EVALUATION OF PALESTINIAN COMMUNITY PHARMACISTS’ KNOWLEDGE, ATTITUDES, AND PRACTICE PATTERNS TOWARDS PROBIOTICS: A CROSS-SECTIONAL STUDY FROM PALESTINE.

Abstract

ABSTRACT Background: Probiotics are living microorganisms that confer health benefits when consumed appropriately. In Palestine, the pharmaceutical market has experienced a significant increase in the availability and use of probiotics. Despite this growth, knowledge, attitudes, and practice patterns (KAP) towards probiotics among Palestinian community pharmacists have not been previously investigated. Objectives: This study was conducted to evaluate the level of KAP towards probiotics among Palestinian community pharmacists, to identify factors affecting these domains, and to assess the perceived needs for additional education. Methods: A cross-sectional study was conducted among licensed community pharmacists in the West Bank of Palestine between January and July 2025, following the STROBE guidelines. Data was collected using an online, self-administered questionnaire adapted from a validated tool by Ababneh and tailored to include additional clinical knowledge domains relevant to the Palestinian context. The questionnaire assessed knowledge (13 items; maximum score = 13) and attitudes (6 items; maximum score = 30, Cronbach’s alpha = 0.664). Clinical practice patterns were evaluated based on specific action-oriented statements within the attitude's domain. Convenience sampling yielded 386 participants. Non-parametric inferential analyses (Mann-Whitney U, Kruskal-Wallis, Spearman’s correlation) were performed using the Statistical Package for the Social Sciences (SPSS). Results: The study surveyed 386 Palestinian community pharmacists. The majority were female (64.2%) with more than 15 years of experience (29.5%). Community pharmacists showed a "Good" level of knowledge (81.6%; Median = 10.0, IQR: Q1 = 9.0, Q3 = 12.0). Among all demographic characteristics we examined, geographic location (City) was the only significant demographic variable (p = 0.023). Attitudes were highly positive (79.8%; Median = 24.0, IQR: Q1 = 21.0, Q3 = 26.0), and 79.5% of pharmacists were interested in more probiotic education. Regarding the clinical practice patterns, more than half of the pharmacists (56.2%) reported that they recommend probiotics without any concern. Spearman’s correlation between knowledge and attitude scores showed a weak positive relationship (r = 0.136, p = 0.008). Because of the absence of strain-specific clinical criteria, institutional practices depend mainly on general acceptance, despite the high clinical engagement. Conclusions: Palestinian community pharmacists made an effort to overcome the gap between their positive beliefs and their everyday practice, more than half of them translating these attitudes into actual recommendation intentions. Although the evidence supporting the use of probiotics continues to grow, a gap still exists between the available evidence and routine practice, as many dispensing practices are still not guided by standardized scientific evidence. There is a need for national clinical protocols and educational programs to improve these practices. This will enable pharmacists to recommend probiotics with more confidence. Keywords: Probiotics; Community Pharmacist; Knowledge; Attitude; Practice; Palestine.