Engagement, disengagement and non-engagement with sustainable healthcare: an exploratory sequential design

Climate change is a pressing global problem requiring action at all levels within society. Healthcare organisations in the United Kingdom (UK) are under increasing pressure to reduce carbon emissions. Healthcare staff often work in challenging conditions with sick patients and limited resources, as a result climate change and sustainability are often a low priority. This portfolio presents research which examines the engagement of staff with the sustainable healthcare agenda, placing emphasis on the psychological perspectives that influence engagement, disengagement and non-engagement.

Chapter 1 introduces the subject, framing the impact of healthcare on climate change and health. This chapter provides an overview of the theoretical context and the significant theories and frameworks that influenced the research. A justification for the methodological and epistemological stance is provided. Chapter 2 presents a literature review on healthcare professional’s perspectives on climate change and sustainable healthcare. The review revealed a scarcity of primary research, and of the nine research papers found there was evidence of situational constraints and psychological barriers to engagement. Chapter 3 sought to examine the findings from the literature amongst a sample of healthcare workers within the UK. This small qualitative study gathered the perspectives of 15 participants from a range of healthcare roles. The findings confirmed the presence of situational constraints and psychological barriers to engagement, thus confirming the findings of the literature review. The findings also revealed a willingness amongst participants to do more to mitigate climate change, however they wanted more education and knowledge on how to do this.

Chapter 4 explored the factors (values, beliefs and norms) that influenced engagement with a sustainable healthcare campaign. This large quantitative study gathered responses via an online questionnaire from 182 participants working in clinical and non-clinical roles across a community NHS trust. The findings revealed that value type (altruistic, biospheric or egoistic) can predict pro-environmental behaviours, and this is mediated by a person’s beliefs and norms. The results showed that low-cost behaviours were easier to predict and the higher the cost the less predictive influence value type has over behaviours.

Chapter 5 examined those who had chosen not to engage with the sustainable healthcare campaign. The same community NHS trust was used but this time participants who had not engaged were approached. The aim was to understand the reasons for non-engagement. A case study design was utilised, and two participants were included, each presenting different reasons for non-engagement. The findings suggested that non-engagement is complex and multi-faceted but was not automatically an indicator of disengagement.

Chapter 6 examines the findings from each piece of research within this portfolio and provides an overarching commentary and synthesis. The limitations are acknowledged and from this the key theoretical, practical and research implications are drawn out and recommendations made. This final chapter has a reflective element which examines the successes and limitations of the methodological approaches used, along with a reflection on the impact this research has had on me.