Development and Psychometric Evaluation of a Sexual and Reproductive Health Literacy (SRHEL) Assessment Tool: A Methodological Study

Abstract

Background: Health literacy is a key determinant of women’s health and a driver of social and economic progress. This study developed and validated a tool to assess sexual and reproductive health literacy (SRHEL), providing a reliable instrument to enhance women’s health and empowerment. Objectives: This study aims to design and validate a comprehensive instrument to assess SRHEL among Iranian women, providing a reliable basis for future interventions to enhance SRHEL and informed health decision-making. Methods: This was a sequential exploratory mixed-method study conducted among women aged 18 - 45 years in 2024 in Tehran, Iran. In the first stage, conventional content analysis and a review of the literature were undertaken to clarify the concept and dimensions of SRHEL. In the second stage, the four steps of the Waltz model were used to design the SRHEL tool. Psychometric evaluation was performed by assessing content validity, face validity, construct validity, and reliability and stability of the tool. Results: Four main themes emerged from the first stage: Sexual and reproductive health (SRH) knowledge, information literacy, comprehensive information evaluation, information evaluation skill, and SRH competency. During the content analysis, items were edited and 26 items were removed. The tool's scale content validity ratio (S-CVR) and Scale-Level Content Validity Index/average (S-CVI/Ave) were 0.88 and 0.975, respectively. In the exploratory factor analysis (EFA), one item was removed and 40 items were extracted across five factors, which explained 52.33% of the variance. Cronbach's alpha and intraclass correlation coefficient (ICC) were 0.91 and 0.93 for the entire tool, indicating its validity and reliability. Conclusions: The SRHEL is a valid tool that can measure SRHEL using 40 items across five dimensions, each evaluated on a five-point Likert scale (never to always). Achieving higher levels of SRHEL can yield many benefits beyond health.