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. 2023 Apr 20;23(1):384.
doi: 10.1186/s12913-023-09370-2.

Behavioural change interventions encouraging clinicians to reduce carbon emissions in clinical activity: a systematic review

Carys Batcup  1 , Matilde Breth-Petersen  1 , Thomas Dakin  1 , Alexandra Barratt  1 , Forbes McGain  1   2 , Ben R Newell  3 , Kristen Pickles  4
Affiliations

Behavioural change interventions encouraging clinicians to reduce carbon emissions in clinical activity: a systematic review

Carys Batcup et al. BMC Health Serv Res. .

Abstract

Background: Clinical activity accounts for 70-80% of the carbon footprint of healthcare. A critical component of reducing emissions is shifting clinical behaviour towards reducing, avoiding, or replacing carbon-intensive healthcare. The objective of this systematic review was to find, map and assess behaviour change interventions that have been implemented in healthcare settings to encourage clinicians to reduce greenhouse gas emissions from their clinical activity.

Methods: Studies eligible for inclusion were those reporting on a behaviour change intervention to reduce carbon emissions via changes in healthcare workplace behaviour. Six databases were searched in November 2021 (updated February 2022). A pre-determined template was used to extract data from the studies, and risk of bias was assessed. The behaviour change techniques (BCTs) used in the interventions were coded using the BCT Taxonomy.

Results: Six full-text studies were included in this review, and 14 conference abstracts. All studies used a before-after intervention design. The majority were UK studies (n = 15), followed by US (n = 3) and Australia (n = 2). Of the full-text studies, four focused on reducing the emissions associated with anaesthesia, and two aimed at reducing unnecessary test ordering. Of the conference abstracts, 13 focused on anaesthetic gas usage, and one on respiratory inhalers. The most common BCTs used were social support, salience of consequences, restructuring the physical environment, prompts and cues, feedback on outcome of behaviour, and information about environmental consequences. All studies reported success of their interventions in reducing carbon emissions, prescribing, ordering, and financial costs; however, only two studies reported the magnitude and significance of their intervention's success. All studies scored at least one item as unclear or at risk of bias.

Conclusion: Most interventions to date have targeted anaesthesia or pathology test ordering in hospital settings. Due to the diverse study outcomes and consequent inability to pool the results, this review is descriptive only, limiting our ability to conclude the effectiveness of interventions. Multiple BCTs were used in each study but these were not compared, evaluated, or used systematically. All studies lacked rigour in study design and measurement of outcomes.

Review registration: The study was registered on Prospero (ID number CRD42021272526) (Breth-Petersen et al., Prospero 2021: CRD42021272526).

Keywords: BCT taxonomy; Behaviour change; Behaviour change wheel; Carbon emissions; Clinical activity; Clinicians; Greenhouse gas emissions; Health system sustainability; Healthcare delivery; Intervention.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Part of the Behaviour Change Wheel, Capability-Opportunity-Motivation-Behaviour Model (COM-B) definitions and example Behaviour Change Techniques (Figure developed by the research team, using information from the Behaviour Change Wheel and the Behaviour Change Techniques Taxonomy [23, 37]
Fig. 2
Fig. 2
PRISMA diagram
See this image and copyright information in PMC

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