Gut health, the microbiome and dietary choices: An exploration of consumer perspectives

Abstract

Aims

To explore consumer perceptions regarding dietary behaviours related to the gut microbiome, to assist in effective translation of research to practice.

Methods

Online focus groups were conducted (adults with no formal medical or nutrition training). Semi‐structured open‐ended questioning explored perspectives related to gut health and dietary behaviours. A qualitative descriptive analysis approach was undertaken in duplicate.

Results

Fourteen focus groups were conducted (n = 38, 15 males, 23 females). Four overarching themes regarding consumer perceptions were identified. These were (a) gut health equates with wellbeing, (b) there are divergent perceptions of how diet influences gut health, (c) interest in scientific evidence does not necessarily influence dietary behaviour and (d) gastrointestinal symptoms influence dietary behaviour.

Conclusions

Consumers are interested in gut health and understand that diet may be important. Given that current literature regarding diet and gut health does not differ from dietary guidelines, consumer interest may provide a timely slant to promote longstanding guidelines. Consumer education to limit scepticism around government messaging, including utilisation of social media by nutrition professionals, may be key to improving adherence to guidelines.

1. INTRODUCTION

The term ‘gut health’ is increasingly used in popular media and by the food industry to refer to the health of the gastrointestinal microbiome. Scientific literature suggests gut health incorporates digestive and immune health as well as microbiome health, ¹ , ² , ³ however the term remains undefined. Over the past 20 years, rapid advancement of microbiome sequencing has progressed the understanding of the role of gut microbes, the health outcomes they influence and ways to modulate these. ³ , ⁴ , ⁵ Commercialisation of gut health products appears to have capitalised on this growth market, sometimes outside of the evidence base. ¹ , ⁶ Positions on optimal microbiome characteristics and specific recommendations to achieve these remain unclear. Consumers' perceptions regarding gut health, including the microbiome, may be a useful start to inform science translation and health messaging.

From a science perspective, the composition, diversity and metabolite production of the microbiota is associated with a myriad of health outcomes including metabolic syndrome, mental health and autoimmune disorders, ⁷ , ⁸ , ⁹ , ¹⁰ hence there is plenty to be gained in translation. Diet is a significant modifiable factor in shaping microbiome characteristics and potentially associated health outcomes. ¹¹ Despite this, evidence regarding precisely how diet influences microbes and associated health outcomes, is not yet at a level where confident prescriptions can be made. It is, however, accepted that a diverse, fibre‐rich diet, as recommended in the Australian Dietary Guidelines, ¹² has beneficial effects on metabolic health ¹³ , ¹⁴ , ¹⁵ , ¹⁶ and these are, at least in part, mediated by the microbiome. ¹⁷ , ¹⁸ While this broadly reinforces the need for promotion of these guidelines, researching the relationship between diet, the microbiome, and potential health outcomes remains problematic. Challenges include disparities in study design and the individualised and multifactorial nature of gut health. ¹⁹ , ²⁰ The inferred need for consistent and comprehensive clinical trials providing the required evidence for dietary recommendations specific to gut health and associated effects is echoed in multiple reviews. ²¹ , ²² , ²³ Understanding whether consumers are aware of these limitations may also assist in providing direction for better gut health communications.

The popularisation of ‘gut health’ has promoted certain dietary choices despite limited science. ⁶ , ²⁴ While translational outcomes may be bettered with improved gut microbiome research design, ²³ consumer needs should be considered at all stages. Given there is already heightened consumer interest toward ‘gut health’, the aim of this study was to explore consumers' perceptions regarding dietary behaviours related to the gut microbiome, to assist in effective translation of research to practice. This may inform science communication to guide appropriate health behaviours which can take advantage of the growing body of research on gut health related to the microbiome.

2. METHODS

A qualitative descriptive approach was employed as we wished to explore the phenomena of gut health through the eyes of the consumer. Qualitative descriptive studies enable exploration of novel areas through detailed description of topics without an existing theoretical perspective. ²⁵ Focus groups were chosen to enable interaction between participants, which supported wide‐ranging discussion and encouraged exploration of diverse perspectives. Ethics was approved by University of Wollongong Ethics Committee, ETH2020/355. Participants (adults >18 years, without formal medical, microbiology, or nutrition training) were initially recruited using convenience sampling ²⁶ through word of mouth and online social networks such as Facebook. Midway through recruitment, maximum variation sampling techniques ²⁷ , ²⁸ were employed to target underrepresented demographic groups. Specifically, males and adults aged >30 years were purposively recruited to achieve a balanced cohort by gender and age. Focus group transcripts were reviewed by a second researcher at two time points throughout data collection. Once both authors agreed that no new discussion points were emerging, recruitment was ceased. Information power was also considered in deciding when to cease recruitment with the study's broad aim, sparse specificity, cross‐case analysis and lack of theoretical background considered. ²⁹ Focus groups were conducted via Zoom (Zoom Video Communications, Inc Version 5, San Jose, California) between November 2020 and May 2021 and were led by one researcher to ensure consistency. Assistance was provided by an experienced qualitative researcher during initial sessions. Small focus groups were preferred based on the online format. ³⁰ A written information and consent form was provided via email prior to involvement. No participation incentives were offered. Demographic information was collected via an anonymous online questionnaire (Appendix S1).

Focus group questions used an open ended, semi‐structured style (Appendix S2). Study aims guided question development with a focus on exploring requirements for translational science in this area. Questions were developed, pilot tested and finalised collaboratively by all authors. Given the context of this study during the COVID‐19 pandemic, questions initially queried perspectives regarding immunity, dietary choices and gut health. As early groups indicated consumers did not consider this relevant, these questions were not pursued further.

Focus groups were audio recorded, and with initial transcription using Otter ai software (Version 1.0, Otter.ai, Los Altos, California). To ensure verbatim transcription, one author listened and re‐read all transcripts to ensure accuracy with a selection verified by another author. Transcripts were imported into NVivo qualitative data analysis software (Version 10, QSR International Pty Ltd., 2012). Transcripts were then read and re‐read by two researchers to further immerse in the data. Data was independently reviewed and coded by both researchers using thematic analysis ³¹ to improve study rigour via triangulation ³² and ensure intercoder reliability. ³³ Codes were discussed and clustered with emergent themes identified inductively. Divergent views were considered in theme generation and are discussed. A second round of coding was completed to ensure all data was assigned to a theme with further discussion to finalise themes and sub‐themes. Exemplar quotes were identified by both researchers and included quotes were chosen by consensus to ensure the best representation of findings.

A second stage of analysis was conducted using content analysis ³⁴ to specifically focus on consumers perceptions of dietary choices that influence gut health. This flexible analysis approach is common in qualitative descriptive research to enhance depth of understanding. ²⁵ Consumer perspectives were grouped and included based on frequency of mention. This was conducted independently by two researchers with outcomes discussed.

Purposeful approaches to ensuring research quality were employed. ³⁵ One researcher was an experienced qualitative researcher and the second was a clinician/postgraduate research student. Both researchers were Accredited Practising Dietitians with knowledge of gut health research and an interest in translation of research to practice in this area. A reflexive journal was kept during focus groups documenting initial observations and emerging themes. ³⁴ These were discussed between authors undertaking analysis to ensure ongoing reflection on personal contexts and influences on research processes and outcomes. ³⁴ , ³⁶ An experienced qualitative researcher not involved in the analysis provided feedback on question development and analysis outcomes. ³⁵ , ³⁷

3. RESULTS

Fourteen focus groups were conducted with 2–4 participants in each (n = 38). The two 2‐person groups occurred due to last‐minute scheduling issues. Each group ran for 45–60 min. The study sample included 23 females (61%) with 68% aged <45 years and 66% having completed higher education (Table 1). Four participants reported having Irritable Bowel Syndrome, no other conditions were disclosed.

TABLE 1.

Characteristics of the sample: consumers ^a (n = 38)

Demographic	N	%	Demographic	N	%
Gender			Area of residence
Male	15	39%	Rural	7	18%
Female	23	61%	Suburban	20	53%
			Urban	11	29%
Age (years)			Income
18–25	7	18%	<$50 000	6	16%
26–35	17	45%	$50 000–$79 999	14	37%
36–45	2	5%	$80 000–$119 999	10	26%
46–55	5	13%	$120 000–$150 000	2	5%
56–65	6	16%	>$150 000	2	5%
>65	1	3%	Prefer not to say	4	11%
Employment status			Education
Full time	29	76%	Completed high school	6	16%
Part time	3	8%	Certificate/diploma	7	18%
Casual	2	5%	Bachelor's degree	18	47%
Student	2	5%	Master's degree	6	16%
Retired	2	5%	PhD/doctorate	1	3%

^a Thirty‐eight consumers were recruited to focus groups investigating consumer perceptions toward gut health. Inclusion criteria were adults >18 years, without formal medical, microbiology, nutrition training, no further exclusion criteria.

Four overarching themes regarding consumer perceptions were identified, (a) gut health equates with wellbeing, (b) there are divergent perceptions of how diet influences gut health, (c) interest in scientific evidence does not necessarily influence dietary behaviour and (d) gastrointestinal symptoms influence dietary behaviour. A number of sub‐themes were also identified within each theme (Figure 1 and Table 2).

FIGURE 1.

Thematic analysis outcomes of focus groups investigating consumer perspectives^a of gut health and associated influences. ^a Thirty‐eight consumers were recruited to focus groups investigating consumer perceptions toward gut health. Inclusion criteria were adults >18 years, without formal medical, microbiology, nutrition training, no further exclusion criteria.

TABLE 2.

Perspectives of focus groups participants ^a regarding gut health, the microbiome and dietary influences

Themes	Sub‐themes	Key examples
(a) Gut health equates with wellbeing		P29: ‘I'd say a healthy gut is one you don't notice’ P28: ‘I mean, if something is bad for your gut health shouldn't it just be bad for you full stop’
(b) There are divergent perceptions of how diet influences gut health		P38: ‘I have a lot of fermented food such as plant‐based kefir and sauerkraut and leafy greens. I know they break down well in your gut and help with diversity’ P29: ‘I wonder in terms of gut health, if everyone was following that triangle (Healthy Food Pyramid) would gut health even be an issue? Do we need a different way of separating food just to target gut health, or do we just need to promote that more and get people to follow that?
(c) Interest in scientific evidence does not necessarily influence dietary behaviour	Consumers are most likely to seek information from social media or social networks	P41: ‘we probably get most of our advice through social circles…. In terms of guidelines, I am aware that there are ones around, but it doesn't seem to get to front of mind in terms of the decision making process’
		P33: ‘I look everything up on the internet. Doctor Google's great, isn't it?’
	Requirements for adherence to dietary recommendations differ amongst participants	P32: ‘I need it to come from professional. If I want information, I would seek a nutritionist or doctor. I'm not gonna take the word of an Instagram or youtuber or Wikipedia article’
		P33: ‘I tend to read all those recommendations and think, yep, that's great. But I go what works for me, if everything's working fine and I feel good, I just run with that’
	Scepticism of evidence behind recommendations	P3: ‘I do think that's the problem with a lot of the government stuff. It's so behind, like the way that we look at food and our health has changed a lot in the last 5 years, but I don't really feel like a lot of the government sources have updated to acknowledge those things’
		P38: ‘I'm a bit sceptical about some of the stuff in government publications just because of some of the reading I've done. I feel the food producers are involved in some of the advice’
		P29: ‘I think of gut health, and I think that's clever marketing, you've turned this, this fizzy drink into being healthy. Regardless of whether it's actually good for you or not gut health, gut health has strayed into the buzzword category’
(d) Gastrointestinal symptoms influence dietary behaviour		P23: ‘I'm pretty confident that if I went to my doctor, they want to know, specifically what the problem is. And if I don't have a specific problem, then it sounds a bit … self‐absorbed, because, to me, it seems like it's fairly resource intensive’
		P13: ‘I think I would have to be motivated by a problem to make me change. So, if research came out that said you'd have to definitely have this to solve the problem you've got. I would probably lean that way but if I didn't think I had a problem I probably wouldn't be swayed by advertising or research or something’

Abbreviations: FSANZ, Food Standards Australia and New Zealand; IBS, irritable bowel syndrome.

^a Thirty‐eight consumers were recruited to focus groups investigating consumer perceptions toward gut health. Inclusion criteria were adults >18 years, without formal medical, microbiology, nutrition training, no further exclusion criteria.

Consumers equated the term ‘gut health’ with ‘wellbeing’ and overall health, associating gut health with mental health, cognition, immune and bowel health. Consumers generally evaluated their ‘gut health’ based on gastrointestinal symptoms such as abdominal pain and bowel regularity; however, noted broad influences on this such as sleep, mental health, physical activity and stress. For example, participants reported less gastrointestinal symptoms with lower levels of stress and associated this with ‘good gut health’. The direction of this relationship, namely whether reduced stress improved ‘gut health’ or vice versa was unclear to participants.

All participants were aware of gastrointestinal bacteria, however, the extent of this knowledge was varied. Participants who had a greater understanding of the role of gastrointestinal bacteria reported an awareness of ‘good versus bad’ bacteria and a perceived importance of ‘bacterial diversity’. These participants were more likely to associate broad health outcomes or ‘wellbeing’ with gastrointestinal bacteria while individuals who had limited knowledge beyond the existence of gastrointestinal bacteria, reported not considering the role of these in ‘gut health’ including gastrointestinal function. Despite this varied awareness and perceived importance, understanding of the function and health implications of gut bacteria was limited across most of the consumer group with few participants aware of the role of bacteria in maintaining the gastrointestinal environment and digestive processes.

The second theme identified that consumers have divergent views regarding how diet influences gut health. All consumers regarded diet as being the most influential modifiable factor on gut health. However, participants who reported awareness of the role of the gastrointestinal bacteria in health outcomes were more likely to attribute those health benefits to fermented foods or probiotic supplements, rather than prebiotic‐rich foods recommended by national dietary guidelines such as wholegrains, fruits and vegetables. Participants were generally unaware of gut health implications of prebiotic‐rich foods as they reported observing less microbiome‐specific claims about these foods. Instead, prebiotic‐containing foods including fermentable carbohydrates were more commonly associated with causing gut symptoms and therefore considered detrimental to gut health. Dietary choices listed by consumers are presented in online supplementary materials (Table S1).

Alternatively, participants who reported a limited awareness of the relationship between health outcomes and gut bacteria, listed high‐fibre foods such as cereals, vegetables and legumes as being beneficial to ‘gut health’ as these were associated with digestive functioning rather than microbiome‐related outcomes. Foods considered beneficial or detrimental to gut health were explored further with probiotic or fermented foods most frequently associated with ‘bettering’ gut health, and discretionary foods (foods not considered necessary for health) associated with worsening gut health. Foods recommended in the Australian Dietary Guidelines ¹² were less frequently mentioned (Table S1).

The next theme identified that interest in scientific evidence does not necessarily influence dietary behaviour. While most consumers reported an interest in the evidence surrounding gut health and dietary influences, this did not always determine health behaviours in this area. An example of this was demonstrated by the gut health information sources identified by those participants citing a desire to understand the evidence, however who turned to social media, social circles, podcasts, radio or books for information. Participants who had not actively sought information regarding this topic reported coming across this information in television, social and print media advertisements, primarily for probiotic supplements, as well as food labels. These consumers still reported an interest in whether these claims are supported by scientific evidence however this was often driven by financial concerns such as not wanting to spend money on a product that would not work. Interestingly, despite reported interest in scientific evidence, some participants reported that regardless of this evidence, when making dietary choices they prefer to ‘go with what they know’ namely, personal experimentation and experiences.

A disconnect between interest in evidence bases and actual behaviours was again evident regarding interest in individuals making health claims in this area. Despite participants' reported reliance on internet or word‐of‐mouth sourced information, participants also reported considering the qualifications of individuals making claims in this area and actively seeking information regarding this. Doctors, dietitians, nutritionists, and general scientists were considered trustworthy sources however the role of a health professional in gut health was considered unclear.

Food label ‘gut health’ claims were another area in which a misalignment between evidence and behaviour was evident. Some participants reported label claims increased their likelihood of purchasing that product and increased their faith in a product's health benefits. This was especially evident with fermented or probiotic foods such as kombucha, kefir and Yakult. Others, however, saw product health claims as ‘marketing’ and a deterrent to purchasing. Few participants reported they would ‘fact check’ a label's health claim. Generally, health claims on labels were considered confusing and were noted to only be considered if health concerns were present.

The evidence‐based Australian Dietary Guidelines, ¹² and potential for specific gut health related guidelines within these, was discussed with participants in order to inform translational opportunities. While most consumers were interested in the Australian Dietary Guidelines, ¹² and thought gut health‐specific recommendations should be incorporated within the current guidelines, a divergent viewpoint was evident with some participants reporting scepticism as a barrier to following current and future national dietary guidelines. This was attributed to confusion related to mixed messaging, distrust in scientific reporting (including bias in research), and a perception that government advice is outdated and influenced by commercial interests. Interestingly, these consumers reported confidence and trust in recommendations regarding dietary fibre intake, despite acknowledging limited understanding of specific health benefits. Participants identified this as a message provided by parents or school curriculums, that is, bodies with no commercial interest.

Participants that did report a role for gut health‐specific guidelines within national recommendations suggested modifications including the addition of fermented foods, reducing dairy and meat intake, and emphasising plant‐based, diverse and ‘whole food’ diets. Concerns regarding the blanket approach of population‐based guidelines given the individualised nature of gut health were noted, as well as concerns that highlighting one food group may displace others, reducing dietary balance. Participants suggested transparent references and an awareness that the recommending body was independent would improve their confidence in forthcoming recommendations. Consumers identified practical ‘food based’ guidelines improve adherence. Participants also indicated a desire to understand the physiological processes behind dietary recommendations.

The final theme identified that gastrointestinal symptoms influence dietary behaviour related to diet and ‘gut health’. Consumers reported the likelihood of making changes related to gut health was driven by curative, rather than preventative, health outcomes. Generally, individuals reported an increased likelihood to adopt changes if they considered their gut to be ‘unhealthy’. This was associated with limited awareness regarding the role of gut health in preventative health, such as influences on non‐communicable disease risk, which is a focus of dietary guidelines.

Individuals expressed uncertainty as to how to evaluate their gut health, with most assuming this would be based on bowel patterns. When questioned regarding how gut bacteria specifically could be assessed, most participants were unsure, however suggestions included colonoscopies, stool samples, hydrogen breath tests, and faecal transplant procedures. Most participants associated these with gastrointestinal conditions such as coeliac disease and did not consider bacterial profiling to be relevant for asymptomatic healthy individuals. A broader understanding of the role of gut bacteria was identified by a small number of participants who suggested that assessing gut health would incorporate external factors such as anthropometric measures, dietary intake, stress, and exercise.

4. DISCUSSION

This research aimed to explore consumer perceptions regarding dietary behaviours related to gut health in order to investigate what is required for effective evidence translation to enable behaviour change. While extensive research is available regarding mechanisms related to gut health, diet and health outcomes, ¹⁷ , ³⁸ , ³⁹ to the best of our knowledge, limited research has explored consumer perceptions regarding this relationship. This research identified consumer interest in gut health and recognised areas of focus for translational science in this area. This may direct future research and ensure the translation of outcomes allows for effective adoption.

Recent research exploring Australian adults' awareness of gut health found 66% of participants were able to define the term ‘gut flora’. ⁴⁰ Likewise, participants in our research indicated awareness of gastrointestinal microbes however most were unable to describe specific health effects despite recognising relationships between the microbiome and overall health. The direction of this relationship as to whether the microbiome influences health outcomes or vice versa, was uncertain amongst consumers. This is perhaps unsurprising as while consumer awareness of the multifactorial nature of gut health aligns with current research interests, scientific evidence regarding these mechanisms remains unclear. Recent research highlighted the complexities of microbiome research with >1500 significant associations found between microbiome‐related outcomes and host factors such as diet, medications and disease. ⁸ While the interplay of these factors remains uncertain to researchers, evidence translation to inform consumer advice is limited.

Despite an awareness of the multifactorial nature of gut health, consumers regarded diet as the primary modifiable influence on the microbiome with fermented and probiotic‐rich foods most frequently noted as beneficial. Similarly, the aforementioned research amongst Australian adults found a large proportion of participants (76%) reported knowledge regarding the term ‘probiotics’ ⁴⁰ while only a third were aware of the term ‘prebiotics’. Prebiotics are understood to benefit host health with advantages including convenience, low cost, and familiarity given their availability within well‐known whole foods ⁴¹ , ⁴² , ⁴³ and therefore promotion of these is warranted.

Consumers considered prebiotic and fibre‐rich foods such as fruits, vegetables and whole grains to be integral to a ‘healthy’ diet however this was not necessarily attributed to microbiome‐mediated outcomes. Despite consumers' reported ‘confidence’ in dietary fibre recommendations, this is not evident in national dietary intake data which indicates less than 30% of Australian adults meet recommendations for fibre intake. ⁴⁴ Dietary fibre is accepted to beneficially modulate the gut microbiome and improve host health. ¹⁸ Consumer interest in gut health may present an opportunity to link what consumers already know about fibre with a ‘gut health’ focus in order to promote high fibre and prebiotic‐rich foods currently recommended in national dietary guidelines. This is important given the aforementioned limited consumer understanding of prebiotics, despite being an area with substantial translatable evidence. ⁴² , ⁴⁵

Our research identified that consumers obtain information pertaining to gut health from social media and social circles. This is an important consideration in order to guide focus areas for nutrition communication given consumers reported a preference for obtaining dietary advice from these platforms rather than government publications. While there are concerns regarding the spread of inaccuracies through online communication platforms, they have been identified to be useful for the dissemination of information in a timely, engaging, and cost‐effective manner. ⁴⁶ A consumer criticism of current recommendations was the notion that these are outdated. Given the last Australian Dietary Guidelines ¹² were released in 2013, it is valid to consider that, particularly in an area such as gut health which has grown rapidly over the past decade, the rigorous effort required to produce a body of work such as the Australian Dietary Guidelines ¹² may limit its ability to remain contemporaneous. In contrast, numerous sources on the internet, of differing levels of credibility, may provide recommendations in this area, with immediacy, prior to official health bodies. ²⁴ Marcon et al ²⁴ reviewed information regarding ‘gut health’ in popular press and found information published on these platforms often overhyped current understandings of the microbiome with limited communication or evaluation of the scientific evidence behind these declarations. ²⁴ Our participants reported interest in understanding the reasoning behind health recommendations and requested practical advice for incorporating recommendations into habitual diets. This presents an opportunity for scientific researchers to utilise information sources identified in this research to engage with consumers and ensure evidence‐based and balanced recommendations regarding gut microbiome science are accessible. Tools such as social media enable the use of engaging graphics, videos and discussion to provide diet‐disease education, recipe ideas, and cooking tips in an easy‐to‐follow way. Additionally, the engagement of health professionals to provide these messages on these platforms has been considered effective in publicising trustworthy messages. ⁴⁷ The ability of social media platforms to allow for the ‘sharing’ of information enables conversation amongst peers and increases visibility of health advice, potentially improving the dissemination of information. ⁴⁷ , ⁴⁸ , ⁴⁹

Consumers noted concerns with the commercialisation of food products and questioned the independence of health recommendations behind food labelling with mixed messages across food labels, advertising, and government platforms leading to confusion regarding food selection. The role of food industry has been a longstanding concern within the nutrition space, with a cautious balance between the need to involve industry in conversations regarding population nutrition to affect food supply while remaining independent, to ensure recommendations solely benefit health. ⁵⁰ , ⁵¹ , ⁵² Food Standards Australia and New Zealand has standards to regulate the use of health claims on food labels. Health claims must be supported by rigorous scientific literature ⁵³ with the enforcement of these standards regulated by state and territory governments. In terms of gut health, Food Standards Australia and New Zealand allows general health claims on products containing prebiotics and probiotics; however, specific quantities and health effects are not identified. ⁵³ Few consumers were aware of any regulation regarding food label claims. An increased awareness regarding these regulatory requirements may reduce confusion associated with choosing supermarket products. Additionally, further responsibility by food companies to ensure packaging claims are clear and provide practical advice for health benefits, for example, ‘one serving (1/2 cup) of this product provides “x” required for “y”’ may assist consumer choices. It is unlikely that effective change regarding consumer food choices will occur without industry engagement. It is likely that change to improve consumer trust in health recommendations, and relevant food reformulation, will require sustained and rigorous policy‐based regulation and incentives between governments, health bodies and food industry alongside a transparent and unified focus on improving population health. ⁵¹ , ⁵²

Despite associating ‘gut health’ with ‘overall health’, consumers reported they would not seek gut health‐related advice unless they had specific symptoms. This focus on curative rather than preventative health behaviours is recognised as a barrier to the implementation of health promotion strategies despite preventative approaches often being the focus of health professional practice and dietary guidelines. ⁵⁴ Interestingly, our participants stated they valued evidence‐based advice, yet listed a range of reasons and influences why they would ‘do what works for them’. This is similar to health promotion research identifying the influence of consumers' motivations, knowledge, social circles, and environmental factors on engagement with health recommendations. ⁵⁴ Given the economic and health benefits of preventative health measures when successfully adopted, understanding these influences on individual behavioural change is important when constructing recommendations. Methods such as individual empowerment, tailored communication strategies, mass media campaigns, and health policy have been identified as useful to instigate preventive health practices. ⁵⁴ This highlights the value of investment in education at a population, health professional, and individual level regarding the potential benefits of broad healthy habits in order to improve gut health and subsequently overall health, beyond digestive symptoms.

The qualitative nature of this research allowed for an in‐depth and explorative understanding of consumer perspectives. While efforts were taken to ensure cohort demographics were representative of the general population, overall numbers were small and most participants were young to middle‐aged females with tertiary education, and this may have influenced the apparent familiarity with topic concepts evident in our findings. This may inhibit the applicability of research findings to the broader population and further research using recruitment methods targeted at mixed education levels, may be required. The use of online platforms for this research presents both advantages and disadvantages. Online platforms are increasingly used for qualitative research. Evaluation of these platforms has identified suitable capacity for rapport building between moderator and participants as well as being convenient and user friendly. ⁵⁵ The online format of this research was beneficial in terms of geographical flexibility allowing for recruitment from a range of locations. While data generated from small online focus groups has been considered satisfactory, ³⁰ our focus groups with <3 participants (n = 2 groups) may have been limited in terms of generation of group discussion and interaction between participants. ⁵⁶ This potentially limited data generation given reduced opportunity for presentation of diverse views and ability for participants to build upon these. Additionally, given the use of social networking for recruitment, some participants were familiar with the moderator which may have influenced responses. Attempts to acknowledge this through researcher reflexivity were made.

This research identified that individuals recognise the health of their gut is important however broader education is required to assist in understanding potential health implications including the potential role of the gut microbiome and the multifactorial nature of diet, lifestyle choices, environmental factors, and mental health in shaping the microbiome. This understanding would aim to influence a more proactive approach to making choices to optimise gut health. An important takeaway of this research is the understanding that individuals are aware that a diet in line with current dietary recommendations, focussing on diverse whole foods, is important for overall health. Despite this, a common misconception noted is the attribution of specific health benefits, namely better gut health, to fermented or probiotic foods as opposed to those currently recommended in the national guidelines, indicating a greater need for a broader conceptual understanding of nutrition and food composition. Further education, potentially through the engagement of health professionals and health bodies with social and traditional media platforms, to encourage and explain the importance of these food groups in this area, in ways that are transparent, practical and applicable, may increase intake in line with current recommendations. The perceived importance of gut health and its current ‘trend’ status may allow a useful and timely slant to encourage consumers to align their intake alongside current recommendations, which are currently poorly followed. This is important as current literature regarding diet and gut health, does not differ from longstanding nutrition recommendations and as such connecting new ideas about gut health to established guidelines may improve the sense of credibility in nutrition messages.

AUTHOR CONTRIBUTIONS

Conceptualization, EJB, GMW; methodology, EJB, LCT, GMW; interview moderation, GMW; formal analysis, GMW, EJB; writing—original draft preparation, GMW; writing—review and editing, GMW, EJB, LCT; supervision, EJB, LCT; project administration, GMW. All authors have read and agreed to the published version of the manuscript. All authors declare that the content has not been published elsewhere.

CONFLICT OF INTEREST

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

ETHICS STATEMENT

Ethics was approved by University of Wollongong's Ethics Committee, ETH2020/355.

Supporting information

Appendix S1 Demographic questionnaire.

Appendix S2 Consumer focus group questions.

Table S1 Dietary behaviours identified by focus group participants as influencing ‘gut health’.

Williams GM, Tapsell LC, Beck EJ. Gut health, the microbiome and dietary choices: An exploration of consumer perspectives. Nutrition & Dietetics. 2023;80(1):85‐94. doi: 10.1111/1747-0080.12769

DATA AVAILABILITY STATEMENT

Data is available upon request from the authors.