This descriptive cross-sectional study was conducted at Gaziantep University Şahinbey Research and Training Hospital, a prominent tertiary care institution serving the southeastern region of Turkey. The hospital was selected as the study site due to its extensive clinical services, diverse medical workforce, and patient demographics that accurately represent the broader Turkish healthcare system.

Target Population: The study population comprised medical personnel at the research site, including physicians, nurses, midwives, and health technicians from various clinical departments.

Sample Size Calculation: Due to the absence of prior data regarding bisphenol awareness in this population, the sample size was determined using the formula for cross-sectional studies, incorporating a 95% confidence level, a 5% margin of error, and an assumed population proportion of 50%. The estimated minimum sample size was 325 participants.

Recruitment Strategy: Participants were selected from various hospital departments during regular business hours utilizing a convenience sampling method. The sample size was increased to 400 participants to mitigate potential non-response and ensure adequate representation across professional categories; ultimately, 397 participants completed the test.

Various approaches were employed to mitigate bias and uphold methodological rigor. Participants were recruited from various major hospital departments to ensure a diverse clinical and professional composition. Due to the absence of rewards or penalties, participation was entirely voluntary, thereby minimizing external selection bias.

The principal investigator received training in neutral interviewing techniques, which encompassed standardizing participant questions and clarifications, refraining from verbal or nonverbal cues that could suggest preferred responses, and sustaining a consistent tone and tempo throughout the process. The absence of “right” or “wrong” answers, assurance of anonymity and confidentiality, clarification that responses would not influence professional evaluations, and the conduct of interviews in private collectively mitigated social desirability bias. The questionnaire was designed as a knowledge assessment instead of a competency test to mitigate anxiety and response distortion.

To mitigate the confounding effects of varying data collection methods, all interviews adhered to uniform protocols, question presentation, and environmental conditions. The data collection process was finalized within 5 months to minimize external influences and the impact of evolving knowledge on the results.

The research data were analyzed utilizing the Statistical Package for Social Sciences (SPSS) version 25.0. Continuous variables were summarized using the mean (x̄) and standard deviation (SD), while categorical variables were summarized with frequency (n) and percentage (%) values. An Independent Samples t-Test was employed to compare two independent groups (e.g., gender: female and male). One-Way Analysis of Variance (One-Way ANOVA) was utilized for variables including three or more groups (e.g., income level: low, medium, high). In instances where normal distribution was present but variances were not homogeneously distributed, the Welch ANOVA test was utilized (17–19). Post-hoc multiple comparison tests, including Bonferroni and Games-Howell, were employed to identify the cause of differences across the groups; disparities were denoted by the numerals “1-2-3-4” and the “>” (greater than) sign. The Chi-square test was employed to investigate the association between categorical variables, while Spearman correlation analysis was utilized to assess the link between ordinal or non-normally distributed data. Furthermore, CHAID (Chi-squared Automatic Interaction Detection) decision tree analysis was used to identify the factors influencing healthcare professionals’ understanding of bisphenol. In all statistical analyses, the significance threshold was established at p < 0.05.

A total of 397 medical professionals from diverse clinical specialties and varying levels of experience participated in this cross-sectional survey. The participants had a mean age of 31.34 ± 6.02 years, with an age range of 21 to 56 years, indicating a relatively young professional workforce consistent with the recent expansion of Turkey’s healthcare system. The sample consisted of 220 female participants (55.4%) and 177 male participants (44.6%), reflecting the typical gender distribution observed in Turkish healthcare facilities, where women are predominantly found in medical and technical roles, as well as in nursing and midwifery.

The educational backgrounds of participants varied considerably: 32 (8.1%) had completed only high school, 94 (23.7%) held associate degrees, 216 (54.4%) possessed bachelor’s degrees, and 55 (13.9%) had attended graduate school. This distribution reflects the diverse educational pathways present in Turkish healthcare professions. The sample comprised 126 doctors (31.7%), 116 nurses (20.2%), 30 midwives (7.6%), and 125 health technicians (31.5%). The relatively low number of midwives in the Turkish healthcare system reflects the specialized nature of the profession.

The distribution of experience levels is outlined below: Among the participants, 169 (42.6%) had 0–5 years of experience, 139 (35.0%) had 6–10 years, 51 (12.8%) had 11–15 years, and 38 (9.6%) had 16 years or more. The distribution indicates a strong representation of both experienced and early-career professionals within the workforce. To ensure balanced representation across marital status categories for comparative analysis, 232 participants (58.4%) were married, while 165 participants (41.6%) were single. A total of 157 participants (39.5%) reported low incomes, 221 participants (55.7%) reported medium incomes, and 19 participants (4.8%) reported high incomes. The prevalence of low-to-medium income groups reflects prevailing compensation trends within the Turkish public health care system.

A total of 94 participants (23.7%) reported prior knowledge of bisphenol chemicals, while 233 participants (58.7%) indicated they were unaware, and 70 participants (17.6%) stated they had no knowledge of them. This baseline result highlighted substantial knowledge gaps requiring thorough investigation. The detailed distribution of these findings is presented in Table 1.

The 13-item Bisphenol Knowledge Assessment revealed significant knowledge gaps among the research participants. The mean score for each item was 0.30 ± 0.27 (range 0–1), indicating that, on average, respondents answered less than one-third of the knowledge evaluation items correctly. The mean score for knowledge was 3.90 ± 3.48 out of a maximum of 13 points (range: 0–12), with a median score of 3.0 points (IQR: 1–7). The central tendency analysis indicates that 50% of test participants scored 3 points or fewer, reflecting an accuracy rate of less than 25%.

An analysis of the score distribution revealed that 89 participants (22.4%) scored between 0 and 1 points, 127 participants (32.0%) scored between 2 and 4 points, 112 participants (28.2%) scored between 5 and 7 points, and only 69 participants (17.4%) scored 8 or higher. The distribution indicates that the entire study population exhibited a deficiency in information, rather than specific subgroups alone.

According to the established criterion of ≥8 correct answers (≥60% accuracy) for determining adequate knowledge, 328 individuals (82.6%) demonstrated insufficient knowledge regarding bisphenol, whereas only 69 participants (17.4%) exhibited sufficient knowledge levels. The result was, indicating a substantial lack of knowledge among healthcare professionals regarding this matter. The 82.6% rate of insufficient knowledge is a significant finding that impacts patient safety, workplace health protection, and the healthcare system’s capacity to educate the public about health. The detailed distribution of these findings is presented in Table 2.

The mean knowledge score for women was 3.82 ± 3.54, while for men it was 4.01 ± 3.42. The independent samples t-test indicated no statistically significant difference between men and women (t = −0.533, p = 0.594; Table 3). This indicates that male and female healthcare workers exhibited equivalent knowledge gaps. The proportions of acceptable knowledge were comparable for both genders. 18.2% of women and 16.4% of men achieved scores that met the criteria (χ² = 0.113, p = 0.736; Table 4).

Married individuals demonstrated significantly higher scores on knowledge assessments compared to their single counterparts (4.26 ± 3.57 vs. 3.39 ± 3.30, t = 2.467, p = 0.014; Table 3). The 0.87-point difference represents a statistically significant and potentially clinically relevant enhancement in knowledge performance. The proportion of individuals possessing sufficient knowledge varied according to marital status. For instance, 20.7% of married individuals possessed sufficient knowledge, while only 12.7% of unmarried individuals did. The observed difference approached statistical significance (χ² = 3.721, p = 0.054; Table 4). The relationship between marital status and knowledge levels may be attributed to several factors, including increased life experience, heightened health consciousness due to familial responsibilities, or greater access to health-related information via spousal networks.

Significant differences in knowledge ratings were observed among various professional categories (F = 3.231, p = 0.022). The average score for doctors was the highest at 4.64 ± 3.61, followed by health technicians at 3.75 ± 3.26, midwives at 3.77 ± 3.19, and nurses at 3.29 ± 3.54 Bonferroni post hoc testing indicated that physicians had significantly higher scores than nurses (mean difference = 1.35, p = 0.015; Table 3). No statistically significant differences were observed in other pairwise comparisons. The knowledge adequacy rates varied among professions: 21.4% for doctors, 16.7% for midwives, 13.6% for health technicians, and 17.2% for nurses. However, these differences were not statistically significant (χ² = 2.694, p = 0.441; Table 4). Doctors may outperform other healthcare professionals due to their extensive training in pathophysiology and toxicology. This indicates that educational interventions must be customized to align with the distinct educational backgrounds and clinical duties of various healthcare professional groups.

Significant disparities in knowledge ratings were observed among groups with varying levels of experience (Welch F = 3.116, p = 0.029). Healthcare workers with 6–10 years of experience demonstrated significantly higher scores compared to those with 0–5 years of experience (4.29 ± 3.48 vs. 3.30 ± 3.15, p = 0.049 in post hoc analysis). The mean knowledge scores corresponding to various experience levels were as follows: 0–5 years (3.30 ± 3.15), 6–10 years (4.29 ± 3.48), 11–15 years (4.33 ± 3.53), and 16 + years (4.61 ± 4.41; Table 3). The data indicates that individuals acquire the majority of their knowledge during the early to mid-stages of their careers, after which their learning tends to decline significantly. As professionals accumulated experience, their knowledge adequacy rates increased: 0–5 years (11.2%), 6–10 years (20.9%), 11–15 years (19.6%), and 16 years or more (28.9%). The observed change was statistically significant (χ² = 9.325, p = 0.025), indicating that engagement in a professional environment enhances knowledge of environmental health (Table 4).

Spearman correlation analysis revealed a statistically significant positive correlation between age and bisphenol knowledge scores (rho = 0.133, p = 0.008; Table 3). This association is considered weak; however, it indicates that knowledge levels generally increase with age. This may be attributed to the accumulation of life experiences and professional development over time.

The duration of professional experience emerged as the most significant demographic factor influencing knowledge adequacy. Chi-square analysis indicated significant associations between experience levels and knowledge adequacy (χ² = 9.325, p = 0.025). The lowest adequacy percentage recorded was 11.2% (19 out of 169) for healthcare workers with 0–5 years of experience. The highest rate, 28.9% (11 of 38), was observed among individuals with 16 or more years of experience. The middle groups included individuals with 6–10 years (29 out of 139, 20.9%) and 11–15 years (10 out of 51, 19.6%; Table 4). The findings indicate that current basic professional education programs inadequately prepare healthcare personnel for environmental health challenges. They primarily acquire knowledge through professional experience and ongoing educational opportunities.

The association between marital status and knowledge adequacy approaches statistical significance (χ² = 3.721, p = 0.054). Married individuals demonstrated a higher likelihood of being adequate (48 out of 232, or 20.7%) compared to single individuals (21 out of 165, or 12.7%; Table 4). The trend can be attributed to several factors: individuals may exhibit increased health awareness due to family responsibilities, receive health information through spouses and family networks, seek knowledge to safeguard their families, or simply reflect the demographic tendency of married individuals being older.

Spearman correlation analysis indicated that age (rho = 0.113, p = 0.025), professional experience (rho = 0.144, p = 0.004), and marital status (rho = −0.104, p = 0.039, with single status receiving higher scores) significantly influenced bisphenol knowledge levels. Significant correlations existed across demographic characteristics: age and professional experience (rho = 0.774, p < 0.001), age and marriage status (rho = −0.566, p < 0.001), and professional experience and marital status (rho = −0.507, p < 0.001). The correlations indicate that the knowledge acquired in regard to each variable may stem from factors such as maturation or life events, rather than being directly attributable to the variables themselves. A little negative correlation existed between professional title and knowledge scores (rho = −0.082, p = 0.104), although this relationship was not statistically significant. The detailed distribution of these findings is presented in Table 5.

Chi-square Automatic Interaction Detection research revealed that professional experience is the primary predictor of knowledge sufficiency, with the initial division appearing at 6 years of experience. In experience categories, marital status appeared as a secondary predictor, with married persons exhibiting superior knowledge adequacy scores across most experience levels. The professional title appeared as a tertiary predictor in specific specialties, with physicians exhibiting enhanced knowledge adequacy evaluations predominantly among individuals with intermediate levels of professional experience. The analysis revealed subgroups of healthcare professionals at heightened risk for insufficient bisphenol A knowledge: single professionals with 0–5 years of experience (highest risk), married professionals with 0–5 years of experience or single professionals with 6–10 years of experience (medium risk), and married professionals with over 6 years of experience, especially physicians (lower risk).

This comprehensive survey reveals that Turkish healthcare professionals exhibit a significant and pervasive lack of understanding on bisphenol, with 82.6% of participants indicating insufficient knowledge about these prevalent environmental pollutants. This is a significant deficiency in knowledge identified in the study on healthcare workers’ environmental health literacy. It significantly impacts patient safety, workplace health safeguards, and the effectiveness of public health education. Our findings align with and expand upon previous global research. Rouillon et al. (2017) reported that 54.3% of French healthcare professionals were unaware of endocrine-disrupting medicines, and 68.8% lacked knowledge regarding their health impacts (14). Our poll focused just on bisphenols; yet, the revelation that 76.3% of participants were unaware of what bisphenols are indicates that the populace in Türkiye may possess less knowledge about them compared to those in Western European healthcare systems.

The deficiencies in knowledge that were identified have an immediate impact on patient care. Healthcare professionals who lack sufficient knowledge regarding bisphenol are unlikely to be able to offer patients sound advice on how to minimize their exposure, identify situations in which they are at a high risk of exposure, or identify potential health issues associated with bisphenol in clinical settings. Bisphenols were unfamiliar to only 23.7% of healthcare professionals. This demonstrates that there is a fundamental lack of awareness regarding these chemicals as health-relevant environmental variables, rather than merely specific knowledge deficits. The findings of Kumar et al. are consistent with this lack of baseline understanding: dental surgeons in Southern India possessed inadequate knowledge regarding BPA, despite their involvement with products that contained it (15).

The lack of comprehension is particularly concerning due to the numerous sources of BPA in healthcare environments, including medical devices, laboratory apparatus, and patient care items. Li et al. discovered that healthcare personnel had elevated levels of BPA in their urine, indicating that the hazards of occupational exposure are significant and potentially greater than those in other professional settings (25). The healthcare professionals’ lack of knowledge regarding these sources of exposure poses a significant danger to their safety while on the job.

The discovery that professional experience is the most reliable predictor of bisphenol knowledge (rho = 0.144, p = 0.004) provides critical insights into the process by which healthcare professionals acquire new knowledge. Healthcare personnel with 6 to 10 years of experience possessed significantly more knowledge than those with 0 to 5 years of experience (4.29 ± 3.48 vs. 3.30 ± 3.15, p = 0.049). This finding implies that healthcare workers are not adequately prepared for environmental health challenges by their initial professional education programs, as knowledge development is predominantly achieved through accrued professional experience and continuing education opportunities. Marguillier et al. discovered comparable outcomes when they examined French perinatal health professionals. They stated that environmental health competency necessitates enhanced training throughout the course of professional development (16). The plateau effect observed in knowledge scores of professionals with over a decade of experience suggests that the current methods of continuing education may not be adequately accommodating the requirements of professionals who require additional education in environmental health.

Physicians demonstrated a significantly greater comprehension of bisphenol than nurses (4.64 ± 3.61 vs. 3.29 ± 3.54, p = 0.015). Nevertheless, only 21.4% of physicians possessed sufficient expertise, indicating that healthcare professionals of all backgrounds have knowledge deficits. The physicians’ superior performance is likely attributable to their increased exposure to pathophysiology, pharmacology, and toxicology during their medical school years. Nurses, midwives, and health technicians are particularly concerned about their decreased knowledge ratings, as they spend a significant amount of time with patients, which is an ideal opportunity for health education and risk counseling. Similar trends were identified in Asian healthcare systems by Zhang et al. They emphasized the necessity of nurses receiving specialized training in environmental health due to their significant role in coordinating patient care and educating patients (17).

The unexpected but potentially critical discovery is the robust correlation between marital status and bisphenol knowledge (4.26 ± 3.57 for married individuals vs. 3.39 ± 3.30 for single participants, p = 0.014). The impact of marital status on health may be attributed to a greater awareness of health issues that is associated with having a family, increased access to health information through family social networks, a stronger desire to learn about environmental health due to concerns about protecting children, or a connection to age and maturity factors that aid in learning and memory capacity.

Healthcare professionals are at an elevated risk of exposure to bisphenol due to their involvement in the handling of medical devices, laboratory apparatus, and patient care materials. The following are all prevalent sources of BPA in healthcare settings: intravenous tubing and connections, medical device housings, laboratory equipment and containers, dentistry materials and instruments, incubators and warming devices, and food service materials. Healthcare professionals are incapable of taking the appropriate precautions to safeguard themselves due to their inadequate comprehension of these sources of exposure.

Healthcare personnel may lack sufficient knowledge regarding bisphenol to prevent patients from being exposed to it when they select and employ medical equipment and materials. Sirasanagandla et al. emphasized the necessity for healthcare professionals to be informed about the risks associated with prenatal BPA exposure in order to protect vulnerable populations, particularly due to the potential impact of the chemical on cardiac development (7). Extra protection from bisphenol exposure is necessary for certain patient categories, including expectant women and developing fetuses, preterm infants and neonates, patients with endocrine problems, individuals with cardiovascular illness, and patients who require extensive medical device assistance.

The identified knowledge gaps indicate that healthcare professional curricula must be revised to incorporate environmental health competencies. Brown et al. examined the comprehension of environmental health among Spanish nurses and emphasized the necessity of incorporating environmental health into the curriculum to enhance competence in this area (18). Educational interventions must encompass fundamental skills such as identifying health risks, safeguarding vulnerable populations, effectively communicating risks, and ensuring workplace safety.

Professional experience serves as a significant predictor of knowledge, indicating that continuing education programs ought to be tailored for individuals at various career stages and in diverse roles. Novice professionals must acquire foundational knowledge in environmental health, whereas experienced individuals should remain informed about recent research and evolving risk assessment methodologies. The variation in knowledge among various professional groups indicates that interprofessional education programs could enhance knowledge consistency and promote collaboration on environmental health issues.

Successful educational interventions require institutional commitment. This entails integrating environmental health topics into mandatory continuing education, developing clinical practice guidelines for environmental health, offering educational resources and decision support tools at the point of care, and establishing consultation services for complex cases. Contemporary educational technologies facilitate the dissemination of knowledge regarding environmental health through various means, including online learning modules featuring interactive case studies, mobile applications providing information at the point of care, virtual reality simulations for training in exposure assessment, and social media platforms for knowledge sharing and updates.

The lack of knowledge among healthcare professionals regarding certain topics indicates that national health policies should prioritize education on environmental health and enhance professional competency. Rai et al. identified similar deficiencies in the knowledge of occupational health among Turkish healthcare professionals, indicating the necessity for systematic policy reforms (20). Healthcare professionals’ licensing and continuing education requirements ought to incorporate competencies in environmental health. This ensures that all healthcare professionals remain informed about the risks and protective strategies associated with environmental health.

Healthcare facilities must establish comprehensive environmental health policies that address staff training and education, assessment of environmental health risks, patient education and counseling, monitoring and protection of workers from exposure, and procurement of products that are safer than those containing BPA. Environmental health education for healthcare professionals must be integrated into broader public health initiatives to enable healthcare personnel to serve effectively as community environmental health educators and advocates.