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Manuscript Title: Exploring the awareness, perceptions, and practices of probiotics in the Saudi population: A cross-sectional study
Manuscript Type: Research Article
Reviewer Recommendation: Minor Revision
Date: October 2025
The manuscript is well-prepared, clearly written, and presents a relevant investigation into the awareness, perceptions, and practices of probiotics among the Saudi population. The study addresses an important gap in the regional public health and nutrition literature. The language is professional and technically sound, and the overall structure adheres to standard scientific conventions.
The work demonstrates methodological rigor, appropriate ethical approval, and adequate data analysis. The results are consistent with the stated objectives, and the discussion places the findings within an appropriate scientific context. Figures and tables are relevant and of acceptable quality, and the authors have provided the necessary raw data in line with PeerJ’s data-sharing policy.
However, some minor revisions are necessary before publication. These relate mainly to stylistic clarity, reporting transparency, and a few methodological clarifications. Specifically, I suggest:
1. Title
Evaluation:
The title accurately reflects the research content and specifies the study design (“cross-sectional study”). It is informative and aligned with scientific norms.
Weaknesses / Suggestions:
The title could be shortened for clarity and conciseness.
Suggested revision: “Awareness, Perceptions, and Practices of Probiotics Among the Saudi Population.”
Consider specifying the participant group more precisely (e.g., “Saudi adults”) if the study exclusively surveyed adults.
2. Abstract
Evaluation:
The abstract is clear and structured, summarizing the aim, design, methods, and key findings. The writing is technically correct, and the English usage is professional.
Weaknesses / Suggestions:
Include representative numerical data (e.g., mean scores, percentages) to support the main results.
The conclusion should specify actionable implications (e.g., for healthcare professionals, educators, or policymakers).
Verify that keywords include relevant terms such as knowledge, perception, probiotics, Saudi Arabia, cross-sectional study.
3. Introduction
Evaluation:
The introduction provides adequate context and rationale for the study. It effectively explains the importance of probiotics and the gap in regional data. References are appropriate and up to date, citing relevant works (Amara & Shibl, 2015; Sanders et al., 2018; Rajab et al., 2023). I recommend that the authors consider including the following article in their literature review to strengthen the background and provide a more recent regional context:
DOI: 10.1186/s12982-025-00732-1
Weaknesses / Suggestions:
The section would benefit from shorter, more focused paragraphs to improve readability.
Include more regional literature on probiotics or dietary supplement use within the Gulf region (2023–2025) to strengthen contextual grounding.
End the section with a clear, single-sentence objective statement, e.g.:
“This study aimed to assess the knowledge, perceptions, and practices regarding probiotics among Saudi adults.”
4. Materials and Methods
Evaluation:
The study design (cross-sectional survey), sampling technique, ethical approval (Qassim University, no. 24-91-20), and analytical methods are well described. The use of SPSS v27 and appropriate statistical tests (t-test, ANOVA, Chi-square) is commendable.
Weaknesses / Suggestions:
The reliability coefficients (Cronbach’s alpha 0.5–0.7) should be justified; a 0.5 score for the knowledge scale is low and requires rationale.
Specify whether normality and homogeneity tests (e.g., Shapiro–Wilk, Levene’s) were conducted before parametric tests.
The sampling method (snowball sampling) should be explicitly discussed as a limitation in terms of representativeness.
Include the full questionnaire or an English version as supplementary material for transparency and reproducibility.
5. Results
Evaluation:
Results are logically presented and supported by tables. The data align with the study objectives, and statistical tests are appropriate. Tables 1–7 are clear and adequately described.
Weaknesses / Suggestions:
Table captions should clearly distinguish between probiotic users and non-users.
All p-values mentioned in the text should include exact numerical values instead of only qualitative statements (“significant difference”).
Include means ± standard deviations or 95% confidence intervals to improve interpretability.
A demographic summary figure or graphical abstract could improve visual comprehension.
6. Discussion
Evaluation:
The discussion accurately interprets the results and compares them to prior literature. The authors highlight demographic influences on probiotic awareness and usage. The tone is balanced and supported by evidence.
Weaknesses / Suggestions:
The discussion is descriptive; more critical analysis is needed, e.g., explore why specific demographics (e.g., gender, education) affect probiotic awareness.
Expand on cultural and informational factors influencing probiotic use in Saudi Arabia.
The limitations section should be elaborated to emphasize issues such as self-report bias, online recruitment limitations, and sampling bias.
7. Conclusion
Evaluation:
The conclusion appropriately summarizes the study’s findings and practical implications. It is concise and consistent with the results.
Weaknesses / Suggestions:
Provide clearer recommendations for policymakers, health educators, or clinicians.
Suggest future research directions such as longitudinal or intervention-based studies, and comparative studies across regions or age groups.
Scope and Originality:
The manuscript presents original research within the journal’s aims and scope. The study question—assessing knowledge, attitudes, and practices regarding probiotics in the Saudi population—is well-defined, relevant, and meaningful. It fills a documented gap in public health nutrition literature in the region.
Methodological Rigor and Ethics:
The design (cross-sectional survey) is appropriate for the stated objectives. Sampling was performed via non-probability (snowball) methods using social media, which is acceptable for exploratory community-level assessments though it limits generalizability.
Ethical approval was obtained (Qassim University, approval no. 24-91-20), and informed consent procedures are clearly described. Participant anonymity was maintained.
Methods and Reproducibility:
Survey instrument construction, validation, and reliability measures are adequately documented. The questionnaire’s Cronbach’s alpha values (0.5 for knowledge, 0.7 for perception) are acceptable though marginal; this limitation is correctly noted.
Statistical analyses (t-tests, ANOVA, chi-square) are appropriate and executed using SPSS v27. Descriptions are sufficient for replication, though the authors should:
Clarify the rationale for interpreting the 0.5 Cronbach’s alpha as acceptable reliability.
Explicitly report the test of normality and homogeneity of variances (for t-tests/ANOVA).
Include confidence intervals for main estimates (knowledge and perception scores) to enhance interpretability.
Overall Assessment (Experimental Design):
Sound and ethical design. Minor methodological clarifications would strengthen transparency and reproducibility.
Data Presentation and Statistical Soundness:
The dataset is robust (N = 286, exceeding the calculated minimum sample size of 269). Results are presented coherently, with clear relationships between demographic variables and knowledge, perception, and practice metrics. Statistical findings are appropriately summarized in tables.
No major inconsistencies were found between reported data and interpretations. However, certain p-values are discussed qualitatively (e.g., “significant differences were observed”) without explicit numerical values in-text—these should be consistently reported for transparency.
Interpretation and Conclusions:
The discussion effectively links the findings to existing literature. The authors provide culturally relevant explanations for observed trends (e.g., gender imbalance, regional preferences, and the influence of education). The conclusions are logical and supported by the data.
The limitations section is appropriately detailed, acknowledging the constraints of snowball sampling, self-report bias, and lack of causal inference. Future directions are practical and aligned with the study’s implications.
Novelty and Contribution:
While not methodologically novel, the manuscript contributes valuable regional data and reinforces international findings regarding demographic determinants of probiotic use. It aligns with PeerJ’s scope, which encourages replication and public health application studies.
Overall Assessment (Validity of Findings):
Statistically sound and well-grounded. Minor reporting refinements (explicit confidence intervals and effect sizes) recommended.
4. General Comments (to Authors)
Language Polishing: Consider professional English editing to further streamline phrasing and ensure fluency.
Figures and Tables: Clarify captions for Tables 4 and 6 to explicitly identify the respondent group.
Statistical Reporting: Include confidence intervals and effect sizes (Cohen’s d, η²) where relevant.
Contextual Depth: Briefly reference additional regional data on probiotic use in Middle Eastern or GCC populations (2023–2025, if available).
Questionnaire Reliability: Elaborate on how a Cronbach’s alpha of 0.5 was deemed acceptable for the knowledge domain.
Graphical Abstract (optional): Consider including a summary figure illustrating demographic predictors of probiotic awareness and usage for visual clarity.
Strengths:
Well-structured, readable manuscript with strong contextual framing.
Adequate sample size and sound statistical analysis.
Relevance to regional nutrition and public health policy.
Data transparency and ethical compliance.
**PeerJ Staff Note:** Please ensure that all review, editorial, and staff comments are addressed in a response letter and that any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.
**Language Note:** When you prepare your next revision, please either (i) have a colleague who is proficient in English and familiar with the subject matter review your manuscript, or (ii) contact a professional editing service to review your manuscript. PeerJ can provide language editing services - you can contact us at [email protected] for pricing (be sure to provide your manuscript number and title). – PeerJ Staff
The researchers are required to:
1) Include the questionnaire used as the supplementary file of the manuscript.
2) Some of the comments given by the reviewers are not addressed in their revised manuscript. For example, lines 48-49 are without update using the latest information as per the suggestion of the reviewer.
3) The authors do not explain if information about the study’s objectives, eligibility criteria, and the voluntary nature of participation was provided to participants, whether they were informed about data confidentiality and anonymity. If informed consent was obtained from all participants before entering the study is not described in the section on participants.
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Issues have been addressed.
**PeerJ Staff Note:** Please ensure that all review, editorial, and staff comments are addressed in a response letter and that any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.
My comments are as follows:
Abstract
• Start with “Probiotics are…” and remove “the human…well-being.”
• Line 15: Consider replacing “both countries (Canada and the US)” with broader terms such as “Western European countries.”
• Line 18: The name of the questionnaire used should be clearly stated. Additionally, the data collection period is missing and should be included.
• The title suggests a focus on awareness, perceptions, and practices regarding probiotics; however, the study found that 65% of respondents had moderate knowledge. The title should be revised to better reflect the study’s actual content. Furthermore, the abstract does not present the results related to awareness and perceptions.
Introduction
• Line 35: Capitalization of "G" and "T" is unnecessary.
• Lines 38–39: Further explanation is needed regarding how gut disturbances lead to disease. Also, clarify the signs and symptoms associated with gut microbiota imbalance.
• Line 43: Examples of probiotics should be provided.
• Line 47: Include the prevalence rate of probiotic consumption.
• Line 48: The information in lines 48–49 should be updated. For instance, a recent study (https://doi.org/10.1016/j.foohum.2023.04.001 ) explores the relationship between probiotics and the gut–skin axis.
• The study hypothesis is not well-justified and should be more clearly articulated.
Materials and Methods
• Line 105: The data collection period is missing and must be stated.
• Line 109: Specify which social media platforms were used to distribute the questionnaire. The use of snowball sampling introduces potential bias, as it relies on personal networks. This method may reduce sample diversity, particularly in terms of socioeconomic status, and may over-represent certain demographics.
• Line 114: The name of the questionnaire should be provided. Additionally, the questionnaire should be included as a supplementary file.
• Line 117: The phrase “if any” is unclear and should be clarified or removed.
• The methods used to categorize “awareness, perceptions, and practices” should be clearly explained.
Results
• Clarify the discrepancy in the number of respondents mentioned in lines 107 and 143.
• In Table 1, it is unclear which states or regions of Saudi Arabia are referred to as north, south, east, west, and central. This should be clearly defined.
Discussion
• Line 237: Compare the level of knowledge about probiotics in Saudi Arabia with that in other countries.
• Line 251: The authors should compare their findings with those reported in previous studies.
• Line 256: Specify what types of educational campaigns could be implemented to improve public understanding of probiotics.
• The strengths and limitations of the study should be discussed explicitly.
• Recommendations for future research are absent and should be added.
Conclusion:
• The conclusion should summarize the key findings of the study more clearly and concisely.
• Line 105: The data collection period is missing and must be stated.
• Line 109: Specify which social media platforms were used to distribute the questionnaire. The use of snowball sampling introduces potential bias, as it relies on personal networks. This method may reduce sample diversity, particularly in terms of socioeconomic status, and may over-represent certain demographics.
• Line 114: The name of the questionnaire should be provided. Additionally, the questionnaire should be included as a supplementary file.
• Line 117: The phrase “if any” is unclear and should be clarified or removed.
• The methods used to categorize “awareness, perceptions, and practices” should be clearly explained.
• Clarify the discrepancy in the number of respondents mentioned in lines 107 and 143.
• In Table 1, it is unclear which states or regions of Saudi Arabia are referred to as north, south, east, west, and central. This should be clearly defined.
Please refer 'Basic reporting' for the details
Acceptable
The introduction and the discussion are far too long and deal with issues such as the mechanism of action of probiotics which are not relevant to the study.
Also, variable definitions of a probiotic are used which, to be honest, are incorrect. Pease refer to the ISAPP definition which is the most widely accepted and employed.
Need more information on the following:
1. The study population - who were they, how were they selected?
2. The questions in the questionnaire - how were they selected? There is a science behind questionnaire design. What principles governed the design of the questionnaire?
3. How were the responses scored? For example, the manuscript describes a 65% rate of knowledge about probiotics but 79% defined them as "dead" organisms which they are not - that is a postbiotic. I would interpret the responses in table 1 to indicate that the respondents had little or no understanding of a probiotic. This is not unusual.
4. The authors describe a power calculation but not sure what was the rationale for this? What was the a priori hypothesis and primary outcomes on which this was based?
Difficult to assess in view of the above mentioned concerns regarding the design of the questionnaire?
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