Public opinions and knowledge about microorganisms

ABSTRACT

Background

The microbiology should be a part of curricula; especially after epidemic COVID-19.

Purpose

The study reports the level of knowledge and opinions of Slovenian citizens about microorganisms.

Sample

The target population of the online survey was Slovenian citizens older than 14 years.

Design and methods

We collected 405 complete surveys, which structured with 47 knowledge items and 18 opinion items about microorganisms.

Results

We found a lack of knowledge among citizens and corresponding misconceptions about microorganisms. There were no statistically significant differences in citizens’ knowledge by age and gender, but citizens with higher educational attainment had better knowledge scores. Participants equate the terms virus, bacteria and microorganisms, an error that can lead to misconceptions. We found that between 15.0 and 20.0% of citizens experience fear of microorganisms. Regarding gender, age and degree level, there were statistically significant differences in participants’ opinions about microorganisms. 45.5% of the participants agreed that the topic of microorganisms is underrepresented in school. This is probably the reason why 44.2% of the participants are not interested in microbiology, although 74.6% are aware that knowledge about microorganisms is important and useful.

Conclusion

It would be good to strengthen the content and ways of working in the education system, because in case of a pandemic like SARS-CoV-2 there would be more understanding of what we are dealing with and less fear of the ignorant.

KEYWORDS:

• Bacteria
• opinions about microorganisms
• knowledge about microorganisms
• virus

Introduction

The importance and practical value of science and scientific literacy, particularly in the domains of microbiology and virology, were once again tested at the end of 2019 and in 2020, owing to the COVID-19 outbreak. In biological reality (Feldman Barret 2020), this virus is a tiny entity, invisible to the naked eye, and even unable to reproduce outside the host organism (Coronaviridae Study Group of the International Committee on Taxonomy of Viruses, et al. 2020), but with huge impact on social reality (Feldman Barret 2020), changing basically all aspects of human lives on the personal, social, and societal levels, locally and globally (Fetzel et al., 2020; Van Bavel et al. 2020). While the science community, apart from some eccentrics, follow long-

While the scientific community, aside from a few eccentrics, has followed long-established scientific protocols to explore the biological and social realities of the new virus, recognising that there are still large portions of unknowns and uncertainties (Smith, Blastland, and Munafò 2020), reactions to the outbreak from individuals and communities to superpower countries ranged from outright ignorance to panic, at least in the early stages of the pandemic (e.g. Anttiroiko 2021; Janssen and van der Voort 2020).

The fact that COVID-19 ‘is the third documented spillover of an animal coronavirus to humans in only two decades that has resulted in a major epidemic’ (Coronaviridae Study Group of the International Committee on Taxonomy of Viruses, et al. 2020, 536), allowing measures to control the outbreak to be prepared beforehand, was largely ignored (Xiao and Torok 2020). According to observations and collected evidence, it has become clear that there is a pressing need for intervention to educate people to gain the capacity to prevent damage caused by a virus instantly and to prepare them for possible future outbreaks (Vergara, Sarmiento, and Lagman 2021). However, by the opinion of the authors, knowledge should not be restricted to viruses and health but should extend to other microorganisms and processes in which they are involved overarching topics from their biology and ecology to biotechnology.

According to Heberlein (2012), to fix a problem, one should react on three levels: a) technological (e.g. invention of a vaccine; wearing a mask); b) systemic (e.g. lockdown; fast-tracking the development of a drug or vaccine); and c) cognitive (e.g. knowledge, control of emotions); the last in the interest of study, and as a basis for technological and systemic responses. It is clear that the response of the authorities and public needed to be taken immediately and sometimes without sufficient background knowledge, owing to the unknown properties of each novel agent of disease and its long-term consequences (Smith, Blastland, and Munafò 2020). However, there should be no excuse for failure to apply measures such as hand washing, avoiding close contacts, wearing masks, covering coughs and sneezes, and cleaning and disinfecting, all of which have been familiar measures to prevent the spread of microorganisms for decades (Liao et al. 2021). However, contrary to common-sense logic, we can witness negation and rejection of such measures, even among people with academic titles and positions of power (Ball and Maxmen 2020), showing the failure of previous health education on transmissive diseases caused more or less exclusively by microorganisms. Once again, it has been recognized that information and opinions provided by laypersons and even some scholars should be critically evaluated to allow optimal opportunity for response at the personal, group and global levels. However, to distinguish words of knowledge and sound recommendations from dubious advice and practices and to discriminate between facts and opinion, appropriate knowledge is necessary in order that people fully understand what is dangerous to their wellbeing (Stefanini 1987).

While much information about the new virus SARS-CoV-2 is still missing, it shares common properties and behaviour with other members of the virus group (Kasmi et al. 2020). Setting aside the debate on whether they are living beings (Villarreal and Witzany 2010), they are, for practical reasons, part of Microbiology. If it was not known before, the COVID-19 lockdown and its consequences indicate the importance of appropriate knowledge in the field of microbiology, leading to the conclusion that when such knowledge is important, then it must become part of obligatory curricula and not be left to chance alone (Šorgo and Špernjak 2012). An additional argument for action toward better education on microorganisms are anti-vaccine movements (Dube, Vivion, and MacDonald 2015), and anti GMO groups (Clancy and Clancy 2016). These arguments for inclusion of microbiology in obligatory education can be easily strengthened by reviewing the many sources supporting the conclusion that microbes can be regarded as the most important group of organisms on Earth, not only because of numbers but also because of the services they provide (Cowan et al. 2013; Margulis and Sagan 1997). Therefore, it is necessary for children to be well informed about their characteristics and functions (Byrne 2011), because knowledge about, and opinions and attitudes toward microorganisms can have long-term consequences in adulthood. Many ideas about microorganisms are usually acquired within the family and are not based on scientific information (Byrne and Sharp 2006). Apart from education, advertising and everyday experience exert a major effect on students’ knowledge and attitudes about microorganisms (Byrne and Grace 2010). According to some studies (Carvalho et al. 2004; Carvalho and Clément 2007; Carvalho et al., 2007), non-scientific conceptions are sometimes very persistent, making conceptual change difficult and thus constituting epistemological learning obstacles. The mass media are indicated as the chosen source of information related to microorganisms in the absence of any contribution by Italian schools. A study by Ruiz-Gallardo and Paños (2018) in primary school showed that all student misconceptions about microorganisms are consistent with the Spanish educational standards, in which microbiology plays a secondary role, and no specific reference to microorganisms is included until the final years of education.

Microbiology practice and content vary within curricula. For example, the curricula of various countries are inadequate or completely lacking content on microbiology in the early school years; such countries include Portugal (Mafra, Lima, and Carvalho 2015), India (Vijapurkar and Konde 2014), England (Byrne 2011), Italy (Bandiera 2007), and Germany (Hilge and Kattmann 2003). Bandiera (2007) reviewed the Italian National Curriculum and some of the most common textbooks used by schools in Rome. For the analysis, a total of 502 questionnaires from students aged 11–14 identified and documented student beliefs about microorganisms. The study confirmed that Italian lower secondary education lacked instruction about microorganisms.

The question of what content would be well served in such common curricula for non-specialists is not easy to answer. The problem is not what to include in such curricula and syllabi; because of diversity, the bigger problem is what to exclude, in that one can find microorganisms and evidence of their activities almost everywhere. Without making a list of all the topics that would be good to cover, we would like to mention a few topics about microorganisms that should be part of everyone’s general knowledge. Without doubt, these are health issues because microorganisms, whether good or bad, form the microbiota of the human body, influencing a number of processes affecting humans and their wellbeing (Ley et al. 2005; Wang et al. 2017). One topic not to be missed is their ecosystem role as the primary agents in the decomposition of organic matter, an exclusive microbial process that enables the continuation of life on Earth (Kulasooriya 2019). When biotechnology is concerned, some microorganisms are useful in industry, e.g. the pharmaceutical and nutraceutical industries, manufacture of dairy products, in the preparation of bio-fertilizers and bio-pesticides, the production of biofuels, as eco-friendly agents of sewage treatment, for cleaning up oil spills, extraction of valuable metals and in the development of microbial-fuel cells (Jones and Rua 2006). Along with the increasing use of products based on Biotechnology, particularly when Genetically Modified Organisms (GMOs) are considered, there are many sceptics who reject these with arguments not rooted in evidence (Clancy and Clancy 2016), which calls for the integration of knowledge about GMOs into education (Šorgo and Ambrožič‐Dolinšek 2010).

It is not just a matter of negotiating a change in content, but after the changes in content, attention should be focused on methods and strategies for including this knowledge in curricula not only to widen knowledge but also to induce action competence to build a capacity to act and react. Byrne (2011) analysed the mental models of children aged 7–14. Results show that negative ideas about microorganisms prevail in all age groups, especially in reference to health, although the oldest students have a greater awareness of the existence of beneficial microorganisms. For all age groups, anthropocentric ideas are typical. Similar findings emerge in Karadon and Şahin (2010), where more than half of 836 respondents defined microorganisms as dirty, harmful or as a type of pollution. In a study by Jones and Rua (2006), children between 8 and 11 represented microorganisms in one of three forms: microorganisms, animals such as insects or scenes such as a garbage dump. Students at all grade levels viewed microorganisms as a general cause of sickness and even death. A potential excuse for excluding microorganisms because they are invisible and too abstract for children can be refuted because studies have shown that the theme of microorganisms can be explored in the early years of learning by using experimental activities (Mafra, Lima, and Carvalho 2015). In a study by Aydin (2015), 47.5% of students in secondary school described microorganisms as, ‘invisible living cells’, and 20.6% of students described them as, ‘microscopic creatures’. In general, students seem to know that microorganisms are microscopic living creatures; however, all of them can be seen with the naked eye. Briggs et al. (2017), testing in eight different institutions, from liberal arts colleges to PhD-granting institutions, in students’ first microbiology course, found a lack of knowledge and misconceptions about microorganisms.

All the above can be recognized as an incentive for curriculum developers to provide spaces where knowledge about and skills involving microorganisms can be nurtured. As always, the problems lie in the details. While introduction of microbiology in educational systems for children and adolescents is necessary, it is not the final step. Because adults are major agents of change, we propose that there should be created, parallel to the formal educational system oriented toward the young, channels where they can get appropriate, scientifically verified knowledge and, even more important, learn how to distinguish such channels from sources of dubious or even false knowledge and recommendations.

The aims of the study and research questions

Slovenian educational standards, as the origin of the study, first explicitly mention the topic of microorganisms in the 6th grade of compulsory 9-year elementary school in the subject Science, where the curriculum specifies animal cells, plant cells, bacteria, viruses and fungi’. Later, Microorganisms are explicitly mentioned in Biology courses at upper secondary school levels in general educational (Gimnazija) programmes and in a couple of educational programmes in life sciences (e. g. Veterinary, Health care) but are missing from most vocational programmes. Therefore, for a large part of the adult population, the last official instruction was provided in elementary school; the rest was left to chance and self-education.

Following concerns about the quality of decisions connected with microorganisms, our aim was to test Slovenian citizens’ knowledge about microorganisms, and their opinions about them. Our background intention was to identify weak spots in knowledge and to warn authorities to take measures for improving formal and informal education. In accordance with these intentions, the research questions were as follows:

1. What is the current level of knowledge about microorganisms?

2. What views are held about microorganisms and how do these relate to behaviour?

3. Are gender, age, and degree level moderating agents of the above research questions?

Materials and methods

For practical reasons and given the limited resources available, the choice was an online survey. The weakness of such a sampling method can be that the sample does not reflect the distribution of the general population, which can be achieved only by random sampling. The most likely respondents of online sampling are younger people proficient in on-line communication and those who use social networks. This can be recognized as a weakness; on the other hand, such sampling, offers an increased chance of including in the sample persons with interest in the topic, in our case microorganisms, who can be agents of change.

Because of the exploratory nature of the research, a direction for the outcomes was not hypothesized.

The instruments

The instrument comprised three parts.

The first part of the survey was a 47-item knowledge test. Agreement with 25 items produced a correct ˝True˝ response, and agreement with 22 items was recognized as a ˝False˝ response.

The second part was an 18-item poll about opinions related to practices where microorganisms are involved. To avoid automatic responses, knowledge and opinion items were deliberately assorted. The knowledge and opinion items were separated for statistical reasons into two parts. Those knowledge items where responses were 1, 2, 3, 5, 6, and 7 were coded as ˝True˝ or ˝False˝, depending on the direction of the item. Answers marked 4 were assigned to the neutral ˝Don’t know˝ group (Table 2). For further analysis, we combined the ‘Don’t know’ answers with the ˝False˝ answers as incorrect responses.

The third part of the questionnaire comprised three questions related to personal information (gender, age, and degree level).

Sample and sampling

The target group was citizens of Slovenia older than 14 years. The questionnaires were anonymous, and from the recorded data, it was not possible to assign responses to any individual. The questionnaire was provided on-line by the 1 ka web service (https://www.1ka.si/). The link to the questionnaire was publicly announced on social networks and allowed to spread in a snowball fashion. Data collection began on 20 September 2017 and ended on 16 March 2018, meaning an almost six-month collection period. By the end of the collection period, 1931 participants had started answering the questionnaire. Of these, 405 participants (21.1%) and 537 (27.8%) partially answered. The aim was to collect at least 500 fully completed surveys, but given the lack of interest and probably the difficulty of the questionnaire, we were unable to collect the sample. However, the number of respondents is such that it enables all planned statistical analyses to be carried out.

The structure of the respondents who completed the survey (N = 405) was as follows: 142 (35.1%) were male, and 263 (64.9%) female. Participants were divided into three age groups: those up to 24 years old comprised 260 (64.2%) participants; those from 25 to 44 years old comprised 83 (20.5%) participants, and those 62 (15.3%) were over 45 years old. According to participants’ degree level, they were divided into five groups: those who completed only compulsory elementary school (227; 56%); those who completed secondary school (67; 17%), those who completed college (25; 6%), those with a bachelor’s degree (67; 9%), and those with a master’s degree or more (49; 12%).

Statistical procedures

To answer the research questions, statistical analyses were performed with the IBM SPSS 24.0 statistical package. The statistical procedures employed were as follows:

• for statistical analysis, variables were checked for normality by applying the Kolmogorov-Smirnov Z test (KS test) at a 0.05 significance level. Nonparametric statistics (Mann-Whitney and Kruskal-Wallis) was performed because not all variables followed normal distribution (Erceg-Hurn and Mirosevich, 2008). Owing to skewed data distribution, mode and median are reported, and means and standard deviations to obtain a better impression of the central tendencies and data distribution. The reliability of the scales was explored by calculating the Cronbach’s alpha. Given the satisfactory alpha levels and to preserve the breadth of the scale, no items were deleted from a pool even if an increase in alpha was predicted.

• Effect sizes were calculated by Cohen’s d.

• Principal Component Analysis with Direct Oblimin Rotation was used to explore the component structure of the attitudes toward health education in the school scale s. Values of KMO (0.82) and Bartlett’s test (Chi-Square = 2477.07; df = 153; p < 0.001) permitted further analysis. Principal components with Eigenvalues above 1 and items with loadings above the 0.4 level are reported (Field 2013), owing to the breadth of the reported findings; however, parallel analysis (Flora and Curran 2004) was the preferred choice to explore the number of components to be retained. Parallel analysis was calculated by an online engine (Patil et al. 2017). Correlations were checked as part of the analysis provided by Factorial and Regression procedures. Pearson’s correlation coefficients were calculated; coefficients below the 0.05 level (two-tailed) were considered significant.

Statistical significance was set at p < 0.05. Questionnaires were kept anonymous, and participants involved in the research were all volunteers.

Results

The aims of the research were to identify the level of participants’ knowledge and opinions about microorganisms, by gender, age group and degree level.

Participants’ knowledge about microorganisms

Knowledge about microorganisms was verified with a 47-item knowledge test. The results are given in Table 1. The best scores, with 78% correct answers per item, were gained by participants on the following items: ‘Microorganisms are found in dairy products such as yogurt or sour milk’; ‘The cell is able to function alone or as part of a larger organism’; and ‘The cell is the smallest basic building and functional unit of the organism’. Only 16% of participants gave the correct answer (a negative) on the item: ‘Sterilization is the process by which more than 99% of microorganisms are destroyed’. This was the lowest score in knowledge about microorganisms.

Table 1. Frequency of participants’ responses and mean scores on knowledge about microorganisms.

Item	True / False	No.	Agree/[%]	Neutral/[%]	Don´t agree/[%]	Correct [%]	Mean†	SD†
Microorganisms are found in dairy products such as yogurt or sour milk.	T	536	417/78	48/9	71/13	78	2.35	1.832
The cell is able to function alone or as part of a larger organism.	T	536	417/78	39/7	80/15	78	2.31	1.961
The cell is the smallest basic building and functional unit of the organism.	T	536	414/78	40/7	82/15	78	2.25	2.091
Some bacteria are able to actively move with the help of flagellum.	T	535	400/75	70/13	65/12	75	2.35	1.792
All bacteria are harmful to humans.	F	421	59/14	47/11	315/75	75	5.72	1.921
All microorganisms are harmful to humans.	F	421	55/13	50/12	316/75	75	5.68	1.837
The cell phone keypad has a comparable number of bacteria to the toilet bowl.	T	535	377/70	51/10	107/20	70	2.67	2.092
Dough rises because of microorganisms.	T	535	373/70	64/12	98/18	70	2.66	2.011
Most microorganisms reproduce by sexual reproduction.	F	535	103/19	86/16	346/65	65	5.27	1.957
Some microorganisms can actively move by swimming.	T	535	325/61	118/22	92/17	61	2.94	1.856
Pasteurization is another name for sterilization.	F	421	98/23	75/18	248/59	59	4.97	2.155
Bacteria contain DNA.	T	536	310/58	91/17	135/25	58	3.12	2.230
Viruses affect only one part of the body.	F	421	88/21	90/21	243/58	58	4.95	1.915
Bacteria are organisms that are generally harmful to health.	F	536	179/33	67/13	290/54	54	4.58	2.172
Tick-borne meningoencephalitis is a disease caused by a virus.	T	536	282/53	102/19	152/28	53	3.44	2.205
Viruses can be parasites of bacteria.	T	421	225/53	133/32	63/15	53	3.14	1.777
A single micro-organism is always made up of only one cell.	F	536	164/30	94/18	278/52	52	4.58	2.203
Viruses have no cellular organization.	T	421	219/52	114/27	88/21	52	3.15	1.903
All yeast fungi are harmless to humans.	F	421	104/25	98/23	219/52	52	4.67	1.936
The bacteria are surrounded by a cell wall.	T	536	271/51	86/16	179/33	51	3.54	2.349
Viral diseases are treated with antibiotics.	F	421	165/39	48/11	208/50	50	4.44	2.408
Bacteria’s spores can spend a few minutes in boiling water.	T	421	208/49	140/33	73/18	49	3.31	1.773
Bacteria can survive for millennia outside the aquatic environment.	T	536	257/48	108/20	171/32	48	3.61	2.043
Bacteria can also be called bacilli.	F	537	216/40	74/14	247/46	46	4.16	2.257
All viruses are harmful to humans.	F	421	153/37	73/17	195/46	46	4.28	2.175
Most bacteria are found on the toilet bowl.	F	535	212/39	90/17	233/44	44	4.16	1.929
Most archaea reside in extreme environments such as thermal springs and salt lakes.	T	421	179/43	181/43	61/14	43	3.38	1.662
All bacteria are anaerobic organisms.	F	421	84/20	155/37	182/43	43	4.68	1.862
All bacteria are prokaryotic unicellular organisms.	T	421	183/43	147/35	91/22	43	3.47	1.912
Lyme borreliosis is caused by bacteria.	T	421	178/42	189/45	54/13	42	3.26	1.692
Paramecia are harmful to humans.	F	421	76/18	173/41	172/41	41	4.58	1.688
Candida is classified as a type of yeast fungus.	T	536	203/39	249/46	84/16	39	3.40	1.691
Methanogenic archaea live in the digestive tract of ruminants.	T	536	208/39	266/50	62/11	39	3.35	1.508
Viruses are the smallest organisms.	T	421	164/39	120/29	137/32	39	3.86	2.093
Archaea play an important role in the circulation of gases in the ecosystem.	T	421	158/38	211/50	52/12	38	3.43	1.533
Microorganisms are viable in a vacuum.	T	535	203/37	176/33	156/30	37	3.79	1.916
Euglena is the only photosynthetic microorganism.	F	536	120/23	222/41	194/36	36	4.32	1.776
Methanogenic archaea are a major source of atmospheric methane.	T	536	173/32	283/53	80/15	32	3.66	1.460
The virus is the only organism capable of being in space.	F	421	94/22	194/46	133/32	32	4.27	1.723
Viruses are obligatory parasites in various cellular structures.	T	421	131/31	178/42	112/27	31	3.87	1.744
The most appropriate habitat for all microorganisms is a warm, humid environment.	F	421	220/52	77/18	124/30	30	3.49	2.005
All microorganisms form spores that endure adverse living conditions.	F	420	152/36	142/34	126/30	30	3.96	1.803
Microorganisms cannot survive in weightless space.	T	536	155/29	189/35	192/36	29	4.22	1.840
Most bacteria are found on money.	F	535	307/58	88/16	140/26	26	3.35	1.937
An individual microorganism can be observed only with a microscope.	F	421	284/68	54/13	83/19	19	2.73	1.930
Some viruses can be parasitic on the surface of cells.	F	535	313/58	128/24	94/18	18	3.03	1.847
Sterilization is the process by which more than 99% of microorganisms are destroyed.	F	421	278/66	76/18	67/16	16	2.75	1.847

†Mean and SD – Standard Deviation were calculated before coding as ˝True˝ or ˝False˝ response.

The best scores on the knowledge test about microorganisms were obtained by two participants – one male and one female, who gave 42 correct answers, meaning that nobody correctly answered all items. Both participants were in the age group between 25 and 44 years old, and both had at least a Master’s degree. The lowest score was obtained by nine participants, eight males and one female (no correct answers) in the age group up to 24 years old. Three of these had completed compulsory elementary school; three had completed secondary school, two had completed college, and one had a master’s degree or more. The mean score for the 537 participants was 20.66 (43.96%), SD = 8.931 achieved points. Distribution of the summative test scores is provided in Figure 1.

Figure 1. Distribution of the summative test scores.

According to gender and age groups, there were statistically significant differences in the level of knowledge about microorganisms among all participants.

The difference in level of knowledge is statistically significant by degree level (χ²_{(1, 4)} = 32.71; p < 0.01). Participants with a master’s degree or higher showed a statistically significant higher level of knowledge than participants who had completed college (p < 0.01); secondary school (p < 0.01); or compulsory elementary school (p < 0.01). Participants with a bachelor’s degree earned a higher score for knowledge than participants with only compulsory elementary school (p = 0.02).

Participants’ opinions about microorganisms

The questionnaire included 18 items where participants indicated their opinions about microorganisms. In Table 2 are presented the response frequencies and their central tendencies.

Table 2. Frequency of participants’ responses and mean scores for attitudes towards microorganisms.

Items	No.	Frequency (N) and answers percentages [%]							M	SD	Me	Mod
		1	2	3	4	5	6	7
Because of the harmful microorganisms in nature, I do not go there.	535	44 (8.2)	14 (2.6)	19 (3.5)	30 (5.6)	27 (5.0)	45 (8.4)	356 (66.3)	5.88	1.93	7	7
I do not like to touch foods that contain bacteria.	535	40 (7.4)	15 (2.8)	32 (6.0)	59 (11.0)	47 (8.8)	78 (14.5)	264 (49.2)	5.52	1.91	6	7
I do not like to touch foods that contain microorganisms.	535	37 (6.9)	16 (3.0)	32 (6.0)	76 (14.2)	39 (7.3)	54 (10.1)	281 (52.3)	5.52	1.92	7	7
Foods produced by the incorporation of microorganisms disgust me.	421	31 (7.4)	25 (5.9)	22 (5.2)	81 (19.2)	33 (7.8)	59 (14.0)	170 (40.4)	5.18	1.96	6	7
Foods containing live microorganisms should be forbidden.	421	36 (8.6)	20 (4.8)	20 (4.8)	90 (21.4)	33 (7.8)	47 (11.2)	175 (41.6)	5.15	1.99	6	7
The compulsory vaccination of children is the result of a conspiracy by doctors who have been bribed by pharmaceutical multinationals.	422	39 (9.2)	23 (5.5)	26 (6.2)	89 (21.1)	29 (6.9)	47 (11.1)	169 (40.0)	5.05	2.04	6	7
It is best not to introduce bacteria into the human body.	535	53 (9.9)	27 (5.0)	38 (7.1)	78 (14.5)	76 (14.2)	85 (15.8)	178 (33.1)	4.99	1.99	5	7
I have never heard of the term Archaea.	421	87 (20.7)	29 (6.9)	20 (4.8)	53 (12.6)	30 (7.1)	28 (6.7)	174 (41.3)	4.64	2.42	5	7
Due to unpredictable environmental consequences, any genetic modification of micro-organisms should be prohibited.	421	93 (22.1)	33 (7.8)	47 (11.2)	99 (23.5)	51 (12.1)	40 (9.5)	58 (13.8)	3.79	2.03	4	4
I am not interested in microbiology.	536	96 (17.9)	66 (12.3)	75 (14.0)	88 (16.4)	63 (11.7)	66 (12.3)	82 (15.3)	3.90	2.06	4	1
The topic of microorganisms was under-represented in school.	421	79 (18.8)	56 (13.3)	56 (13.3)	105 (24.9)	46 (10.9)	45 (10.7)	34 (8.1)	3.60	1.86	4	4
Because of the responsibility to others, people should be vaccinated against the flu.	421	106 (25.2)	51 (12.1)	74 (17.6)	85 (20.2)	40 (9.5)	23 (5.5)	42 (10.0)	3.33	1.92	3	1
Children who are not vaccinated against infectious diseases are a threat to themselves.	421	177 (42.0)	58 (13.7)	61 (14.5)	77 (18.3)	45 (10.7)	17 (4.0)	46 (11.0)	3.26	1.98	3	1
It is inconsiderate to others to spend time with people when you have a respiratory disease.	535	173 (32.2)	72 (13.4)	80 (14.9)	98 (18.2)	35 (6.5)	44 (8.2)	33 (6.1)	3.03	1.90	3	1
I am in favour of mandatory vaccination for tick-borne meningoencephalitis.	421	150 (35.6)	51 (12.1)	51 (12.1)	83 (19.7)	30 (7.1)	23 (5.5)	33 (7.8)	2.98	1.95	3	1
Bacteria in dairy products are good for health.	536	168 (31.3)	91 (16.9)	72 (13.4)	99 (18.4)	45 (8.4)	22 (4.1)	39 (7.3)	2.97	1.87	3	1
I do not use the term archaea in everyday life.	536	265 (49.3)	56 (10.4)	39 (7.3)	80 (14.9)	23 (4.3)	14 (2.6)	59 (11.0)	2.66	2.07	2	1
Knowledge about microorganisms is important and useful.	421	193 (45.8)	69 (16.4)	52 (12.4)	47 (11.2)	21 (5.0)	17 (4.0)	22 (5.3)	2.46	1.80	2	1

M = mean; SD = standard deviation; Me = median; Mod = mode.

With the Mann-Whitney U test, we found statistically significant differences by gender in participants’ opinions on four items:

• ‘It is best not to introduce bacteria into the human body’; (U = 16,032.50; Z = −2.604; p (2-tailed) < 0.01). Effect size between groups is small (r = 0.25). Males show statistically significant greater agreement with the item than do females.

• ‘The compulsory vaccination of children is the result of a conspiracy by doctors who have been drugged by pharmaceutical multinationals’; (U = 15,967.50; Z = −2.615; p (2-tailed) < 0.01). Effect size between groups is small (r = 0.28). Males show statistically significant greater agreement with the item than do females.

• ‘Bacteria in dairy products are good for health’; (U = 16,449.00; Z = −2.176; p (2-tailed) = 0.03). Effect size between groups is small (r = 0.21). Females show statistically significant greater agreement with the item, than do males.

• ‘Knowledge about microorganisms is important and useful’; (U = 16,760.00; Z = −2.040; p (2-tailed) = 0.04). Effect size between groups is small (r = 0.16). Females show statistically significant greater agreement with the item than do males.

Statistically significant differences among participants by age group occur in five statements:

• ‘I do not like to touch foods that contain bacteria’; (χ²_(1,2) = 10.44; p < 0.01), where participants older than 46 were statistically more in agreement with the item than younger participants, 24 or below. Effect size between groups is medium (r = 0.32).

• ‘It is inconsiderate to others to spend time with people when you have a respiratory disease’; (χ²_(1,2) = 6.92; p = 0.03), where participants 24 years old or younger are statistically more in agreement with the item than participants from 25 to 45 years old. Effect size between groups is small (r = 0.40).

• ‘The compulsory vaccination of children is the result of a conspiracy by doctors who have been bribed by pharmaceutical multinationals’; (χ²_(1,2) = 8.54; p = 0.01), where participants from 25 to 45 years old were statistically more in agreement with the item than the youngest participants. Effect size between groups is small (r = 0.32).

• ‘I do not like to touch foods that contain microorganisms’; (χ²_(1,2) = 8.51; p = 0.01), where participants from 25 to 45 years old were statistically more in agreement with the item than the youngest participants. Effect size between groups is small (r = 0.32).

• ‘Foods containing live microorganisms should be forbidden’; (χ²_(1,2) = 8.99; p = 0.01), where participants 46 or older were statistically more in agreement with the item, than the youngest participants, 24 or below. Effect size between groups is medium (r = 0.42).

Statistically significant differences among participants by degree level do occur in two statements:

• ‘It is inconsiderate to others to spend time with people when you have a respiratory disease.’; (χ²_(1,4) = 11.14; p = 0.03), where participants who completed only compulsory elementary school show statistically more disagreement with the item than participants who completed secondary school (effect size between groups is small: r = 0.28); college level (effect size between groups is small; r = 0.49); and participants who completed a master’s degree or higher (effect size between groups is small; r = 0.38).

• ‘Because of the responsibility to others, people should be vaccinated against the flu’; (χ²_(1,4) = 10.66; p = 0.03), where participants who completed only compulsory elementary school show statistically more agreement with the item than participants who completed secondary school (effect size between groups is small: r = 0.32); and participants, who completed a master’s degree or higher (effect size between groups is small; r = 0.33).

Statistically significant Pearson’s correlations between items in participants’ opinions about microorganisms are provided in Appendix 1. There were no statistically significant Pearson’s correlations between participants’ opinions on each item, to the total score of participants’ knowledge about microorganisms.

There was no statistically significant correlation between participants’ opinions and their knowledge about microorganisms.

Principal component structure of attitudes toward microorganisms

The PCA was performed on the entire dataset of participants’ attitudes about microorganisms. In our study, 18 items on opinions (Table 2) form five components that can be retained (Table 3) on the basis of Eigenvalue > 1 criteria, and four on the basis of results from the parallel analysis. With the four remaining components (Table 3), 55.28% of variance can be explained. The first and third components have appropriate Cronbach’s alphas, as well. All 18 items loaded above the 0.4 level and were therefore included in the analysis.

Table 3. Rotated component matrix of participants’ opinions.

Items	Component
	1	2	3	4
I do not like to touch foods that contain bacteria.	0.83
I do not like to touch foods that contain microorganisms.	0.83
Because of the harmful microorganisms in nature, I do not go there.	0.79
Foods reproduced by the incorporation of microorganisms disgust me.	0.79
Foods containing live microorganisms should be forbidden.	0.75
It is best not to introduce bacteria into the human body.	0.69
The compulsory vaccination of children is the result of a conspiracy by doctors who have been bribed by pharmaceutical multinationals.	0.61
I have never heard of the term archaea.	0.43
Due to unpredictable environmental consequences, any genetic modification of micro-organisms should be prohibited.		0.67
It is inconsiderate to others to spend time with people when you have a respiratory disease.		0.61
I do not use the term archaea in everyday life.		0.53
Bacteria in dairy products are good for health.		0.53
The topic of microorganisms was under-represented in school.		0.45
I am in favour of mandatory vaccination for tick-borne meningoencephalitis.			−0.81
Because of the responsibility to others, people should be vaccinated against the flu.			−0.79
Children who are not vaccinated against infectious diseases are a threat to themselves.			−0.57
I am not interested in microbiology.				0.78
Knowledge about microorganisms is important and useful.				0.50
Explained variance	25.60	14.57	8.26	6.84
Eigenvalue	4.61	2.62	1.49	1.23
Cronbach’s alpha	0.78	0.52	0.62	0.44

With the first component, we can explain 25.60% of variance (Cronbach’s alpha = 0.78). The first component combines mostly attitudes towards microorganisms in food or the surrounding environment. In relation to items loaded in the first component, we can detect a positive tone in attitudes toward microorganisms. A high percentage of participants, 79.7%, despite the presence of harmful microorganisms in nature, do nevertheless go there. The majority of participants disagree with the following items: ‘I do not like to touch foods that contain bacteria (78.5%); I do not like to touch foods that contain microorganisms (69.7%); Foods produced by the incorporation of microorganisms disgust me (62.2%); and Foods containing live microorganisms should be forbidden’ (60.6%). Participants are mostly aware of the importance of microorganisms in everyday life for all living beings, but we did detect around 15% of participants who are afraid of microorganisms.

The second component (Cronbach’s alpha = 0.52) explains 14.57% of variance and comprises five items, where participants’ opinions about microorganisms are not uniform. Participants cannot decide whether ‘Due to unpredictable environmental consequences, any genetic modification of micro-organisms should be prohibited’. The reason is probably a lack of knowledge about microorganisms, meaning that 45.4% of participants agree with the statement; 24.9% are neutral about the statement ‘The topic of microorganisms was under-represented in school’. On the other hand, 60.5% are aware of the danger of respiratory disease; ‘It is inconsiderate to others to spend time with people when you have a respiratory disease’.

The third component (Cronbach’s alpha = 0.62) explains 8.26% of variance and comprises three items, which all load negatively. The third component combines attitudes towards vaccination. The majority agree on or remain undecided whether people should be vaccinated against tick-borne meningoencephalitis (79.5%) and ‘flu (75.1%). In the past few years, Slovenian people have been considerably divided about vaccinations. The reason can be sought in the copious polemic against vaccination, on account of which people cannot decide if vaccinations against several diseases are helpful or are merely being promoted by powerful pharmaceutical multinationals.

The fourth and last component (Cronbach’s alpha = 0.44) explains 6.84% of variance and comprises two items. These participants are aware of the importance of knowledge about microorganisms but are not interested in this topic, as evidenced by poor results on the items testing knowledge about microorganisms (Table 3).

Results of the PCA Analysis should be considered as preliminary and as requiring improvement of the instrument; nevertheless, they show the direction of the research, especially the findings summarized in the last three components. The snowball generated sample was always likely to be skewed in the direction of those with more knowledge of microorganism, leaving open the issue of opinions among the silent majority.

Discussion

As established in the introductory section, microorganisms are an important factor in the maintenance and evolution of life on Earth (Zilber-Rosenberg and Rosenberg 2008) and in almost all aspects of human life; this calls for solid knowledge about and, consequently, a more appropriate view of microorganisms. As was revealed by the sometimes confusing response to the latest COVID-19 outbreak, a factor unknown at the time of the study, many are unaware of or totally ignore resources and measures to prevent transmission of the disease. By checking social networks, it is easy to find evidence that too many find support for their actions or lack thereof with referencing dubious sources or misunderstanding basic principles of microbiology and biotechnology. Now it is impossible to connect such attitudes to the level of knowledge revealed from our research, which calls for a new study. However, we can speculate on solid grounds that knowledge, or its lack causes unnecessary transmission and many consequences of the disease; our findings, along with many other international studies addressing microbiology, were probably early predictors of catastrophe. The findings in this study of 521 participants show a lack of knowledge about microorganisms at all levels of participants’ age, gender and degree level – even though the snowball sampling meant that they were probably better educated than average. The mean score of participants on the knowledge test about microorganisms was 20.66 points (43.96%), although all 47 items were at the knowledge level of compulsory elementary school. Participants, for example, could not distinguish between bacteria, viruses and microorganisms. The majority think that all these terms designate the same subject, which is not true. Our results agree with the study by Jones and Rua (2006), which found that the terms virus and bacteria were used for the same subject, and frequently by people in all age groups. All participants in the Jones and Rua (2006) study had previously heard of the terms, but there were differences in the understanding of bacteria and viruses. One idea common to all student age groups that emerged from the transcripts was the belief that bacteria caused viruses. The participants mix the two terms and consequently, confuse the concomitant knowledge. In a study by Simonneaux (2000), students said that ‘viruses were harmful to humans, that bacteria were not too harmful, and that they cause health problems only when they were abundant’.

Lack of knowledge about microorganisms can cause problems in the lives of individuals. According to our results, 74.0% of participants agree with the item ‘Most bacteria are found on money’, which is not true, and 54.0% participants agree with the item ‘All viruses are harmful to humans’, which is also not true. Our results partly concur with those from the study by Aydin (2015). He found that most students think that microorganisms can be both harmful and harmless (68.7%).

Despite the Slovenian curriculum, where students in 7th grade learn about paramecia and can observe these through a microscope, 49% of participants agreed with the item ‘Paramecia are harmful to humans’. In 6th grade, students bake bread, but 48% of participants still agree that ‘All yeast fungi are harmless to humans’. In this study there were no statistically significant differences in participants’ knowledge about microorganisms, by gender or age group. The statistically significant differences were found in relation to degree level. The participants who had completed a master’s degree or higher, showed more knowledge about microorganisms, which concurs with the study of Jones and Rua (2006), where students, teachers and medical professionals held different concepts of microorganisms. The more educated they were, the better the knowledge about and conceptions of microorganisms they possess.

This knowledge deficiency can contribute to negative interactions with various objects. Many studies showed that primary school students have a limited view of microorganisms and connect microorganisms basically to disease (Byrne 2011; Byrne and Grace 2010; Faccio et al. 2013; Gillen and Williams 1993; Harms 2002; Hilge and Kattmann 2003; Jones and Rua 2006; Nagy 1953; Simonneaux 2000). Our results concur with previous studies, because 18.2% of participants in this study agree with the item ‘Foods containing live microorganisms should be forbidden’, and 22% of participants agree with the item ‘It is best not to introduce bacteria into the human body’. Some agreements indicate fear of microorganisms, because 16.2% of participants agree with the item ‘I do not like to touch foods that contain bacteria’, while 15.9% of participants agree that ‘I do not like to touch foods that contain microorganisms’; in contrast, 61.6% of participants are aware that ‘Bacteria in dairy products are good for health’. Another result where we can claim fear of microorganisms is the item where 14.3% of participants avoid going into the natural environment because of the harmful microorganisms there. According to the results and the participants’ honesty, 45.5% agree with the item ‘The topic of microorganisms was under-represented in school’. Negative interpretations sometimes accompany lack of knowledge and misconceptions, which could have been caused by teachers in primary and lower secondary school, who are not experts in this field. Lack of knowledge and misconceptions about microorganisms are the most likely reason that 44.2% of participants are not interested in microbiology, even though 74.6% of participants are aware that ‘Knowledge about microorganisms is important and useful’. In contrast, Aydin (2015), found positive ideas about microorganisms along with student knowledge.

Conclusion

Based on the empirical findings, we were able to answer our research questions.

1. Is the level of Slovenian citizen’s knowledge of microorganisms satisfactory?

Slovenian citizens’ knowledge about microorganisms was not at a satisfactory level. They lacked knowledge and held several misconceptions about microorganisms. Most participants equate distinct concepts, like virus, bacteria and microorganism, as one and the same.

• (ii) Are the gender, age or degree level of participants related to their knowledge about microorganisms?

Regarding participants’ age and gender, there were no statistically significant differences in knowledge about microorganisms. According to degree level, participants with lower level degrees had a greater deficiency in their knowledge about microorganisms.

• (iii) Do Slovenian citizen have a fear of microorganisms?

The majority of participants have no fear of microorganisms; however, around 15.0 to 20.0% of participants do fear them, even in everyday life; as a result, these people would like to ban foods containing live microorganisms; they do not like to touch foods that contain bacteria or microorganisms; they do not venture into nature because of the harmful microorganisms.

(iv)Do participants’ opinions about microorganisms differ statistically in relation to gender, age or degree level?

Participants’ opinions about microorganisms, depending on gender, age and degree level, do differ to a statistically significant degree.

We did not find statistically significant correlations between participants’ opinions and knowledge about microorganisms.

The lack of knowledge about microorganisms among Slovenian participants is probably similar to that in other countries, which calls for an international study covering the same topics and using the same instruments. Based on fragments collected from studies, the only possible conclusion is that knowledge of microbiology should be somehow improved. While inclusion of missing parts can be done in elementary and secondary school levels, how to include such knowledge in adult education remains an open issue. One possible solution that could lead toward better knowledge is to include the basics of microbiology at the early educational stages, leaving the door open to improve it in later years. Slovenian curricula lack content on microbiology in the early school years, which could be one cause of the limited knowledge among the adult population. According to some studies of the positive effect of learning about microorganisms in the early school years (Byrne and Sharp 2006; Byrne 2011), Slovenian primary schools should include education about microorganisms. More emphasis should also be placed on pre-existing content about microorganisms in lower secondary school. Once schooling has been completed, it can be difficult to change the level of knowledge, and when scientific knowledge conflicts with intuitive, naive knowledge, the challenge is even greater (Jones and Rua 2006). A curriculum adapted to the characteristics of modern society could help children appreciate microorganisms as part of their daily life and inform their decisions now and in the future (Byrne 2011). The curriculum should include teaching about the use of microorganisms in biotechnology, and genetic modification at the comprehensive level at these stages, along with the connections to the services and products we use. This study, even with all its limitations, can be regarded as a valuable signpost indicating the way to improve curricula and adult education about not only microorganisms but also how to live with them.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed at https://doi.org/10.1080/02635143.2021.1952407.