Validating the Malay Version of Adolescent Sexual and Reproductive Health Knowledge and Attitudes Questionnaires
Abstract
Adolescent Sexual and Reproductive Health (SRH) knowledge is crucial for informed decision-making, yet cultural barriers in Malaysia limit open discussions, creating significant knowledge gaps. This study validated the Malay version of the Adolescent SRH Knowledge and Attitudes Questionnaire to address this need. The validation process included expert content review (6 panelists), face validity testing (30 respondents), and psychometric analysis among 100 adolescents in Sarawak. The questionnaire demonstrated excellent content validity as rated by the experts and strong face validity among adolescents. The knowledge domain showed high internal consistency (α = 0.935), while the attitude domain had moderate reliability (α = 0.682), with refinements improving item alignment. The validated questionnaire provides a culturally adapted tool for assessing SRH among Malaysian adolescents, supporting targeted interventions. Future studies should expand validation to diverse populations and the assess longitudinal stability.
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References
1. WHO. Adolescent Sexual Reproductive Health Geneva, Switzerland: World Health Organization; 2025. https://www.who.int/southeastasia/activities/adolescent-sexual-reproductive-health
2. Albert Sekhar M, Edward S, Grace A, Pricilla SE, G S. Understanding Comprehensive Sexuality Education: A Worldwide Narrative Review. Cureus. 2024;16(11):e74788. https://doi.org/10.7759/cureus.74788
3. Win SS, Lasimbang HB, Win MMC, Parash MTH, Aung SNL, Yeap TB, et al. Knowledge, Attitude and Practice Towards Sexual and Reproductive Health Including Comprehensive Sexuality Education Among First Year Students of University Malaysia Sabah (UMS), Malaysia. Malaysian Journal of Public Health Medicine. 2020;20(1):184-191. https://doi.org/10.37268/mjphm/vol.20/no.1/art.449
4. Mustapa MC, Ismail K, Mohamad M, Ibrahim F. Knowledge on Sexuality and Reproductive Health of Malaysian Adolescents – A Short Review. Procedia - Social and Behavioral Sciences. 2015;211:221-225. https://doi.org/10.1016/j.sbspro.2015.11.088
5. Khalaf ZF, Low WY, Khoei EM, Ghorbani B. Sexuality Education in Malaysia. Asia Pacific Journal of Public Health. 2014;26(4):358-366. https://doi.org/10.1177/1010539513517258
6. Awang H, Wong LP, Jani R, Low WY. Knowledge of Sexually Transmitted Diseases and Sexual Behaviours Among Malaysian Male Youths. Journal of Biosocial Science. 2013;46(2):214-224. https://doi.org/10.1017/S0021932013000114
7. Tay CG, Jalaludin MY, Low WY, Lim CT. Cross-Cultural Adaptation and Validation of the Malay Language Version of the TZO-AZL Preschool Children Quality of Life Questionnaire. Journal of Child Health Care. 2013;19(2):167-181. https://doi.org/10.1177/1367493513503583
8. Aziz A, Nordin NIF, Norhayati MN, Norsa’adah B, Isa SNI. Psychometric Properties of the 'Skala Kepuasan Interaksi Perubatan-11' to Measure Patient Satisfaction With Physician-Patient Interaction in Malaysia. Family Practice. 2013;31(2):236-44. https://doi.org/10.1093/fampra/cmt062
9. Saddki N, Sulaiman Z, Ali SH, Tengku Nur Fadzilah Tengku H, Abdullah S, Rahman A, et al. Validity and Reliability of the Malay Version of WHO Women’s Health and Life Experiences Questionnaire. Journal of Interpersonal Violence. 2013;28(12):2557-2580. https://doi.org/10.1177/0886260513479029
10. Haron K, Shaffie Z, Ghazi HF, Isa ZM. Women’s Attitude and Its Influence on Violence During Pregnancy in Northern State of Peninsular Malaysia: Cross-Sectional Study. Journal of Interpersonal Violence. 2018;36(5-6):NP2576-NP600. https://doi.org/10.1177/0886260518759059
11. Khalid N, Jamani NA, Aziz KHA, Draman N. The Prevalence of Sexual Dysfunction Among Postpartum Women on the East Coast of Malaysia. Journal of Taibah University Medical Sciences. 2020;15(6):515-521. https://doi.org/10.1016/j.jtumed.2020.08.008
12. Ooi PS, Draman N, Muhamad R, Yusoff SSM, Norhayati MN, Haron J, et al. Sexual Dysfunction Among Women With Breast Cancer in The Northeastern Part of West Malaysia. Sexual Medicine. 2021;9(3):100351. https://doi.org/10.1016/j.esxm.2021.100351
13. Setiyorini A, Sitaresmi MN, Nisman WA. Development and validation of Adolescent Sexual and Reproductive Health – Knowledge, Attitude, and Self-Efficacy Questionnaires (ASRH-KASeQ). International Journal of Adolescent Medicine and Health. 2024;36(4):351-358. https://doi.org/10.1515/ijamh-2024-0073
14. Rahman A, Ibrahim MI, Rahman RA, Arifin WN, Ahmad M. Development and Validation of a Malay Version of the Questionnaire on Pornography Attitudes and Exposure for Youth in Kelantan. Malaysian Journal of Medical Sciences. 2020;27(2):129-150. https://doi.org/10.21315/mjms2020.27.2.14
15. Ali MM, Hoesni SM, Rosharudin NA, Yusoff SR, Razman MOI, Khairuddin KF, et al. Translation and Validation of the Malay Version of The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA). International Journal of Environmental Research and Public Health. 2022;19(18):11399. https://doi.org/10.3390/ijerph191811399
16. Tiang K-P, Chander SM, Hui MTC, Palaniapan P. Knowledge and Perception of Sexual Health Among Medical Undergraduates: A Cross-Sectional Study. Open Journal of Epidemiology. 2016;06(04):233-243. https://doi.org/10.4236/ojepi.2016.64023
17. Silva SBd, Cabral TdM, Pinto TMP, Durand LB. Instrument of Self-Perception and Knowledge of Dental Erosion: Cross-Cultural Adaptation to the Brazilian Population. Brazilian Oral Research. 2015; 29(1):1-11. https://doi.org/10.1590/1807-3107BOR-2015.vol29.0053
18. Zhang Y, Xie W, Xiang D. Develop and Test the Reliability and Validity of the Postoperative Visual Function Rehabilitation Compliance Assessment Scale for Children With Congenital Cataract. 2023. https://doi.org/10.21203/rs.3.rs-3313057/v1
19. Tang H, Min Z, Liu Y. Translation and Cross-Cultural Adaptation of the Questionnaire of Sleep Health for Using in Chinese Older. 2020. https://doi.org/10.3390/ijerph17238792
20. Pati S, Ghosal J, Dutta A, Kshatri J, Das A, Kanungo S, et al. Development, Validation & Amp; Pilot Testing of a Questionnaire to Assess Healthcare Seeking Behaviour, Healthcare Service Utilization & Amp; Out-of-Pocket Expenditure of Particularly Vulnerable Tribal Groups of Odisha, India. The Indian Journal of Medical Research. 2023;157(5):412. https://doi.org/10.4103/ijmr.ijmr_3570_21
21. Rodrigues IB, Adachi JD, Beattie KA, MacDermid JC. Development and Validation of a New Tool to Measure the Facilitators, Barriers and Preferences to Exercise in People with Osteoporosis. BMC Musculoskeletal Disorders. 2017;18(1):540. https://doi.org/10.1186/s12891-017-1914-5
22. Lasanthika C, Wanigasuriya K, Hettiaratchi U, Amarasekara T, Goonewardena S. Psychometric Properties of an Instrument to Determine the Factors Affecting Treatment Adherence Among Patients Receiving Hemodialysis in Sri Lanka. Journal of Patient Experience. 2023;10:237437352311515. https://doi.org/10.1177/23743735231151558
23. Huang S-M, Lai JC-Y, Li C-C, Chen P-H, Lien P-J, Lien C-T. Development and Validity Testing of an Assessment Tool for Oncofertility Barriers in Multidisciplinary Healthcare Providers on the Breast Cancer Team. Journal of Nursing Research. 2022;30(2):e195. https://doi.org/10.1097/jnr.0000000000000479
24. Connell J, Carlton J, Grundy A, Buck ET, Keetharuth AD, Ricketts TC, et al. The Importance of Content and Face Validity in Instrument Development: Lessons Learnt From Service Users When Developing the Recovering Quality of Life Measure (ReQoL). Quality of Life Research. 2018;27(7):1893-1902. https://doi.org/10.1007/s11136-018-1847-y
25. Rodrigues AT, Ferreira M, Roque F, Falcão Al, Ramalheira E, Figueiras A, et al. Physicians’ Attitudes and Knowledge Concerning Antibiotic Prescription and Resistance: Questionnaire Development and Reliability. BMC Infectious Diseases. 2015;16(1). https://doi.org/10.1186/s12879-015-1332-y
26. Kachouchi A, Sebbani M, Karroumi S, Adali I, Manoudi F. Cross-Cultural Adaptation and Validation of the Moroccan Arabic Version of the Schizophrenia Quality of Life Short-Version Questionnaire (SQoL-18). 2023. https://doi.org/10.21203/rs.3.rs-2968202/v1
27. Lisha NE, Neilands TB, Erguera XA, Saberi P. Development of the Mobile Technology Vulnerability Scale Among Youth and Young Adults Living With HIV. International Journal of Environmental Research and Public Health. 2021;18(8):4170. https://doi.org/10.3390/ijerph18084170
28. Bujang MA, Omar ED, Baharum NA. A Review on Sample Size Determination for Cronbach’s Alpha Test: A Simple Guide for Researchers. Malaysian Journal of Medical Sciences. 2018;25(6):85-99. https://doi.org/10.21315/mjms2018.25.6.9
29. Acharya DR, Thomas M, Cann R. Validation of a Questionnaire to Measure Sexual Health Knowledge and Understanding (Sexual Health Questionnaire) in Nepalese Secondary School: A Psychometric Process. Journal of Education and Health Promotion. 2016;5(1):18. https://doi.org/10.4103/2277-9531.184560
30. Awang H, Rahman A, Sukeri S, Hashim N, Rashid NRNA. A Reliability Study of the Malay Version of the Malaysian Ministry of Health's Adolescent Client Satisfaction Questionnaire Among Adolescents Attending Health Clinics in Northeastern Malaysia. Korean Journal of Family Medicine. 2020;41(6):412-415. https://doi.org/10.4082/kjfm.19.0030
31. Khoei EM, Motamedi M, Shahbazi M, Rahimi-Naghani S, Salehi M, Hajebi A, et al. Psychometric Properties of the Persian Version of Sexual and Reproductive Health Illustrative Questionnaire. 2020. https://doi.org/10.21203/rs.3.rs-28488/v1
32. Guo S, Armstrong R, Waters E, Sathish T, Alif SM, Browne GR, et al. Quality of Health Literacy Instruments Used in Children and Adolescents: A Systematic Review. BMJ Open. 2018;8(6):e020080. https://doi.org/10.1136/bmjopen-2017-020080
33. Roux F, Chih H, Hendriks J, Burns S. Validation of an Adolescent Ovulatory Menstrual Health Literacy Questionnaire. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2023;63(4):588-593. https://doi.org/10.1111/ajo.13680
34. Yassir YA, McIntyre GT, Bearn D. Three Questionnaires to Assess the Perception of Fixed Orthodontic Therapy Before, During and After Treatment: Validity and Reliability. European Journal of Orthodontics. 2016:cjw076. https://doi.org/10.1093/ejo/cjw076
35. Frantz A, Holmgren K. The Work Stress Questionnaire (WSQ) – Reliability and Face Validity Among Male Workers. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-019-7940-5
36. Duffy D, Yourkavitch J, Bruinvels G, Rinaldi N, Wideman L. The Development and Initial Validation of the Health and Reproductive Survey (HeRS). Women's Health. 2021;17:174550652110048. https://doi.org/10.1177/17455065211004814
37. Brüggemeier B, Breiter M, Kurz M, Schiwy J. User Experience of Alexa When Controlling Music. 2020;9:1-9. https://doi.org/10.1145/3405755.3406122
38. Graafland M, Dankbaar M, Mert A, Lagro J, Wit-Zuurendonk LDd, Schuit SCE, et al. How to Systematically Assess Serious Games Applied to Health Care. Jmir Serious Games. 2014;2(2):e11. https://doi.org/10.2196/games.3825
39. Olson DH. FACES IV and the Circumplex Model: Validation Study. Journal of Marital and Family Therapy. 2011;37(1):64-80. https://doi.org/10.1111/j.1752-0606.2009.00175.x
40. Yusoff MSB. ABC of Response Process Validation and Face Validity Index Calculation. Education in Medicine Journal. 2019;11(3):55-61. https://doi.org/10.21315/eimj2019.11.3.6
41. Karim IKA, Sutan R, Tamil AM, Ahmad N. Development and Validation of the Adolescent Sexual and Reproductive Competency Assessment Tool (ASRH-CAT) for Healthcare Providers. Healthcare. 2023;11(8):1116. https://doi.org/10.3390/healthcare11081116
42. Haraldsson P, Rolander B, Jonker D, Strengbom E, Josefsson KA. Further Psychometric Evaluation of the Structured Multidisciplinary Work Evaluation Tool (SMET) Questionnaire: Practical Implications in Healthcare Settings. Work. 2022;73(4):1279-1295. https://doi.org/10.3233/WOR-210095
43. Arije O, Madan J, Hlungwani T. Validation of the Adolescent Health Quality of Care (AHQOC) Index for Mystery Client Studies. Plos One. 2023;18(6):e0285888. https://doi.org/10.1371/journal.pone.0285888
44. Patel M, Sheikh S, Brailsford J. Validating the HELP Survey to Understand Health Disparity Influence on Chronic Pain. Journal of Pain Research. 2022;Volume 15:545-560. https://doi.org/10.2147/JPR.S338669
45. Lee S-H, Yeo KJ, Handayani L. Development and validation of a sexual and reproductive health knowledge scale. International Journal of Public Health Science (IJPHS). 2022;11(3):815-822. http://doi.org/10.11591/ijphs.v11i3.21570
46. Heffernan E, Maidment DW, Barry J, Ferguson MA. Refinement and Validation of the Social Participation Restrictions Questionnaire: An Application of Rasch Analysis and Traditional Psychometric Analysis Techniques. Ear and Hearing. 2019;40(2):328-339. http://doi.org/10.1097/AUD.0000000000000618
47. Salem GA, Bowie P, Morrison J. Hospital Survey on Patient Safety Culture: Psychometric Evaluation in Kuwaiti Public Healthcare Settings. BMJ Open. 2019;9(5):e028666. https://doi.org/10.1136/bmjopen-2018-028666
48. Josefsson KA, Juuso P, Gard G, Rolander B, Larsson A. Health Care Students' Attitudes Toward Addressing Sexual Health in Their Future Profession: Validity and Reliability of a Questionnaire. International Journal of Sexual Health. 2016;28(3):243-250. https://doi.org/10.1080/19317611.2016.1199453
49. Turan N, Çulha Y, Özdemir Aydin G, Kaya H. Reliability and Validity of the Adapted Turkish “Students’ Attitudes Towards Addressing Sexual Health Questionnaire” (SA-SH-TR). SAGE Open. 2021;11(1): 2158244021989305. https://doi.org/10.1177/2158244021989305
50. Tabatabaeeian SA, Kharaju ZG, Hosseinian S, Taheri A, Adam F. Psychometric Properties of the Sexual Five-Facet Mindfulness Questionnaire (FFMQ-S): Validation Among a Community Sample of Persian-Speaking Women. 2023:1-19. https://doi.org/10.21203/rs.3.rs-2931932/v1
51. Hall KS, Manu A, Morhe E, Harris LH, Loll D, Ela E, et al. Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana. The Journal of Sex Research. 2018;55(1):60-72. https://doi.org/10.1080/00224499.2017.1292493
52. Gausman J, Othman A, Al-Qotob R, Shaheen A, Aldiqs M, Hamad IL, et al. Measuring Health Service Providers’ Attitudes Towards the Provision of Youth-Friendly Sexual and Reproductive Health Services: A Psychometric Study to Develop and Validate A Scale in Jordan. BMJ Open. 2022;12(2): e052118. http://dx.doi.org/10.1136/bmjopen-2021-052118
53. Tohit NFM, Haque M. Forbidden Conversations: A Comprehensive Exploration of Taboos in Sexual and Reproductive Health. Cureus. 2024;16(8). https://doi.org/10.7759/cureus.66723
54. Institute for Public Health. Adolescent Health Survey 2022 Sarawak. Shah Alam, Selangor, Malaysia: National Institutes of Health, Ministry of Health Malaysia; 2022. https://iku.gov.my/images/nhms-2022/Report_Malaysia_nhms_ahs_2022.pdf
55. Etikan I, Bala K. Sampling and Sampling Methods. Biometrics & Biostatistics International Journal. 2017;5(6). https://doi.org/10.15406/bbij.2017.05.00149
56. Vongxay V, Thongmixay S, Stoltenborg L, Inthapanyo A, Sychareun V, Chaleunvong K, et al. Validation of the Questionnaire on Sexual and Reproductive Health Literacy for Adolescents Age 15 to 19 Years in Lao People's Democratic Republic. HLRP: Health Literacy Research and Practice. 2022;6(1):e37-e50. https://doi.org/10.3928/24748307-20220207-01
57. Fahme SA, Khater B, Dagher M, DeJong J, Abdulrahim S. Developing A Sexual and Reproductive Health Educational Intervention for Adolescent Syrian Refugee Girls: Challenges and Lessons Learned. Frontiers in Reproductive Health. 2022;4. https://doi.org/10.3389/frph.2022.780157
58. Lee S-H, Yeo K-J. Sexual and Reproductive Health Knowledge Among Primary School Students in Malaysia. Journal of Education and Health Promotion. 2022;11:89. https://doi.org/10.4103/jehp.jehp_542_21
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