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

ABSTRACT Introduction Microplastics (MPs) have emerged as pervasive environmental contaminants, with growing concerns about their potential health impacts, including neurocognitive effects. In Indonesia, where plastic pollution is severe, no validated tool exists to assess public plastic use patterns and MP awareness in relation to cognitive health. Objective This study aimed to develop and validate a comprehensive questionnaire evaluating plastic consumption behaviors, MP knowledge, attitudes, and their association with cognitive function in Indonesian adults. Material and methods A cross-sectional pilot study was conducted with 30 participants (80% female, mean age 37.4±13.7 years). The questionnaire was developed through literature review, expert consultation, and focus group discussions, covering six domains: demographics, health history, MP knowledge, plastic use behaviors, environmental attitudes, and cognitive screening (AD-8). Validity was assessed using Pearson’s correlation, and reliability was measured via Cronbach’s alpha. Result The questionnaire demonstrated strong validity for knowledge (r=0.379, p=0.039), behavior (r=0.726, p<0.001), and attitude sections (r=0.385, p=0.036), with acceptable reliability (α=0.623). Neurocognitive assessment revealed significantly lower AD-8 scores in participants with cognitive decline (mean=11.14) versus normal cognition (mean=18.03, p=0.038). Key findings included high single-use plastic consumption, limited awareness of MP regulations (70% uninformed), and an attitude-behavior gap in mitigation efforts. Discussion The tool effectively identified MP knowledge gaps and behavioral risks while suggesting a plausible link between plastic exposure and cognitive impairment. The AD-8’s sensitivity and specificity supported its utility for screening, though the modest sample size limited statistical power for correlation analyses. Conclusion This validated questionnaire provides a critical foundation for assessing MP-related cognitive risks in Indonesia. Future studies should expand validation in larger cohorts and investigate causal mechanisms. The findings underscore the need for public education and policy interventions to reduce plastic exposure.