes more complex every day since it is a human health and environmental hazard (2). Recycling is an essential principle in solid waste management, which refers to the process that separates various wastes and processes some wastes as raw materials for the production of new materials (3). In most cases, the recyclable dry components in municipal waste consist of plastic, paper, cardboard, glass, metals, textiles, and dry bread (4). Recycling and reuse of solid waste have long been proposed as an economic model considering reducing raw material costs, energy saving, waste reduction, scarcity/depletion of resources, and increased environmental pollutions. Although these approaches diminish the problems in urban services, they could also increase national incomes (5). It is noteworthy that recycling waste materials could remarkably affect waste disposal costs (6). Studies in Denmark show that the recycling of paper and cardboard is the most viable option environmentally compared to burying/burning due to the reduced emission of air pollutants (7). The most prominent advantages of waste recycling management are less waste generation, optimization of proper waste collection and disposal, attention to recycling, health education and raising the understanding of different groups of students, attention to resources and production, along with the awareness of the composition and rate of waste production, and laying the basis of proper solid waste management.

According to the literature, the type of generated wastes in urban areas is directly correlated with the activity system of production facilities and lifestyle (8). Studies indicate that pro-environmental attitudes, awareness of recycling, adequate home space, and distance from residence to recycling sites/disposal bins, social norms, and financial incentives are among the primary influential factors in the recycling behavior of individuals. Furthermore, previous studies have confirmed that women have better recycling behaviors compared to men (9). Involvement in recycling activities has been reported to be higher in individuals with a high income compared to those with a low income (9), as well as in educated individuals compared to those who are illiterate (10) and in the elderly compared to the youth (11).

Some reports indicated that effective policies for waste management could influence household recycling behaviors (12,13). Additionally, developing appropriate waste management policies could contribute to the success of the interventions and programs. Therefore, the adoption of adequate policies should be based on specific programs and strategies, particularly for students who are outside the target organizations. Comprehensive support is an effective strategy for changing organizational policies. Comprehensive support plays a crucial role in developing new rules or providing the required funding for the execution of various programs (14). The statistics regarding the status of waste disposal in Iran demonstrate that the recycling order and landfilling have received insufficient or partial attention, respectively (15). In the first step of performance, the success of material recycling programs depends on cooperation, without which the most essential part of recycling (i.e., separation of materials from the source) utterly represents a failure (16). In their study, Almasi et al evaluated the knowledge and performance of the students in Yazd (Iran) regarding the management of municipal solid waste and reported that the performance of the citizens in terms of waste separation from the source and waste transportation to the collection vehicle was unfavorable. On the other hand, performance in the timely delivery of waste to the Municipality of Yazd was observed to be acceptable. In contrast, the citizens’ communication with waste recycling organizations and storage at home before waste delivery was poor. Evidence attests to the average or adequate awareness of the recycling of various waste items such as paper/cardboard, glass, metals, and plastics. However, the reduction of waste production and efficacy of waste disposal methods have been reported to be moderate or poor. Citizens’ awareness regarding diseases transmitted through waste and their effects has been found to be acceptable (17). In the study conducted by Rodrigues et al, the citizens of Gorgan, Gonbad, and Aliabad Katoul (Iran) had adequate knowledge of the environmental effects of waste. Conversely, they had moderate awareness of recycling, approaches for the reduction of waste at home, and waste disposal methods. Moreover, performance in waste segregation at source ranked average in the mentioned study (18). Likewise, Zeng et al focused on investigating public awareness and economic value of the separate collection of rural waste at source in China. The sample population included 518 residents of rural areas. According to the obtained results, some rural households performed waste recycling and food discretion. In the mentioned research, public awareness of the importance of waste segregation was reported to be enhanced through the mass media and more than 50% of students were able to separate their waste. On the other hand, the main obstacles of waste recycling were the inadequate knowledge of recycling and the lack of recycling facilities (19). The acceptance of various responsibilities by scholars at a national level in the future could contribute to the promotion and transfer of environmental information to students in the community and enhance their knowledge, attitude, and performance in providing educational solutions and policymaking in this regard. In this regard, the present study aimed to evaluate the correlations between the knowledge, attitude, and performance of the students of the School of Health at Hamadan University of Medical Sciences, Iran regarding waste management in 2020-2021.

2. Materials and Methods

The present descriptive-analytical, cross-sectional study was conducted on the students of Hamedan University of Medical Sciences selected based on the schedule of virtual university classes due to the current coronavirus pandemic. The sample population was determined to be 70. Data were collected using a researcher-made questionnaire, and the content validity was used to assess its validity. To this end, the questionnaire was presented to three faculty members of the School of Health to be examined based on the objectives of the target community and the title of the research, as well as the items regarding knowledge and attitude in terms of content and compliance with the research objectives. In addition, the retest method was applied to determine the reliability and the reliability of the questionnaire based on Pearson’s correlation coefficient. The participants were selected via a random sampling technique. The sample size was calculated based on the schedule of virtual university classes due to the current pandemic, and the statistics on the number of students attending the university was determined using (Eq.1):

Considering d=0.05 and α=0.05 and based on the previous studies in this regard, 70 students were selected as the final sample population (20). The inclusion criterion was studying at Hamedan University of Medical Sciences while the exclusion criterion included an unwillingness to participate in the study. The questionnaire was organized into three sections. The first section included the demographic variables of the students (Table 1), and the second section had 30 items, each of which was assigned a score (Table 2). Finally, the third and fourth sections contained 20 items on attitude (Table 3) and 24 functional items (Table 4) each given three points, respectively. The community data were transferred to SPSS (version 21) as raw data. Mann-Whitney U and Kruskal-Wallis tests were used for comparing the group and determining the mean significance of the variables of knowledge, attitude, and performance, respectively. Data were reported as mean ± standard deviation, and linear regression analysis and means comparison were conducted as well.

3. Results and Discussion

3.1. Demographic Characteristics of the Students

Table 5 presents the descriptive information of the studied students. In total, 61 participants were females (87.1%), and nine of them were males (12.9%). In general, the number of female students completing the questionnaire was higher than that of male students. In terms of age, 60, 5, and 4 students were in the age range of 24-20 (85.7%), 25-28 (7.1%), and 29-31 (5.7%) years, respectively, and one student aged 35-32 years (1.4%). In addition, 64 students were single (91.4%) while six cases were married (8.6%). According to the results, female students had more knowledge and better performance in waste management.

Regarding the education level, 61 subjects were studying for a bachelor’s degree (87.1%), and 3 (4.3%) and 6 (8.6%) cases were master’s students and Ph.D. candidates, respectively. According to the findings, most of the students, who completed the questionnaire, studied environmental health (n=26, 37.1%). Among the participants, 16 cases (22.9%) received special training on recognizing the adverse effects and management of waste while 54 of them (77.1%) received no prior training. Furthermore, 38 students (54.3%) were exposed to posters/other methods of municipal solid waste recycling or management within an academic or work environment (internship). In comparison, no such exposure was reported in 32 students (45.7%). Based on our findings, the source of information on waste segregation were radio and television, newspapers and magazines, advertisements of municipal organizations, and other sources in 21 (30%), 12 (17.1%), 13 (18.6%), and 24 (34.3%) students, respectively. Moreover, 16 students (22.9%) claimed the contraction of infectious diseases due to contact with garbage or contaminated equipment in themselves or others around them while no such cases were reported in 54 students (77.1%).

3.2. Analytical Section

Table 6 provides the mean scores of knowledge and attitude, which were considered acceptable, while the mean performance score was average. Table 7 presents a positive correlation between attitude and awareness, as well as the performance with knowledge and attitude.

Data on the correlations between knowledge variables with contextual, demographic, and main variables are summarized in Table 8. Based on the results, the amount of the knowledge of the studied students for recycling management was structured in three factors of academic degree, subject study, and education train. Additionally, among the average of knowledge among male and female students, there was no meaningful difference (P > 0.05). However, the obtained results indicated significant correlations between knowledge with marital status, as well as knowledge with previous training courses regarding waste management (P< 0.05). According to data in Tables 9 and 10, the average attitude among all students was not meaningful (P < 0.05) except for environmental health students, and other students were trained through media and posters, and the like. In addition, the highest amount of performance was related to college graduation and primary education. According to the statistical test, this difference was meaningful. In comparison, no significant associations were observed between performance with other variables (P > 0.05). Notably, knowledge, attitude, and performance were considered as predictors of waste management. Table 11 summarizes data on the linear regression model regarding predicting waste management with knowledge, attitude, and performance. Performance derived from the survey is considered relevant from a previous train education and their knowledge (P < 0.05). The application of knowledge, attitude, and practice studies is a developing popular way to survey community psychology and performance related to environmental issues. In this study, the knowledge, attitude and practices (KAP) survey was used through a cross-sectional research design to capture the knowledge, attitude, and performance of the students of Hamadan University of Medical Sciences, particularly on solid waste recycling during 2020-2021. Among the enrolled subjects, the results indicated that a more significant number of women completed the data collection instrument. In terms of marital status, single students were more likely than married students. Further, the majority of the students were studying for a bachelor’s degree. Generally, the investigation demonstrated that most postgraduate students of environmental health engineering had proper knowledge and attitude. In any case, less than half of them had the right performance on several items on material recycling. This indicates that most postgraduate students, at the time of the study, were somehow aware of the meaning of appropriate solid wastes recycling and represented good attitudes toward these matters.

Desa evaluated students from secondary schools, universities, and colleges in Nigeria and reported unsatisfactory knowledge levels on environmental issues among student-respondents while finding good conception ratings. The students were at least aware but could not explain why environmental problems continue to exist in their community (21). In research conducted by Zeng et al, students were reported to have become aware of the importance of waste separation through the public media. In the present study, 22.9% of participants confirmed the contraction of various infections in themselves or others around them due to contact with contaminated equipment (19). Similarly, Rahmaddin et al researched the KAP about waste management in communities near Martaputra River Bank in Indonesia. The community’s attitude and their knowledge were considered suitable. However, the results on performance showed unsatisfied behaviors for handling and managing river-dumped wastes (22), demonstrating that the student’s knowledge and attitude were completely correlated with their performance. The recycling of solid wastes counting plastic/glass, cans, and paper was also related to good knowledge rating rather than attitudes. Adeolu et al also reported the most positive correlations between knowledge and performance levels (23). Comparable to the result of this research, respondents with higher knowledge scores were more likely to represent good practices on solid waste management (24). The demographic information including gender and age did not indicate any statistically meaningful correlation with the students’ KAP ratings. Similar research was performed by Adeolu et al, and the results revealed that the KAP level did not differ between male and female respondents (23). According to the findings of the current research, the mean scores of knowledge and attitude were favorable in 77.1% of the students, which is consistent with the findings of Almasi et al (17) and Rodrigues et al (18), indicating the adequate knowledge of intelligent cities regarding the diseases caused by waste and the environmental impact of waste (18). On the other hand, Strydom proposed contradictive results in this regard (25), showing the lower knowledge level of students regarding waste hazards and an average performance score, which is in line with the results of Almasi et al (17). The findings of the current research demonstrated significant correlations between knowledge with marital status, as well as knowledge with previous training on waste management. In the study by Rodrigues et al, knowledge and waste management were correlated while no significant associations were denoted between knowledge and other statistical variables (18). Our findings also indicated a significant correlation between attitude and prior training on waste management, which corroborates with the results of Al-Khateeb et al (26), indicating the impact of this variable on students’ attitudes toward waste recycling. According to the results of the present study, attitudes and other statistical variables represented no significant correlation. Simultaneously, a significant association was observed between performance and prior training on waste management. Conversely, no significant correlations were found between performance and other statistical variables. Based on our findings, knowledge, attitude, and performance could predict waste management. This is congruent with the findings of Ma et al, implying that attitude was predictive of waste management (27). To consider ethical issues, informed consent was obtained from the students, and data were anonymously collected through information coding for data analysis.

4. Conclusion

According to the results, the importance of waste management should be emphasized in the community, especially among students, and our findings could be beneficial for this purpose. Furthermore, proper planning is required to enhance the knowledge, attitude, and performance of the students of Hamadan University of Medical Sciences regarding waste management through appropriate identification of the influential factors.

Conflict of Interest Disclosures

The authors declare that they have no conflict of interests.

Acknowledgments

This article is based on project No. 9908065483, supported by the Health Science Research Center of Hamadan University of Medical Sciences.

References

1. Shekdar AV. Sustainable solid waste management: an integrated approach for Asian countries. Waste Manag 2009; 29(4):1438-48. doi: 10.1016/j.wasman.2008.08.025 [Crossref] [ Google Scholar]
2. Marshall RE, Farahbakhsh K. Systems approaches to integrated solid waste management in developing countries. Waste Manag 2013; 33(4):988-1003. doi: 10.1016/j.wasman.2012.12.023 [Crossref] [ Google Scholar]
3. Wilson CD, Williams ID. Kerbside collection: a case study from the north-west of England. Resour Conserv Recycl 2007; 52(2):381-94. doi: 10.1016/j.resconrec.2007.02.006 [Crossref] [ Google Scholar]
4. Miranda R, Monte MC, Blanco A. Analysis of the quality of the recovered paper from commingled collection systems. Resour Conserv Recycl 2013; 72:60-6. doi: 10.1016/j.resconrec.2012.12.007 [Crossref] [ Google Scholar]
5. Miranda R, Monte M, Blanco A. Impact of increased collection rates and the use of commingled collection systems on the quality of recovered paper. Part 1: increased collection rates. Waste Manag 2011; 31(11):2208-16. doi: 10.1016/j.wasman.2011.06.006 [Crossref] [ Google Scholar]
6. Keränen JT, Ervasti I. Amounts of non-fibrous components in recovered paper. Resour Conserv Recycl 2014; 92:151-7. doi: 10.1016/j.resconrec.2014.09.010 [Crossref] [ Google Scholar]
7. Schmidt JH, Holm P, Merrild A, Christensen P. Life cycle assessment of the waste hierarchy–a Danish case study on waste paper. Waste Manag 2007; 27(11):1519-30. doi: 10.1016/j.wasman.2006.09.004 [Crossref] [ Google Scholar]
8. Magrinho A, Semiao V. On the effect of MSW moisture content on meeting target recycling rates. Waste Manag 2008; 28(2):310-7. doi: 10.1016/j.wasman.2007.01.008 [Crossref] [ Google Scholar]
9. Sidique SF, Lupi F, Joshi SV. The effects of behavior and attitudes on drop-off recycling activities. Resour Conserv Recycl 2010; 54(3):163-70. doi: 10.1016/j.resconrec.2009.07.012 [Crossref] [ Google Scholar]
10. Ekere W, Mugisha J, Drake L. Factors influencing waste separation and utilization among households in the Lake Victoria crescent, Uganda. Waste Manag 2009; 29(12):3047-51. doi: 10.1016/j.wasman.2009.08.001 [Crossref] [ Google Scholar]
11. Padilla AJ, Trujillo JC. Waste disposal and households’ heterogeneity Identifying factors shaping attitudes towards source-separated recycling in Bogotá, Colombia. Waste Manag 2018; 74:16-33. doi: 10.1016/j.wasman.2017.11.052 [Crossref] [ Google Scholar]
12. Andersson C, Stage J. Direct and indirect effects of waste management policies on household waste behaviour: the case of Sweden. Waste Manag 2018; 76:19-27. doi: 10.1016/j.wasman.2018.03.038 [Crossref] [ Google Scholar]
13. Morlok J, Schoenberger H, Styles D, Galvez-Martos JL, Zeschmar-Lahl B. The impact of pay-as-you-throw schemes on municipal solid waste management: the exemplar case of the county of Aschaffenburg, Germany. Resources 2017; 6(1):8. doi: 10.3390/resources6010008 [Crossref] [ Google Scholar]
14. Daryabeigi Zand A, Vaezi Heir A, Mikaeili Tabrizi A. Investigation of knowledge, attitude, and practice of Tehranian women apropos of reducing, reusing, recycling, and recovery of urban solid waste. Environ Monit Assess 2020; 192(7):481. doi: 10.1007/s10661-020-08445-5 [Crossref] [ Google Scholar]
15. Reyes MJ, Madrigal DV. Assessing students’ awareness, attitude, and practices on solid waste management in a Philippine catholic school. Philipp Soc Sci J 2020; 3(1):9-20. doi: 10.52006/main.v3i1.125 [Crossref] [ Google Scholar]
16. Esa N. Environmental knowledge, attitude and practices of student teachers. Int Res Geogr Environ Educ 2010; 19(1):39-50. doi: 10.1080/10382040903545534 [Crossref] [ Google Scholar]
17. Almasi A, Mohammadi M, Azizi A, Berizi Z, Shamsi K, Shahbazi A. Assessing the knowledge, attitude and practice of the Kermanshahi women towards reducing, recycling and reusing of municipal solid waste. Resour Conserv Recycl 2019; 141:329-38. doi: 10.1016/j.resconrec.2018.10.017 [Crossref] [ Google Scholar]
18. Rodrigues AP, Fernandes ML, Rodrigues MFF, Bortoluzzi SC, Gouvea da Costa SE, Pinheiro de Lima E. Developing criteria for performance assessment in municipal solid waste management. J Clean Prod 2018; 186:748-57. doi: 10.1016/j.jclepro.2018.03.067 [Crossref] [ Google Scholar]
19. Zeng C, Li H, Xia F, Niu D, Zhao Y. Source-separated collection of rural solid waste in China. In: Maletz R, Dornack C, Ziyang L, eds. Source Separation and Recycling. Cham: Springer; 2017. p. 151-74. 10.1007/698_2017_30.
20. Mor RS, Sangwan KS, Singh S, Singh A, Kharub M. E-waste management for environmental sustainability: an exploratory study. Procedia CIRP 2021; 98:193-8. doi: 10.1016/j.procir.2021.01.029 [Crossref] [ Google Scholar]
21. Desa A, Ba’yah Abd Kadir N, Yusooff F. A study on the knowledge, attitudes, awareness status and behaviour concerning solid waste management. Procedia Soc Behav Sci 2011; 18:643-8. doi: 10.1016/j.sbspro.2011.05.095 [Crossref] [ Google Scholar]
22. Rahmaddin MY, Hidayat T, Yanuwiadi B, Suyadi Suyadi. Knowledge, attitude, and action of community towards waste management in river bank of Martapura. Int J Appl Psychol 2015; 5(4):96-102. doi: 10.5923/j.ijap.20150504.03 [Crossref] [ Google Scholar]
23. Adeolu AT, Enesi DO, Adeolu MO. Assessment of secondary school students’ knowledge, attitude and practice towards waste management in Ibadan, Oyo State, Nigeria. J Res Environ Sci Toxicol 2014; 3(5):66-73. doi: 10.14303/jrest.2014.021 [Crossref] [ Google Scholar]
24. Ahmad J, Noor SM, Ismail N. Investigating students’ environmental knowledge, attitude, practice and communication. Asian Soc Sci 2015; 11(16):284. doi: 10.5539/ass.v11n16p284 [Crossref] [ Google Scholar]
25. Strydom WF. Barriers to household waste recycling: empirical evidence from South Africa. Recycling 2018; 3(3):41. doi: 10.3390/recycling3030041 [Crossref] [ Google Scholar]
26. Al-Khateeb AJ, Al-Sari MI, Al-Khatib IA, Anayah F. Factors affecting the sustainability of solid waste management system-the case of Palestine. Environ Monit Assess 2017; 189(2):93. doi: 10.1007/s10661-017-5810-0 [Crossref] [ Google Scholar]
27. Ma J, Hipel KW, Hanson ML, Cai X, Liu Y. An analysis of influencing factors on municipal solid waste source-separated collection behavior in Guilin, China by Using the Theory of Planned Behavior. Sustain Cities Soc 2018; 37:336-43. doi: 10.1016/j.scs.2017.11.037 [Crossref] [ Google Scholar]