Abstract
BACKGROUND: Pharmaceutical pollution is a growing global concern with serious implications for ecosystems, human health, and water quality. In Jordan, this issue is amplified by weak enforcement of disposal regulations and low public awareness, with studies showing as few as 10% of residents return unused medicines to pharmacies. As trusted medication experts, pharmacists are uniquely positioned to advocate for and implement green pharmacy practices, the integration of environmental stewardship across the pharmaceutical lifecycle. However, the extent to which Jordanian pharmacists are equipped and enabled to fulfill this role has not been systematically assessed. OBJECTIVE: This study aimed to provide the first comprehensive assessment of the knowledge, attitudes, and practices (KAP) of both hospital and community pharmacists in Jordan regarding green pharmacy and to identify key predictors of their engagement. METHODS: This cross-sectional survey was conducted over a one-month period among 380 licensed pharmacists practicing in community and hospital settings across Jordan’s three administrative regions. A validated, self-administered questionnaire was used to assess KAP, perceived barriers, and recommendations. The primary outcomes were scores for knowledge, attitudes, and practices. Descriptive statistics were used to summarize KAP levels, and three separate multivariable logistic regression models were developed to identify predictors of Good Knowledge (score ≥ 80%), Positive Attitude (score > 27), and Good Practice (score ≥ 23). RESULTS: The study identified a significant attitude-practice gap. While pharmacists demonstrated overwhelmingly positive attitudes (mean score 4.4 ± 0.7), this did not translate into consistent practice (mean score 2.9 ± 1.2), particularly for actions requiring systemic support. Multivariable logistic regression analyses revealed that prior training was a consistent and powerful predictor across all domains. Good Knowledge (score ≥ 80%) was most strongly predicted by prior training (aOR = 5.21) and practicing in a chain pharmacy (aOR = 1.60). Highly Positive Attitude (mean score > 4.0) was significantly predicted by younger age (< 35 years; aOR = 1.95) and prior training (aOR = 1.80). Critically, Good Practice (mean score ≥ 3.5) was not predicted by attitude, but by structural and educational factors: prior training (aOR = 3.85), practicing in a chain pharmacy (aOR = 2.01), and a hospital setting (aOR = 1.75). CONCLUSION: This study, the first to assess comprehensively KAP on this topic in Jordan, underscored that the primary barriers to green pharmacy were systemic, not a lack of professional will. The findings provided an evidence-based roadmap, highlighting the urgent need for national guidelines, targeted training, and supportive infrastructure to empower pharmacists to translate their positive attitudes into meaningful environmental stewardship. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-026-08600-5.