Abstract: U.S. Public Understanding of the Human Microbiome: Implications for Provider-Patient Communication about Illness

◆ Kasey A. Foley, Pennsylvania State University
◆ Emily P. Caldes Firgens, Pennsylvania State University
◆ Rachel R. Vanderbilt, Pennsylvania State University
◆ Erina L. MacGeorge, Pennsylvania State University

With partially preventable and modifiable illnesses on the rise in the United States (CDC, 2014; Sturm, 2013), and threats to global health increasing in severity (e.g., CDC, 2016), healthcare systems are turning to primary care providers to carry out preventative counseling and interventions with patients (WHO, 2019). Increasingly, the medical community recognizes that the human microbiome, or the microbes that live in and on the body (e.g., bacteria, bacteriophages, fungi, protozoa, and viruses), is integrally connected to health and wellness due to its involvement in multiple physiological processes and illnesses (Ursel, Metcalf, Parfrey, & Knight, 2012). For example, disruptions in the microbiome can contribute to weight gain, high cholesterol, anxiety, and pain (e.g., Carballa et al., 2015; Thaiss et al., 2016). Primary care providers may find it useful to reference the microbiome when discussing connections between wellness, lifestyle, diagnoses, and treatments, and trying to motivate patients’ health behavior change. However, the utility of microbiome-based explanation and motivational messaging likely hinges on public understanding of the microbiome, and providers’ capacity to supplement that understanding where necessary. It is therefore important to understand what the public knows about the microbiome and what misconceptions they hold:

RQ1: How well does the U.S. public currently understand the human microbiome?

Patient awareness of their own knowledge (or lack thereof) about health also has the potential to influence responsiveness to providers’ education and influence. When patients have but do not recognize their health knowledge gaps or misconceptions, they will typically be more resistant to health messaging that contradicts their own thinking (Rapp & Braasch, 2014). Thus, providers who reference the microbiome in discussion with patients may be met with greater resistance if patients do not know what the microbiome is or how it functions and lack awareness of their ignorance. Thus, it is important to examine how accurately members of the public can assess their own knowledge about the microbiome.

RQ2: What is the association between actual and perceived public understanding of the microbiome?

An analysis of survey responses from a geographically, racially, and educationally representative sample of U.S. citizens (N = 1010) to identify observed and perceived public knowledge about the human microbiome is in progress. Participant knowledge was measured using a single open-ended item (i.e., “As you understand it, what is the microbiome of the human body?”). A quantitative coding scheme was deductively developed to assess participant understanding that the microbiome (a) consists of microorganisms, (b) exists in or on the human body (i.e., is not made by the body), and (c) is healthy and normal (i.e., is not harmful). A single item was used to measure participant’s perceived knowledge about the microbiome on a 5-point Likert-type scale (1 = Very Low, 5 = Very High). A correlation analysis will be employed to test the association between observed and perceived participant understanding of the microbiome.

Results will have important implications for clinical practice and the dissemination of information that promotes, supports, and motivates patient health behaviors in primary care.