The survey’s design deserves closer attention when interpreting its findings. The researchers relied on convenience sampling, recruiting participants through professional networks and social media platforms rather than through a randomized or stratified framework. This approach is common in health-professional research because it is inexpensive and fast, but it means the 320 respondents cannot be assumed to represent the wider professional population of Turkey, let alone other countries. Those who choose to answer surveys about microbiota and probiotics may plausibly hold stronger interests or more favorable views on the topic than colleagues who declined, a phenomenon researchers describe as self-selection bias. The authors themselves acknowledge this limitation, and it is one reason the reported figures, such as the 72.8 percent who recommend probiotic products, should be read as descriptive of this sample rather than as national estimates.

The distribution of professions within the sample was notably balanced. Physicians, nurses, and pharmacists each contributed 78 participants, or 24.4 percent apiece, while dietitians accounted for 86 participants, or 26.9 percent. This near-even split is a methodological strength, because it allowed the investigators to compare awareness scores across four groups with broadly comparable numbers, reducing the risk that an overrepresented profession would dominate the pooled statistics. At the same time, each subgroup remains modest in size, which means the confidence intervals around group means are wide and smaller differences between professions might not have been detected.

The instrument at the heart of the study, the Microbiota Awareness Scale, is a validated questionnaire yielding scores between 18 and 100, with higher values reflecting greater awareness. The overall mean of 77.00, with a standard deviation of 8.5, indicates that respondents generally answered a large share of awareness items correctly, but the authors are careful to note that no validated cut-off exists for the scale. In other words, there is no agreed threshold above which a person can be labeled knowledgeable and below which they are deemed uninformed. This absence of a benchmark is why the researchers frame their conclusions in relative terms, emphasizing differences between professional groups rather than absolute judgments about whether any group is adequately informed.

The statistical approach reflected the nature of the data. Because awareness scores were not normally distributed, the team used the Kruskal-Wallis test, a non-parametric method for comparing more than two independent groups, and followed it with post-hoc analyses to identify which pairs of professions differed. The result was highly significant, with a p value below 0.001, and the post-hoc comparisons showed that dietitians outperformed every other group. Dietitians averaged 83.39 points, pharmacists 77.89, nurses 73.66, and physicians 72.42. The roughly eleven-point spread between the highest and lowest groups is substantial relative to the scale’s standard deviation, suggesting a genuine difference in familiarity with microbiota concepts rather than statistical noise.

That dietitians lead is perhaps unsurprising given their training. Nutrition and dietetics curricula typically include extensive coursework on the gastrointestinal tract, dietary fibers, fermented foods, and the role of the gut microbiota in health and disease, whereas medical and nursing programs often cover these topics more briefly, and pharmacy education emphasizes drug-related microbiology over nutritional ecology. Pharmacists’ intermediate position may reflect their exposure to probiotic products in practice, since these are sold over the counter in pharmacies and are a frequent subject of customer questions. The finding that physicians scored lowest, at 72.42, is noteworthy given their authority in clinical decision-making, and it echoes a recurring theme in the literature: foundational microbiota science has entered curricula more slowly than it has entered the marketplace.

The knowledge items themselves yielded encouraging but incomplete results. About 76.9 percent of participants correctly defined probiotics, and 71.3 percent correctly defined prebiotics. These figures imply that roughly one in four respondents could not accurately define probiotics and nearly three in ten could not define prebiotics, despite the questions being directed at professionals who may be asked about these products by patients or customers. The distinction matters in practice. Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, whereas prebiotics are substrates that are selectively utilized by host microorganisms, conferring a health benefit. Confusing the two, or assuming that any fermented food or supplement qualifies, can lead to advice that does not match the underlying evidence.

Attitudes, by contrast, were almost uniformly positive. More than 95 percent of respondents viewed both probiotics and prebiotics as beneficial for health. Such enthusiasm is consistent with the broad scientific consensus that these interventions can help in specific contexts, but it also raises the question of whether favorable attitudes are grounded in detailed knowledge of which strains, doses, and indications are supported by evidence. Probiotic effects are widely understood to be strain-specific and condition-specific; a preparation shown to help with antibiotic-associated diarrhea, for example, cannot be assumed to help with irritable bowel syndrome or atopic dermatitis. A professional who believes probiotics are generally good may still struggle to guide a patient toward the right product for a particular problem, or to recognize when evidence is absent.

The most striking result of the survey is the divergence between recommendation behavior and personal practice. Nearly three quarters of respondents, 72.8 percent, said they recommend probiotic products to others, yet only 23.4 percent reported consuming them regularly themselves. The authors are careful to distinguish these two behaviors, noting that professional recommendation and personal consumption are distinct constructs. A clinician may recommend a product because they judge it appropriate for a patient’s condition while personally seeing no reason to take it, or they may hesitate to consume supplements themselves while still viewing them favorably for specific indications. Nevertheless, the size of the gap, nearly fifty percentage points, invites reflection on how confidence in a product’s value for others coexists with limited personal use.

Several explanations are plausible. Professionals may reserve recommendations for situations where they perceive a clear indication, while personal consumption requires an ongoing perceived benefit for oneself. Cost is another consideration; high-quality probiotic products can be expensive, and regular use represents a recurring expense that many may deem unnecessary in the absence of a specific health concern. Some respondents may also hold a implicit distinction between therapeutic use, which they endorse professionally, and preventive or wellness use, which they regard with more skepticism for themselves. The survey design cannot disentangle these motivations, but the pattern aligns with the knowledge-attitude-practice framework that the authors invoke, in which knowledge and favorable attitudes do not automatically translate into corresponding behavior.

This framework, known in health-services research as the KAP model, posits a progression from awareness to attitude to practice, and it underlies many educational interventions. The present study illustrates a classic KAP gap: attitudes were overwhelmingly positive, knowledge was moderate, and practice lagged behind both. The authors argue that this gap highlights the potential importance of structured, evidence-based educational interventions, and the phrasing is deliberate. Education that merely promotes enthusiasm for probiotics would likely widen the attitude-practice divide without improving the quality of advice; what is needed is training that equips professionals to match products to indications, interpret strain-specific evidence, and communicate uncertainty honestly to patients.

The cross-sectional design imposes important limits on interpretation. Because awareness, attitudes, and practices were measured at a single point in time, no causal claims can be made about whether greater awareness leads to better recommendation behavior or more consistent personal use. It is equally possible that professionals who recommend probiotics frequently become more aware of microbiota concepts through practice, or that unmeasured factors such as workplace setting, years of experience, or personal health history shape both awareness and behavior. The authors explicitly call for longitudinal research to address these questions, and such studies could follow professionals through their training and early careers to see how knowledge and practice evolve together.

The study’s provenance also merits mention. The research was conducted by a team at Sivas Cumhuriyet University in Turkey, based in the Department of Nutrition and Dietetics within the Faculty of Health Sciences, and received no external funding, which reduces concerns about commercial influence. Ethical approval was granted by the university’s Non-Interventional Clinical Research Ethics Committee, and all participants provided informed consent. The article is published open access in BMC Medical Education under a Creative Commons license, and the version shared in September 2026 is an accepted manuscript that will be replaced by the final Version of Record after further edits. The survey received approval number 2023-03/43, indicating that planning began well before publication, a reminder that the products and evidence base professionals encounter today may have evolved since the questionnaire was designed.

For readers weighing the practical implications, the study’s message is less about the merits of any particular probiotic product and more about the infrastructure of professional knowledge. When a substantial minority of health professionals cannot define prebiotics, and when recommendation behavior far outpaces personal familiarity, the market for these products is being shaped by advice that rests on uneven foundations. Strengthening that foundation, through curriculum reform, continuing education, and access to strain-specific evidence summaries, would serve both professionals and the patients who trust their guidance. The Turkish survey offers a snapshot of where that foundation currently stands, and its call for longitudinal follow-up provides a clear agenda for the next phase of research.

Subject of Research: Healthcare professionals' knowledge, attitudes, and practices regarding microbiota, probiotics, and prebiotics

Article Title: Microbiota, probiotics, and prebiotics: a cross-sectional survey of healthcare professionals’ knowledge, attitudes, and practices

Article References: Tekin, T., Baglam, N., & Dincer, E. (2026). Microbiota, probiotics, and prebiotics: a cross-sectional survey of healthcare professionals’ knowledge, attitudes, and practices. BMC Medical Education. https://doi.org/10.1186/s12909-026-10425-1

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10425-1

Keywords: microbiota, probiotics, prebiotics, healthcare professionals, survey, medical education, knowledge-attitude-practice gap, dietitians, pharmacists, nurses, physicians, microbiome