Introduction

Irritable bowel syndrome (IBS) is a disorder of the gut brain interaction (DGBI) characterized by abdominal pain and altered bowel habits, affecting approximately 10% of adult populations worldwide1,2,3. The prevalence of IBS in China exhibits variation across distinct regions and demographic groups. A meta-analysis, encompassing a total of 76,763 subjects, revealed that the overall prevalence of IBS in China is estimated to be 6.5%4. Despite its prevalence, IBS remains a challenging condition due to its multifactorial etiology, which involves a combination of genetic, environmental, and psychosocial factors, as well as risk factors such as stress, diet, and gastrointestinal infections. Additionally, the limited effectiveness of current treatment options contributes to the ongoing difficulty in managing the condition5,6. This common DGBI imposes a significant burden on health-related quality of life (QOL) and results in increased healthcare costs7.

The KAP (Knowledge, Attitude, and Practices) model, established in the 1950s, holds substantial relevance in healthcare by assessing the knowledge, attitudes, and behaviors of target populations in their interaction with healthcare information8,9. This model’s core premise, emphasizing the influence of knowledge on attitudes, which in turn guide individual behaviors, offers a robust framework for addressing health-related challenges10. Healthcare professionals, especially doctors, may not need detailed knowledge of every illness, but having a solid understanding of common conditions like IBS can streamline initial assessments and help minimize diagnostic errors11. Furthermore, comprehending the knowledge and attitudes of healthcare professionals towards IBS may enhance patient care, leading to more accurate diagnoses and improved treatment, ultimately elevating the quality of life for IBS patients. Notably, research is scarce in this area, with only one comparable study among pharmacists, highlighting the need for further investigation into the KAP of healthcare professionals regarding IBS12. Therefore, this study aimed to investigate the KAP of healthcare professionals towards IBS.

Methods

Study design and participants

This cross-sectional study was conducted among healthcare professionals from 5 centers, including Jining No. 1 People’s Hospital, the People’s Hospital of Sishui County, Traditional Chinese Medicine Hospital of Sishui County, Liangshan County No.2 People’s Hospital, and Quanpu Health Center of Liangshan County, between June and August, 2023. Inclusion Criteria: (1) healthcare professionals, including physicians, nurses, medical technicians, pharmacists, and other healthcare workers, who agreed to participate in this study; (2) Commit and cooperate to complete the questionnaire survey. Exclusion Criteria: (1) questionnaires completed in less than 85 s; (2) refusal to answer the questionnaires; (3) age less than 18 or more than 100 years old; (4) age minus years of work experience less than 18; (5) selecting “unaware” in all parts of the knowledge section. The Ethical approval (2023-052) for this study was obtained from the Medical Ethics Committee of Jining No. 1 People’s Hospital, and informed consent was obtained from all of the participants. All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Questionnaire

The questionnaire was developed based on “Gastroenterology Society of Chinese Medical Association. Expert Consensus Opinions on irritable bowel syndrome in China in 2020”13 and with input from 3 experts, including 2 chief gastroenterologists and 1 chief psychologis, and underwent a pilot test (n = 32). The Cronbach’s α coefficient was 0.973, with respective values of 0.943, 0.774, and 0.924 for the knowledge, attitude, and practice dimensions. The final questionnaire, provided in the Chinese language, encompassed four data collection dimensions comprising a total of 43 items. These dimensions consisted of: sociodemographic characteristics (10 items); knowledge dimension (15 items, rated on a scale of 2, 1, and 0 for responses signifying “very familiar,” “heard of,” and “unaware,” respectively, with a possible score range of 0–30); attitude dimension (7 items, scored as 5, 4, 3, 2, and 1 for responses indicating “strongly agree,” “agree,” “neutral,” “disagree,” and “strongly disagree,” respectively, with a potential score range of 7–35, except for item 1 where scoring was reversed); and practice dimension (11 items, rated on a scale of 5, 4, 3, 2, and 1 for responses indicating “always/strongly adhere,” “often/adhere,” “sometimes/moderate,” “rarely/do not adhere,” and “never/strongly do not adhere,” respectively, with a potential score range of 11–55, except for item 10 where scoring was reversed). Achieving scores exceeding 70% of the maximum score in each section denoted sufficient knowledge, a positive attitude, and proactive practice14.

This study recruited participants through convenience sampling in the 5 hospitals. The trained research assistants invited the healthcare professionals who met the inclusion criteria for participation randomly. The questionnaires were distributed to study participants via the online platform based on the SoJump (https://www.wjx.cn/) application, and a QR code was generated to allow the data collection through WeChat. Participants log in by scanning the QR code sent by WeChat and then complete the questionnaire. The completeness, internal coherence, and reasonableness of all questionnaires were checked by the investigators. To ensure quality control further, respondents were required to complete the questionnaire through WeChat login, limiting each IP address to one completed questionnaire. All questions in the questionnaire were also mandatory. Questionnaires completed in less than 90 s.

Statistical analysis

Statistical analysis was conducted using SPSS 26.0 (IBM Corp., Armonk, N.Y., USA). Continuous variables were described using mean ± standard deviation (SD), and between-group comparisons were performed using t-tests or analysis of variance (ANOVA). Categorical variables were presented as n (%). Pearson correlation analysis was employed to assess the correlations between knowledge, attitude, and practice scores. Structural equation modeling (SEM) was performed based on the following hypotheses: (1) Knowledge has an effect on attitude and practice; (2) Attitude has effect on practice. Two-sided p < 0.05 were considered statistically significant in this study.

Results

Initially, a total of 757 questionnaires were collected in the study, and they were excluded according to the following criteria: (1) 36 cases in which the questionnaire took less than 85s to fill in; (2) 4 cases who refused to answer the questionnaires; (3) 3 cases whose age was less than 18 or more than 100 years old; (4) 2 cases with a difference between age minus years of work experience less than 18; (5) 22 cases who selected “unaware” in all parts of the knowledge section. The remaining valid questionnaires were 697 (92.1%) cases. Among them, 499 (71.59%) were female, 383 (54.95%) had a Bachelor’s Degree, and 358 (51.36%) were physicians. Their mean knowledge score was 10.9 ± 9.57 (possible range: 0–30), mean attitude score was 29.33 ± 3.39 (possible range: 7–35), and mean practice score was 35.67 ± 8.75 (possible range: 11–55). In addition, their knowledge score varied from healthcare professionals with different gender (P = 0.003), education (P < 0.001), occupation (P < 0.001), professional title (P = 0.023), department (P < 0.001), and with families have IBS (P < 0.001). As for the attitude score, there were differences among healthcare professionals with different years of work experience (P = 0.002), department (P < 0.001), and with families have IBS (P = 0.037). The practice scores were found to vary among healthcare professionals with different gender (P = 0.003), occupation (P < 0.001), institution type (P < 0.001), department (P < 0.001), and with families have IBS (P = 0.008) (Table 1).

Table 1 Demographic characteristics.
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The distribution of knowledge dimensions revealed that the three questions with the highest number of participants choosing the “Very well known” option were “Colonoscopy can be used in IBS patients to rule out organic lesions.” (K8) with 40.75%, “IBS is primarily characterized by abdominal pain, bloating or discomfort, along with changes in bowel habits such as frequency and stool consistency.” (K2) with 39.02%, and “IBS is one of the most common gastrointestinal functional disorders.” (K1) with 35.58%. On the contrary, the three questions with the highest number of participants choosing the “Unknown” option were “Acupuncture and moxibustion can be used for the management and treatment of IBS.” (K15) with 29.56%, “Traditional Chinese Medicine attributes the pathogenesis of IBS to liver stagnation and spleen deficiency, often using herbs that soothe the liver and invigorate the spleen.” (K11) with 27.69%, and “Increasing research suggests that IBS may result from acute or chronic infectious gastrointestinal inflammation, with some correlation to the severity of infection and the duration of antibiotic use.” (K6) with 25.82% (Table S1).

Attitudes of respondents revealed that 58.13% believe that IBS has a favorable prognosis, and excessive concern is unnecessary (A1). Additionally, 93.97% of respondents think that despite the favorable prognosis, IBS patients should maintain a positive outlook (A2). A total of 95.84% of respondents advocate attention to daily dietary habits even with a good prognosis for IBS (A3). Furthermore, 95.56% of respondents believe that healthcare professionals should carefully consider the differential diagnosis of IBS to prevent delays caused by misdiagnosis (A4). Meanwhile, 94.26% of respondents perceive the favorable prognosis of IBS as dependent on active patient involvement in treatment (A5). Similarly, 95.55% of respondents believe that healthcare professionals should offer guidance on preventing IBS triggers, including gastrointestinal infections, food intolerances, and medication irritants (A6). Finally, 85.94% of respondents highlight the importance of non-gastrointestinal healthcare professionals being proficient in recognizing IBS symptoms, diagnostic methods, and procedures (A7) (Table S2).

Around 30.84% of healthcare professionals proactively seek information and guidelines on IBS (P1). Around 23.96% actively participate in IBS-related training (P2). About 31.42% take an active role in educating patients and their families about IBS-related knowledge (P3). A notable 30.71% are very familiar with IBS symptoms, diagnostic methods, and procedures (P4). A substantial 38.02% pay attention to alerting patients with similar symptoms to undergo differential diagnosis for IBS (P5). A majority, 57.95%, actively encourage IBS patients to undergo colonoscopy to rule out organic lesions (P6). Around 58.91% advise patients to regulate their gut microbiota (P7). A significant 62.42% remind patients to avoid IBS triggers whenever possible (P8). Nearly 59.4% actively provide counseling for patients’ anxiety, depression, and other psychological issues (P9). It is noteworthy that 24.96% of healthcare professionals would forgo necessary diagnostic tests, such as colonoscopy, CT scans, abdominal ultrasound, etc., due to patient misunderstanding (P10). Lastly, around 31.57% encourage IBS patients to undergo acupuncture treatment (P11) (Table S3).

Pearson’s correlation analysis revealed that, there were positive correlations between knowledge and attitude (r = 0.329, P < 0.001), as well as knowledge and practice (r = 0.288, P < 0.001). Additionally, a significant correlation was observed between attitude and practice (r = 0.452, P < 0.001) (Table 2). The Structural Equation Modeling (SEM) analysis demonstrated that the model exhibited highly favorable fit indices, indicating a well-fitting model (Table 3). This analysis also revealed the direct influence of knowledge on attitude (β = 0.195, P < 0.001) and practice (β = 0.410, P < 0.001). Additionally, attitudes were found to have a direct influence on practice (β = 0.607, P < 0.001) (Table 4; Fig. 1).

Table 2 Correlation analysis.
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Table 3 Model fit.
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Table 4 Path analysis.
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Fig. 1
figure 1

Path analysis. In this figure, K represents Knowledge, A represents Attitude, and P represents Practice. Each latent variable is measured by several observed variables (K1–K15, A1–A7, P1–P11). The arrows indicate direct and indirect paths relations between the latent variables, with corresponding path coefficients shown. e1–e35 represent the error terms for each observed variable, while the numbers reflect the strength of the relationships between the latent variables and their observed indicators.

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Discussion

Healthcare professionals had inadequate knowledge, positive attitude and suboptimal practice towards IBS. Their KAP might be influenced by gender, education, occupation, professional title, department, with families have IBS, years of work experience, and institution type. This study emphasizes the need for comprehensive strategies that enhance knowledge, align attitudes with evidence-based practices, and surmount barriers to ultimately enhance clinical practice and outcomes for individuals with IBS.

The findings from this study on healthcare professionals’ knowledge, attitude, and practice regarding IBS reveal a significant gap between healthcare professionals’ attitudes and knowledge, with a relatively positive attitude contrasted with inadequate knowledge scores15. This discrepancy emphasizes the need for targeted educational interventions to bridge the knowledge-attitude gap16. While these results align with prior research indicating a knowledge deficit among healthcare professionals, it remains surprising that such a positive attitude does not consistently translate into optimal clinical practice17. Addressing barriers such as time constraints and resource limitations is crucial for improving patient care18.

Notably, knowledge scores exhibited variations based on gender, education, occupation, professional title, department, and With families have IBS, suggesting that these factors have a discernible influence on healthcare professionals’ understanding of IBS19. Male participants had significantly higher knowledge compared to females, highlighting the importance of gender-specific educational interventions. Professionals with higher education levels, particularly those with a Master’s Degree or higher, exhibited greater knowledge, underscoring the significance of advanced education in enhancing understanding20. Additionally, differences in practice scores across different institution types suggest a potential influence of hospital settings on IBS management practices21. These findings underscore the need for tailored strategies to address the specific knowledge gaps, attitudes, and practices within distinct subgroups of healthcare professionals22. To improve clinical practice and patient outcomes, targeted educational interventions, professional development programs, and institutional support systems should be designed to address these variations comprehensively, thereby fostering more effective and standardized care for individuals with IBS23.

The study also reveals areas of alignment with established knowledge and significant gaps that warrant focused discussion. Notably, the results indicate a robust understanding among participants of core IBS concepts such as the utility of colonoscopy for ruling out organic lesions and the characteristic clinical presentation of IBS, which is consistent with the prevailing medical literature24. This knowledge foundation aligns with the conventional diagnostic and epidemiological aspects of IBS, reflecting a positive aspect of clinical practice. However, it is concerning that a significant proportion of participants displayed unfamiliarity with complementary therapeutic modalities like acupuncture and moxibustion, as well as traditional Chinese medicine’s perspective on IBS pathogenesis. Moreover, the relatively limited awareness of the potential link between infectious gastrointestinal inflammation and IBS development raises questions about the integration of emerging research findings into clinical practice. To enhance clinical practice, targeted educational interventions are essential to foster a broader understanding of complementary therapies and to ensure healthcare professionals stay abreast of evolving insights into the multifactorial nature of IBS. These interventions can bridge existing knowledge gaps and empower healthcare professionals to provide more holistic and evidence-informed care to individuals with IBS25. The surprising discrepancies in awareness regarding these alternative and emerging aspects of IBS may be attributed to variations in educational backgrounds, access to updated information, or institutional emphasis on conventional approaches26. Therefore, it is imperative to address these discrepancies by integrating comprehensive and contemporary IBS education into healthcare professional training programs and promoting continuous learning in clinical practice.

The attitudes of the respondents offer valuable insights that can significantly inform and improve clinical practice in the management of IBS. Healthcare professionals generally view IBS with a favorable prognosis and emphasize the importance of maintaining a positive outlook among patients, reflecting an overall optimistic stance within the healthcare community27. These attitudes underscore the potential benefit of adopting a patient-centered approach that not only addresses the physical aspects of IBS but also acknowledges the importance of psychological well-being in symptom management. Furthermore, the strong consensus on the need to consider dietary habits and the role of patient involvement in achieving a favorable prognosis highlights the significance of comprehensive care that integrates dietary guidance and active patient participation. Additionally, the call for diligence in considering differential diagnoses underscores the complexity of IBS diagnosis and the need for healthcare professionals to maintain a vigilant approach to rule out other conditions28. Moreover, the recognition that healthcare professionals should play a pivotal role in guiding patients to prevent IBS triggers emphasizes the importance of patient education and proactive preventive measures. Lastly, the emphasis on non-gastrointestinal healthcare professionals’ proficiency in recognizing IBS symptoms underscores the necessity of interdisciplinary collaboration and knowledge dissemination across medical specialties.

Regarding practice, a substantial proportion of healthcare professionals sought IBS-related information and guidelines, reflecting a commitment to staying informed and evidence-based in their practice. This aligns with the dynamic nature of medical knowledge and the need for continuous learning to provide optimal care29. Furthermore, their active participation in IBS-related training reflects dedication to professional development, emphasizing the importance of equipping healthcare professionals with the latest insights and skills for IBS management. They play a significant role in patient education, showing a comprehensive approach to IBS care. However, the potential consideration of forgoing necessary diagnostic tests due to patient misunderstanding suggests a need for improved patient communication and education to safeguard essential diagnostic procedures.

The results of the correlation analysis unveiled important associations among the key variables in this study. Positive correlations were observed between knowledge and attitude30, as well as between knowledge and practice, emphasizing the interconnection between these components in healthcare professionals’ IBS management. Furthermore, a significant correlation was found between attitude and practice, underlining the inherent relationship among these factors31. The SEM analysis validated these relationships, indicating a well-fitting model. Importantly, this analysis elucidated direct influence, with knowledge influencing both attitude and practice, and attitudes playing a direct role in shaping practice. These findings collectively emphasize the significance of enhancing knowledge as a foundation for fostering positive attitudes and, in turn, translating them into clinical practice for more effective IBS management32.

This study had limitations. Firstly, the cross-sectional design employed in this study limits the establishment of causal relationships between variables, as it captures data at a single point in time. This design restricts our ability to ascertain whether changes in knowledge, attitude, or practice occurred over time or were influenced by external factors. Additionally, the study was conducted within a specific time frame and in five hospitals of Shandong Province, potentially limiting generalizability of the findings to a broader population of healthcare professionals in different settings around China. Furthermore, the use of self-administered questionnaires may introduce response bias, as participants may provide socially desirable responses or have varying interpretations of questionnaire items. Lastly, a notable portion of participants were employed in gastroenterology departments, potentially introducing bias due to their specific professional background.

Conclusion

In conclusion, healthcare professionals demonstrated gaps in knowledge, positive attitude and suboptimal practice towards IBS. Their KAP might be influenced by gender, education, occupation, professional title, department, with families have IBS, years of work experience, and institution type. Based on the findings of this study, it is recommended that clinical practice in managing IBS be improved by enhancing healthcare professionals’ knowledge through educational interventions, promoting a positive attitude towards IBS patients with an emphasis on empathy and patient-centered care, and implementing evidence-based protocols and guidelines for IBS management. These steps are essential to ensure the delivery of high-quality care and better outcomes for individuals with IBS.