Nurses’ knowledge, attitudes and practices relating to probiotics and prebiotics: a cross-sectional study in Palestine

Abstract

Probiotics and prebiotics are widely used dietary interventions for gut health and immune-related outcomes. Nurses play a key role in patient education, yet data on their understanding and use of these supplements in Palestine are limited. This study assessed nurses’ knowledge, attitudes, and practices regarding probiotics and prebiotics and examined factors associated with knowledge. A cross-sectional study was conducted from December 2024 to March 2025 using a validated self-administered questionnaire. A total of 400 nurses working in government, private, university hospitals, and clinics across Palestine participated. The survey was administered online using a convenience sampling approach. Knowledge items were scored (correct = 1; incorrect/“don’t know”/missing = 0), and a total knowledge score was calculated. Descriptive statistics, univariate tests, and multivariable linear regression were used to examine factors associated with knowledge. The mean total knowledge score was 18.69 ± 7.58. Regarding probiotics, 72.5% of nurses had poor knowledge, while only 3.0% were classified as having good knowledge. Similarly, 70.0% of participants had poor knowledge about prebiotics, with just 4.2% showing good knowledge. Attitudes were generally positive, 85.5% agreed that probiotics and prebiotics are beneficial for overall health and 81.0% were willing to recommend them. However, only 32.0% had ever recommended them, and 13.0% did so frequently. In multivariable regression, higher knowledge scores were associated with female gender ( p = 0.042), prior probiotic use ( p < 0.001), and receiving specific education on probiotics/prebiotics ( p = 0.001), age was not significant ( p = 0.797). The findings highlight substantial gaps in probiotics and prebiotics knowledge among nurses in Palestine, despite their overall positive attitudes. Targeted education and institutional guidance may support more evidence-informed counseling, but longitudinal studies are needed to evaluate whether education improves clinical practice.