The impact of knowledge and attitudes on physicians', nurses' and pharmacists' recommendation of probiotics: A systematic review

Introduction: Interest in probiotic use has surged in past decades, and the current evidence base suggests clinical benefits of probiotics. To take probiotic use into account, healthcare providers should be knowledgeable about how and when to recommend probiotics. The purpose of this systematic review was to understand how knowledge and attitudes impact physicians, nurses, and pharmacists (PNPs) in their probiotic recommendation behavior.Methods: MEDLINE, EMBASE, Web of Science, CINAHL and PsycINFO were systematically searched from inception until December 17, 2021. Studies focusing on PNPs' knowledge/attitude and behavior were included. Non-English studies, reviews, conference abstract/proceedings, and research letters were excluded. Title/ab-stract and full-text screening, along with quality assessment using Joanna Briggs Institute's Critical Appraisal Checklist for Analytical Cross-Sectional Studies, were conducted independently and in duplicate. Data were synthesized narratively.Results: Seventeen cross-sectional studies were included. Based on available data, at least 6697 PNPs were recruited. PNPs generally had good knowledge of probiotics. Physicians and pharmacists conveyed positive at-titudes about probiotics, while nurses' attitudes were unreported. Most PNPs reported lacking recommendation experience and/or would not recommend probiotics to patients. Common barriers preventing recommendation included a lack of supporting information and a perceived lack of efficacy.Conclusions: Our findings demonstrate that PNPs made limited probiotics recommendations. Given the small number of included studies with varied sample sizes, this review's findings should be interpreted cautiously. Since few studies analyzed how knowledge of probiotics was acquired or applied, future research should investigate the inclusion of probiotics in PNP curricula and scope of practice. Registration Number: PROSPERO #CRD42022311784