5.2.1 Attitude components of questionnaire
In this survey, 46.6% of respondents indicated a favourable attitude toward probiotics, whereas only 4.1% of respondents indicated a negative attitude. This was comparable with studies conducted in India, Indonesia and Pakistan, as majority of the healthcare professionals and health science students had a positive attitude towards probiotics (Soni et al., 2018; Arshad et al., 2021;
Rahmah et al., 2021). The positive attitude of the health science students towards probiotics can be linked to the fact that Malaysian consumers have high self- motivation to maintain wellness and strong belief in probiotic nutraceutical products that can improve general well-being (Chong and Teh, 2020). Most respondents (87.8%) strongly agreed that probiotics can provide beneficial health outcome to human when ingested orally. This findings are consistent with Soni et al. (2018), as 85.7% of the respondents believed that probiotics are beneficial for the patients. Comparably, Rahmah et al. (2021) reported that there
52 were 47.1% of respondents agreed and 48.3% of respondents strongly agreed that probiotics consumption can bring health benefits to human. Research has shown that probiotics can aid in restoring gut microflora balance, reinforcing the intestinal barrier integrity and modulating the immune system by stimulating the production of immunoglobulins and cytokines, also increase the activity of natural killers cells and macrophages (Maldonado Galdeano et al., 2019).
However, nearly half of the respondents disagreed that probiotics could be an alternative in preventing (41.6%) or treating (50.2%) skin problems, despite majority of respondents had strong belief in health benefit of probiotics. This results also explained that there was only minority of the respondents (22.6%) agreed that they would recommend probiotics for their future patients in prevention and treatment of skin disorders, since most of the respondents had little knowledge on gut-skin axis. On the contrary, a study conducted by Rahmah et al. (2021) reported that half of the respondents (55.2%) agreed that probiotics may be used in place of alternative treatments to stop gastrointestinal upset caused by pathogenic infections. This may infer that most health science undergraduates have learnt about the health benefits of probiotics towards digestive system but uncommonly being taught on the topic related to the application of probiotic supplements on skin health. A systematic review has revealed that the potential role of probiotics in reducing skin sensitivity and TEWL, improving skin hydration and elasticity, and have positive impact on skin barrier function (Salem et al., 2018). Another research performed by Jung et al. (2013) has reported that patients who were administered with probiotics and minocycline had experienced a significant decrease in the total number of lesions. Furthermore, there were 82.8% of the respondents strongly agreed that
53 probiotics could be used as an adjunct in medical treatment to alleviate the side effects of antibiotics. However, this result is not parallel to a study performed by Rahmah et al. (2021), as 51.7% of the respondents have neutral stance on the capability of probiotics in preventing the side effects of antibiotics. The difference between our study and the previous study may be because health science undergraduates in Malaysia have been taught on the application of probiotic supplements in alleviating the side effects of antibiotics due to alteration of intestinal microbiome. There was a research done by the Malaysian Society of Gastroenterology and Hepatology reported that the use of probiotics in clinical practice is generally well tolerated, effective and safe in the management of antibiotic-associated diarrheal and other diarrheal diseases (Lee et al., 2021). The current study also highlighted that majority of the health science undergraduates (85.1%) would like to learn more about probiotics. This result is congruent with (Rahmah et al., 2021), as majority of the respondents (88.5%) would like to know more about probiotics.
5.2.2 Attitude towards probiotics among gender and ethnicity
From the study, the attitude score is female respondents (M=23.13, SD=2.65) is higher than the male respondents (M=22.65, SD=2.58), although the result was not statistically significant. The result is comparable to a study performed by Arshad et al. (2021), as the female healthcare professionals (56.6%) had a more positive attitude towards probiotics than the male healthcare professionals (43.5%). This may be related to the perception that the females are predominantly more concern about their health than males through searching for
54 health information and seeking medical treatment for health problems (Rouquette et al., 2018). Furthermore, the current study reported that Chinese respondents (M=23.0, SD=2.70) has better attitude score of probiotics than the other counterparts, although the findings were not statistically significant.
Although probiotic research on the ethnicity parameter is limited, it may be explained that an uneven distribution of respondents across the three races leads to an anomalous finding. Therefore, more research is required to validate the relationship between attitude on probiotics and ethnicity.
5.2.3 Attitude towards probiotics among age group and year of study The findings in this study also indicated that age group of 21 to 23 years had better attitude score than the other age groups, although the outcomes were not statistically significant. This result is comparable with Arshad et al. (2021), as there was no significant association between attitude towards probiotics and year in practice. This study also reported that the attitude towards probiotics in fourth year of study (M=23.44, SD=2.06) was higher than the counterparts. These results are not consistent with Arshad et al. (2021), as there was 88.0% of the respondents from age group of 26 to 30 years old had less positive attitude than the respondents from age group of below 25 years old. These differences may be due to the present study had lower number of respondents in the fourth years of study (n=25, 11.3%) when compared to the counterparts, and hence contributed to large proportion of positive attitude in fourth year of study (56.0%). These findings suggest that additional factors may influence the perception towards probiotics that may be examined in future research.
55 5.2.4 Attitude towards probiotics among undergraduate programme Moreover, the findings revealed that the nursing students (M=23.33, SD=1.97) scored better than the other health science undergraduates in attitude component, although the outcomes were not statistically significant. This result was in line with Rahmah et al. (2021), as the nursing students had marginally higher attitude mean score than medical students. Although the nutrition-related degree, such as dietetics students have greater exposure to medical nutrition therapy compared to nursing students, yet dietetics students had slightly lower attitude score towards probiotics. There aren’t many studies investigating at the attitude towards probiotic supplements among different health science undergraduate programme and hence, more researches need to be done to determine the contributing factors.
5.2.5 Attitude towards probiotics among CGPA
In addition, the results reported that respondents with CGPA of 2.5 to 2.99 (M=21.38, SD=3.22) scored significantly poorer than the counterparts. This may infer that students with low CGPA have poor health perception which is evidenced by the negative associations between CGPA with fast food and alcohol consumption, and use of marijuana and electronic vaping products (Reuter and Forster, 2021). Another study also reported that those Malaysian undergraduates who scored poor CGPA performance had significant negative relationship with BMI and high physical activities (Talib et al., 2013).
56 5.2.6 Attitude towards probiotics among skin problems
The current study also revealed a significant association between rash and probiotics-related attitudes, ꭓ2= 10.761, p=0.005. Majority of respondents with rash (73.9%) were reported to have good attitude level towards probiotics. This result may imply that those respondents with eczema had perceived benefit about probiotics on alleviating their rash symptom. It was evidenced by a study revealed that positive health perception was observed among subjects who had chronic conditions and more likely to use botanical supplements to improve health or address specific conditions (Alonso Street et al., 2021).