DEVELOPMENT AND VALIDATION OF A QUESTIONNAIRE ASSESSING MICROPLASTICS EXPOSURE, KNOWLEDGE, AND ATTITUDES TOWARD MICROPLASTICS IN RELATION TO COGNITIVE FUNCTION IN INDONESIA

This study successfully developed and validated a comprehensive questionnaire in Indonesia to assess microplastic exposure, knowledge, and attitudes in relation to cognitive function, demonstrating its effectiveness as a tool for evaluating MP-related cognitive risks among Indonesian adults.

The Gist

Imagine your body is a bustling city, and your brain is the city's central command center, managing everything from your memory to your mood. Now, imagine that invisible, tiny plastic shards (microplastics) are like microscopic graffiti tags or dust motes that have started to settle everywhere in this city—in the water, the food, and even the air.

This research paper is essentially the blueprint for a new "City Health Report Card" designed specifically for Indonesia. Here is the story of how they built it and what they found, explained simply:

1. The Problem: The Invisible Guest

We all know plastic is everywhere. But scientists are worried that these tiny plastic fragments are sneaking into our bodies and potentially messing with our brains. The problem? In Indonesia, nobody had a proper tool to ask people, "How much plastic are you using?" and "Do you know how it might hurt your brain?" It was like trying to diagnose a patient without a thermometer or a stethoscope.

2. The Solution: Building the "Plastic & Brain" Questionnaire

The researchers decided to build a custom tool—a questionnaire—to measure three things:

• Exposure: How much plastic are you touching and eating? (Like checking how much dust is on your windowsill).
• Knowledge: Do you actually know what microplastics are? (Do you know they are smaller than a grain of sand?).
• Attitudes: Do you care, and are you willing to change? (Are you the type of person who brings a reusable bag, or do you just grab the plastic one?).

They also included a special section called the AD-8, which is like a "Brain Fitness Test." It's a short, 8-question checklist that helps spot if someone's memory or thinking skills are starting to slip, similar to how a mechanic checks if a car engine is making strange noises.

3. The Test Drive: The Pilot Study

Before rolling this out to the whole country, they took it for a "test drive" with 30 people in Jakarta. Think of this as a soft launch of a new app to see if the buttons work and if people understand the instructions.

What they found:

• The Tool Works: The questionnaire was reliable. It successfully measured what it was supposed to measure, just like a good scale accurately measures weight.
• The Knowledge Gap: Most people had heard of microplastics, but many didn't know the details. It was like knowing "smoke is bad" but not understanding why or how it gets into your lungs.
• The "Say-Do" Gap: Many people said they were worried about plastic and the environment, but their daily habits (like using single-use water bottles every day) didn't match their worries. It's like saying you want to be fit but ordering a large pizza every night.
• The Brain Connection: This is the most interesting part. The study found a link between people who used a lot of single-use plastics and those who showed signs of cognitive decline (trouble with memory or focus). While the study was small and can't prove that plastic caused the brain issues (correlation isn't causation), it's a strong warning sign. It's like noticing that every time the city's air quality drops, more people start coughing.

4. The Verdict: Why This Matters

This paper is a foundation stone. It's the first time Indonesia has a validated tool to connect the dots between plastic pollution and brain health.

• The Good News: We now have a way to measure the problem accurately.
• The Bad News: The problem is real, and people are exposed to a lot of plastic without realizing the potential risks to their minds.
• The Future: The researchers plan to use this tool on thousands of people to get a clearer picture. They want to prove that if we reduce plastic, we might also protect our brains.

The Big Takeaway

Think of this study as the first step in a detective story. The researchers have found a new magnifying glass (the questionnaire) and spotted some suspicious clues (the link between plastic and brain fog). They aren't ready to arrest the "plastic criminal" just yet, but they have enough evidence to tell the city (Indonesia) to start cleaning up its act before the damage gets worse.

In short: We are swimming in plastic, and this study is the first to ask, "Hey, is this plastic fogging up our brains?" The answer so far is a cautious, "Yes, it might be."

Technical Summary

1. Problem Statement

• The Gap: Microplastics (MPs) are pervasive environmental contaminants with emerging evidence of neurotoxicity (oxidative stress, disrupted neurotransmitter function). However, there is no validated instrument in Indonesia to assess MP exposure, public knowledge, and attitudes specifically in relation to cognitive health.
• The Context: Indonesia faces high plastic production and waste issues, with MPs detected in local water sources and consumer products. The lack of a standardized tool hinders the ability to quantify risks and understand the link between plastic consumption patterns and neurocognitive decline in the Indonesian population.
• Objective: To develop, validate, and pilot a comprehensive questionnaire that evaluates MP exposure (via plastic use patterns), knowledge, attitudes, and their association with cognitive function using the AD-8 screening tool.

2. Methodology

• Study Design: Cross-sectional pilot study conducted between March and June 2023 in Jakarta, Indonesia.
• Participants: 30 adults recruited via an online platform (Google Forms).
  • Demographics: Mean age 37.4 ± 13.7 years; 80% female; 80% with low education levels (based on the study's classification); 43.3% unmarried.
• Instrument Development:
  • Process: Literature review $\rightarrow$ Expert consultation (environmental scientists, public health experts) $\rightarrow$ Focus Group Discussions (FGDs) with community representatives.
  • Structure: The final questionnaire comprises six domains:
    1. Demographics & Health History.
    2. Microplastic Knowledge (sources, size, entry routes).
    3. Plastic Use Behaviors (frequency of single-use plastics, disposal methods).
    4. Environmental Attitudes (concern levels, willingness to change).
    5. Awareness of Regulations (e.g., Indonesia's 2030 plastic restrictions).
    6. Cognitive Screening: Integrated the AD-8 (Ascertaining Dementia 8-item) questionnaire, a self-reported tool for memory and executive function decline.
• Statistical Analysis:
  • Validity: Assessed using Pearson's correlation coefficients ($r$) between questionnaire domains and expected outcomes.
  • Reliability: Measured using Cronbach's alpha ($\alpha$) for internal consistency.
  • Associations: Spearman correlation and Mann-Whitney U tests were used to analyze relationships between plastic use, cognitive scores, and confounding variables (age, gender, education).
  • Software: SPSS version 28.0.

3. Key Contributions

• First Validated Instrument: This study presents the first validated questionnaire in Indonesia specifically designed to link microplastic exposure patterns with cognitive function.
• Integrated Approach: It uniquely combines behavioral assessment (plastic use), psychometric assessment (knowledge/attitudes), and clinical screening (AD-8) into a single tool.
• Policy-Relevant Data: The tool identifies specific gaps in public knowledge (e.g., misconceptions about MP size) and awareness of regulations (e.g., the 2030 ban), providing actionable data for public health interventions.

4. Key Results

• Validity: The questionnaire demonstrated strong validity in three key domains:
  • Plastic Use Patterns (Exposure): $r = 0.726$ ($p < 0.001$).
  • Knowledge: $r = 0.379$ ($p = 0.039$).
  • Attitudes: $r = 0.385$ ($p = 0.036$).
  • Note: Awareness of regulations showed borderline significance ($r = 0.485, p = 0.07$).
• Reliability: The overall internal consistency was acceptable with a Cronbach's alpha of 0.623 across the four main sections.
• Cognitive Findings:
  • Group Differences: Participants with cognitive decline (identified via AD-8) had significantly lower scores compared to those with normal cognition ($p = 0.038$). The mean score for the decline group was 11.14, versus 18.03 for the normal group.
  • Correlation: A moderate inverse relationship was observed between the frequency of plastic use and cognitive performance ($r = -0.323$), though this did not reach statistical significance ($p = 0.081$), likely due to the small sample size.
• Behavioral Insights:
  • High consumption of single-use plastics (bottled water, packaged food) was prevalent.
  • A significant "attitude-behavior gap" exists: while most participants expressed concern about health risks, few had changed their behaviors.
  • Knowledge Gaps: Many participants incorrectly believed microplastics were visible to the naked eye (1–5 cm) rather than microscopic (<1 mm).
  • Regulatory Awareness: Nearly 70% of participants were unaware of Indonesia's 2030 single-use plastic restrictions.

5. Significance and Limitations

• Significance:
  • The study provides a crucial, validated tool for future epidemiological research in Indonesia to monitor the neurocognitive impacts of environmental pollution.
  • It highlights an urgent need for public education campaigns targeting specific misconceptions about MPs and the implementation of stricter waste management policies.
  • The findings suggest a potential link between high plastic exposure and cognitive impairment, warranting further large-scale investigation.
• Limitations:
  • Sample Size: The pilot study involved only 30 participants, limiting statistical power and generalizability.
  • Study Design: The cross-sectional nature prevents the establishment of causal relationships between MP exposure and cognitive decline.
  • Self-Reporting: Reliance on self-reported plastic consumption introduces potential recall bias.
  • Reliability Score: While acceptable, the Cronbach's alpha (0.623) suggests the instrument requires further refinement and testing in a larger, more diverse population.

Conclusion: The authors successfully developed a preliminary but effective instrument for assessing the intersection of microplastic exposure and cognitive health in Indonesia. The study underscores the necessity of integrating environmental health assessments with neurocognitive screening to guide future public health policies and research.