Validation of a Sexual Health Literacy Scale for Secondary School Students in High-Risk Area of Thailand
Keywords:
Health literacy, Sexual health, Student, Factor analysis, PsychometricsAbstract
Adolescents need strong sexual health literacy to make decisions that help avoid unintended pregnancies and sexually transmitted infections. This study validated the Sexual Health Literacy Scale for Secondary School Students (SHLSS) in high-risk area of Thailand, using Confirmatory Factor Analysis (CFA). Secondary data from a 2018 cross-sectional survey involving 319 secondary school students in Chonburi Province, Thailand, were used. The SHLSS consists of 28 items across four dimensions: Access, Understand, Appraise, and Apply. CFA results demonstrated strong reliability, with a Cronbach’s alpha of 0.90, and satisfactory construct validity, as composite reliability values ranged from 0.88 to 0.91. Factor loadings varied between 0.43 and 0.81, indicating moderate to strong correlations. However, the Access dimension exhibited lower convergent validity (AVE = 0.28), suggesting need for refinement. These findings highlight need for further validation across diverse cultural groups and support the SHLSS as a promising framework for guiding sexual health education and policy development for adolescents.
References
Debella A, Tamire A, Bogale K, Berhanu B, Mohammed H, Deressa A, et al. Sexual and reproductive health literacy and its associated factors among adolescents in Harar town public high schools, Harari, Ethiopia, 2023: a multicenter cross-sectional study. Front Reprod Health 2024; 6:1358884. DOI:10.3389/frph.2024.1358884
Nematzadeh S, Shahhosseini Z, Moosazadeh M, Hamzehgardeshi Z. Sexual health literacy level and its related factors among married medical sciences college students in an Iranian setting: a web based cross sectional study. Reprod Health 2024; 21(1):53. DOI:10.1186/s12978-024-01756-7
Settheekul S, Fongkaew W, Viseskul N, Boonchieng W, Voss JG. Factors influencing sexual risk behaviors among adolescents: A community-based participatory study. Nurs Health Sci. 2019 Jun; 21(2): 186-97. DOI:10.1111/nhs.12580
Boonmongkon P, Shrestha M, Samoh N, Kanchawee K, Peerawarunun P, Promnart P, et al. Comprehensive sexuality education in Thailand? A nationwide assessment of sexuality education implementation in Thai public secondary schools. Sex Health. 2019 Jun; 16(3): 263-73. DOI:10.1071/SH18121
Norkaew J, Homchampa P, Chanthamath S, Wongkongdech R. SESS Model for Adolescent Sexual Health Promotion: A Quasi-Experimental Two-School Evaluation in Thailand.
Int J Environ Res Public Health. 2025; 22(10): 1536. DOI:10.3390/ijerph22101536
Chevasutho P, Jiamjarasrangsri W. Occupational health and safety of sex workers: a review article. Biomed Sci Clin Med 2022; 61(3): 144–52.
Phuwasuwan N, Kittipichai W, Chamroonsawasdi K, Taechaboonsermsak P. Sexual health literacy among secondary school students in Chonburi Province. Public Health Policy and Laws Journal 2023; 9(1): 85–95. (In Thai).
Narkbubpha R, Thongma N, Tongpeth J, Sarakshetrin A, Chinglek W. Sexual health literacy among female adolescent students in the educational system, Phetchaburi Province. Journal of The Royal Thai Army Nurses 2024; 25(2): 75–82.
Cherwanitchakorn S, Lapvongwatana P, Chansatitporn N, Lagampan S, Pichayapinyo P. Predictors of sexual and reproductive health literacy among female students in Bangkok, Thailand. Southeast Asian J Trop Med Public Health 2023; 54(6): 1243–53.
Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 2012; 12(1): 80. DOI:10.1186/1471-2458-12-80
Rashidi K, Watson P, Farahani H, Chesli RR, Abiri FA. Developing and validating the sexual health literacy scale in an Iranian adult sample. Humanities Soc Sci Commun 2023; 10(1): 180. DOI:10.1057/s41599-023-01669-z
World Health Organization. Defining sexual health: report of a technical consultation on sexual health, 28-31 January 2002, Geneva. Geneva: WHO; 2006. Available from: http:// www.who.int/publications/i/item/9789241599905, accessed 20 November, 2025.
Thongnopakun S, Manwong M, Visanuyothin S, Wattanaburanon A, Suwannarat W, Magteppong W. Development and validation of a sexual health literacy measurement tool for pregnancy prevention among adolescents (SHL-PPA). J Multidiscip Healthc 2023; 16: 2417–30. DOI:10.2147/JMDH.S420640
Phuwasuwan N. Sexual health literacy among secondary school students in Chonburi Province. [M.Sc. Thesis in Public Health]. Bangkok: Faculty of Graduate Studies, Mahidol University; 2020. (In Thai).
Nunnally JC, Bernstein IH. Psychometric Theory. 3rd ed. New York: McGraw-Hill; 1994.
Kline RB. Principles and practice of structural equation modeling. 5th ed. New York: Guilford Press; 2022.
Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis: a global perspective. Pearson; 2010.
Bloom BS, Thomas HJ, Madaus GF. Handbook on formative and summative evaluation of student learning. USA, NY: McGraw-Hill; 1971.
Tabachnick BG, Fidell LS. Using multivariate statistics. 6th ed. Pearson; 2013.
Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res 1981; 18(1): 39–50. DOI:10.1177/002224378101800104
Henseler J, Ringle CM, Sarstedt M. Testing measurement invariance of composites using partial least squares. Int Mark Rev 2016; 33(3): 405–31. DOI:10.1108/IMR-09-2014-0304
Dunn TJ, Baguley T, Brunsden V. From alpha to omega: a practical solution to the pervasive problem of internal consistency estimation. Br J Psychol 2014; 105(3): 399–412. DOI:10.1111/bjop.12046
DeVellis RF. Scale development: theory and applications. 4th ed. Sage; 2017.
Vongxay V, Albers F, Thongmixay S, Thongsombath M, Broerse JEW, Sychareun V, et al. Sexual and reproductive health literacy of school adolescents in Lao PDR. PLoS One 2019; 14(1): e0209675. DOI:10.1371/journal.pone.0209675
Streiner D. Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess 2003; 80(1): 99–103. DOI:10.1207/S15327752JPA8001_18
Pleasant A, McKinney J, Rikard RV. Health literacy measurement: a proposed research agenda. J Health Commun 2011; 16(sup3): 11–21. DOI:10.1080/10810730.2011.604392
Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st Century. Health Promot Int 2000; 15(3): 259–67. DOI:10.1093/heapro/15.3.259
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Creative Commons License CC-BY-ND
