Measuring Attitudes Toward Plastics: A Cross-Cultural Adaptation and Patient Evaluation Study.

Individual behaviors play a crucial role in generating and mitigating plastic pollution. Understanding citizen knowledge and perceptions is therefore critical to inform effective public interventions. Surveys can provide this information, but they must use well-designed and culturally adapted tools to be reliable. We present the Italian cross-cultural adaptation of an Australian questionnaire identified via systematic review as meeting high-quality standards. The tool included 21 items (Likert-scale, multiple-choice, and open-ended). In accordance with literature indications, we performed forward and back translation and subsequent review by an Expert Committee, producing a pre-final version. A stratified sample of 43 citizens assessed clarity of each item and provided feedback, which guided further Expert Committee revision. Ten items showed comprehension problems, and seven of them were rephrased because they were confusing or redundant. Items with technical terms such as "bioplastics" and "biodegradable" proved challenging, leading to the addition of brief explanations in the introduction to the questionnaire. This process produced a rigorously developed, culturally appropriate instrument for assessing public understanding of plastic pollution in Italy. This standardized tool, if adapted in multiple languages, will enable international surveys and meta-analyses to guide global strategies. Psychometric validation is recommended before large-scale deployment of the tool.