Measurement Development of Health Literacy and Unwanted Pregnancy Prevention Behavior for Thai Female Adolescents


  • Ungsinun Intarakamhang Behavioral Science Research Institute, Srinakharinwirot University
  • Thanchanok Khumthong Division of the Department of Health Service Support, Ministry of Public Health


measurement, health literacy, adolescent pregnancy, /unwanted pregnancy preventing, sexual risk behavior, path model


The unwanted pregnancy rate of Thai female adolescents under 20 years of age was as high as 14.7 percent, which was more than 10 percent of the World Health Organization standard. Thus, this research aims to 1) develop a Health Literacy (HL) Scale for unwanted pregnancy prevention of Thai female adolescents, 2) evaluate the level of HL of Thai female adolescents, and 3) confirm the path model of HL that influences the unwanted pregnancy preventing behaviors. The subjects used to test the research hypothesis were adolescents aged 15 to 21 years old of 2,001 subjects by stratified random sampling and quota sampling including 500 subjects per each of 4 regions in Thailand. The results showed that: 1) the HL Scale was a five-level scale questionnaire in total 71 items, with a reliability of Cranach’s alpha-coefficient between .847 to .928 and a good range of factor loading from .403 to .834, 2) the overall HL of the subjects was at the low level for 95.5 percent. The unwanted pregnancy preventing behaviors were at the fair level for 51.4 percent of total subjects, at a low level and very good at 46.7 and 1.8 3 percent respectively, and 3) the path model of HL that influence health behaviors were consistent with the empirical data with a Chi-Square=321.08, df=29, pvalue=0.00, RMSEA=.071, GFI=0.96, CFI= 0.96 as the illustrations show. It was also found that Health Literacy skills directly influenced on unwanted pregnancy preventing behaviors.Finally, basic/functional Health literacy had a significant indirect relationship with unwanted pregnancy preventing behaviors through communicative/interactive health literacy and critical health literacy; the weights of influence were .26, .86 and .43 respectively. Therefore, the promotion guideline on the unwanted pregnancy preventing behaviors should be beginning by evaluating HL levels of the female adolescents, and then developing program for enrichment each HL level related sexual risk behavior and technics to prevent pregnancy.


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WHO. Pregnant adolescent: delivering on global promise of hope. Geneva: National Center for Health Statistics; 2006.

Information and Communication Technology Center. The social situation analysis Report: The development of information system in social map in 2013.Bangkok: Office of the Permanent Secretary, Ministry of Social Development and Human Security; 2013. (In Thai).

Information and Communication Technology Center. Childhood status of Thai adolescents.Bangkok: Ministry of Social Development and Human Security; 2011. Retrieved on August 12, 2014 from (In Thai).

Reproductive Health Bureau. Reproductive health situation in teens and youth. Bangkok: Department of Health, Ministry of Public Health; 2007. (In Thai).

Reproductive Health Bureau. Birth statistics for Thai teens in 2013. Bangkok: The Printing Office Agency to assist veterans in Royal Shu patham; 2014. (In Thai).

Nomsiri, A., Srisiri, S.,Virutsetazin, K., &Malarat, A. Development of sexual health literacy indicators for early adolescent. Thammasart Medical Journal 2015; 15(4): 609-621. (In Thai).

Shrestha, S.Socio-cultural factors influencing adolescent pregnancy in rural Nepal. International Journal of Adolescent Medicine and Health 2002; 14(2): 101-9.

Khaikeow, S. Teenage pregnancy: Health promotion. Journal of Nursing Science2004; 21(1): 20-27. (In Thai).

Commission. Report of the commission on the national reform in public health and environment, topic “Health literacy and health communication reform”. Bangkok: The secretariat of the house of representatives, officiated national reform steering assembly; 2016. (In Thai).

WHO. Health promotion glossar. Geneva:WHO Publications; 1998.

Nutbeam, D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International 2000;15(3): 259-267. doi: 10.1093/heapro/15.3.259.

Manganello, J. A. Health Literacy and adolescents: a framework and agenda for future research.Health Education Research 2008; 23(5): 840-847. doi: 10.1093/her/cym069.

Edwards, M., Wood, F., Davies, M., & Edwards, A. The development of health literacy in patients with a longterm health condition: The health literacy pathway model. BMC Public Health 2012; 12(130): 1-15.

Intarakamhang, U.,& Kwanchuen, Y. The development and application of the ABCDE-health literacy scale for Thai adults. Asian Biomedicine 2016; 10(6): 587-594. doi: 10.5372/1905-7415.1006.527.

Sørensen,K. Health literacy: the neglected European public health disparity. Maastricht University, the Netherlands; 2013.

Osborne, R.H., Batterham, R.W., Elsworth, G.R., Hawkins, M., & Buchbinder, R. The grounded psychometric development and initial validation of the health literacyquestionnaire (HLQ). BMC Public Health 2013;13: 1-17.

Nutbeam, D. The evolving concept of health literacy. Social Science & Medicine 2008; 67(12): 2072-8.

Nutbeam, D. Defining and measuring health literacy: what can we learn from literacy studies? Int. J Public Health 2009; 54: 303-305.

Tripetchsriurai, N.,&Kedcham, D. The development of health literacy assessment tools for obesity among the secondary school students: grade 9 (phase 1). Bangkok: Samcharoen Panich (Bangkok) Ltd.; 2011. (In Thai).

Davis, T. C., Wolf, M. S., Arnold, C. L., Byrd, R. S.,Long, S. W., Springer, T.,Kennen, E., & Bocchini, J. A. Development and validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): A tool to screen adolescents for below-grade reading in health care settings. Pediatrics 2006; 118(6): e1707-14. doi: 10.1542/peds.2006-1139.

Norman, C. D.,& Skinner, H. A. eHEALS: The eHealth literacy scale. Journal Medication International Research 2006; 8(4): e27.doi: 10.2196/jmir.8.4.e27.

Chang, L. Health literacy, Self-reported status and health promotion behaviors for adolescents in Taiwan. Journal of Clinical Nursing 2011;20: 190-196.doi: 10.1111/j.1365-2702.2009.03181.x.

Murphy, R., Straebler, S., Cooper, Z., &Fairburn, C. G. Cognitive behavioral therapy for eating disorders. Psychiatr Clin North Am2010; 33(3): 611–627.doi: 10.1016/j.psc.2010.04.004.

Cronbach, L. J. Essentials of psychological testing. New York: Harper & Row; 1990.

Diamantopoulos, A., & Siguaw, J. A. Introducing LISREL. London: Sage Publications; 2000.

Saiyod, L., & Saiyod, A. Educational research technique. Bangkok: Suriyasan Publishers, Co., Ltd.; 1995. (In Thai).

Singthong,N., Raecha, W., Chantrima, P., Taweechep, T., Faengna, S., Namnuy, S.,& others. Risk behavior in premature pregnancy, Secondary school in Tumbon Banprang, Amphoe Dan khun Thot, Nakhon Ratchasima Province.The 2ndNational Conference & Research Presentation “Create and Development to Approach ASEAN Community II” on 18-19 June 2015 at Nakhonratchasima Colledge; 2015. (In Thai).

Lertsakornsiri., M. Factors associated with unwanted adolescent women pregnancy in the perceived of the first year students at Saint Louis College. Journal of The Royal Thai Army Nurses2014; 15(1): 90-98. (In Thai).

Sriweingya,J., &Kasiphol, T. Factors related to sexual risk behaviors among grad 2 of secondary school students Bangapi, Bangkok. Proceeding in the 6th National and International Conference in Science2015; 1(6): 114-122. (In Thai).



How to Cite

Intarakamhang, U., & Khumthong, T. (2017). Measurement Development of Health Literacy and Unwanted Pregnancy Prevention Behavior for Thai Female Adolescents. Journal of Public Health Nursing, 31(3), 19–38. Retrieved from



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