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Background <p>Declining fertility rates and limited awareness of fertility risk factors pose major reproductive health challenges. FertiSTAT is a self-assessment tool for fertility risk awareness but has not been culturally adapted suitable for Indonesian population.</p> Objective <p>To perform transcultural adaptation and evaluate the validity and reliability of the Indonesian version of FertiSTAT as a screening tool for fertility risk awareness for Indonesian population.</p> Methods <p>This methodological study was conducted involving 7 expert panel members, 4 certified translators, and 92 subjects, through a 6 stages transcultural adaptation process which included expert content validation, forward–backward translation, face validation, cognitive debriefing, and test–retest reliability assessment. Content validity was measured using the Content Validity Index, while reliability was assessed using Cohen’s kappa and Spearman correlation.</p> Results <p>All items retained conceptual equivalence and cultural relevance. Content validity showed CVI &gt; 0.80 for all items and face validity demonstrated mean Likert scores &gt; 3. Test–retest reliability showed variable agreement; several items achieved strong consistency, while lower values were mainly due to sensitive, subjective, fluctiative or strong homogenity of test-retest responses. Stability was sufficient for screening purposes. One additional item, tuberculosis was included on expert panel recommendations due to its prevalence and relevance to infertility in Indonesia.</p> Conclusion <p>The Indonesian version of FertiSTAT demonstrated good content and face validity following transcultural adaptation, with preliminary test-retest reliability findings showed variation across individual items, likely reflecting differences in item sensitivity, subjectivity, and or low-variability nature of some questions. Nevertheless, these items were retained based on expert panel judgment regarding their conceptual and clinical relevance, and future refinement may include brief explanatory notes to support more consistent interpretation by respondents. Further studies with larger, more diverse populations may be needed to strengthen psychometric evaluation and confirm broader clinical and public health applicability. Beyond its clinical relevance, the Indonesian version of FertiSTAT may also support policy development, public health promotion, and fertility awareness campaigns by providing a structured means of improving fertility-related knowledge. It also has potential for integration into digital health applications, which may improve access to fertility awareness information and support earlier decision making and health-seeking behavior.</p>

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Transcultural adaptation, validity and reliability testing of infertility risk self-assessment questionnaire (FertiSTAT) to Indonesian language a methodological study

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  • 发表日期：

    2026年7月3日

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  • Andon Hestiantoro,
  • Utomo Budidarmo,
  • Gita Pratama,
  • Aria Kekalih

摘要

Background

Declining fertility rates and limited awareness of fertility risk factors pose major reproductive health challenges. FertiSTAT is a self-assessment tool for fertility risk awareness but has not been culturally adapted suitable for Indonesian population.

Objective

To perform transcultural adaptation and evaluate the validity and reliability of the Indonesian version of FertiSTAT as a screening tool for fertility risk awareness for Indonesian population.

Methods

This methodological study was conducted involving 7 expert panel members, 4 certified translators, and 92 subjects, through a 6 stages transcultural adaptation process which included expert content validation, forward–backward translation, face validation, cognitive debriefing, and test–retest reliability assessment. Content validity was measured using the Content Validity Index, while reliability was assessed using Cohen’s kappa and Spearman correlation.

Results

All items retained conceptual equivalence and cultural relevance. Content validity showed CVI > 0.80 for all items and face validity demonstrated mean Likert scores > 3. Test–retest reliability showed variable agreement; several items achieved strong consistency, while lower values were mainly due to sensitive, subjective, fluctiative or strong homogenity of test-retest responses. Stability was sufficient for screening purposes. One additional item, tuberculosis was included on expert panel recommendations due to its prevalence and relevance to infertility in Indonesia.

Conclusion

The Indonesian version of FertiSTAT demonstrated good content and face validity following transcultural adaptation, with preliminary test-retest reliability findings showed variation across individual items, likely reflecting differences in item sensitivity, subjectivity, and or low-variability nature of some questions. Nevertheless, these items were retained based on expert panel judgment regarding their conceptual and clinical relevance, and future refinement may include brief explanatory notes to support more consistent interpretation by respondents. Further studies with larger, more diverse populations may be needed to strengthen psychometric evaluation and confirm broader clinical and public health applicability. Beyond its clinical relevance, the Indonesian version of FertiSTAT may also support policy development, public health promotion, and fertility awareness campaigns by providing a structured means of improving fertility-related knowledge. It also has potential for integration into digital health applications, which may improve access to fertility awareness information and support earlier decision making and health-seeking behavior.