Validation of a New Questionnaire Assessing the Health Impact of Divorce on Women: An Exploratory Factor Analysis
Last reviewed: March 2026
Key Findings
- A new questionnaire was developed and validated to assess the physical and psychological health consequences of divorce among Malaysian women, addressing a gap in locally validated instruments.
- Exploratory factor analysis identified distinct dimensions of divorce-related health impact, including physical health symptoms, psychological distress, social functioning, and economic wellbeing.
- The instrument demonstrated acceptable psychometric properties, including adequate internal consistency and construct validity, supporting its use in Malaysian research and clinical settings.
- The study highlighted the multidimensional nature of divorce’s health impact on women, reinforcing the need for holistic post-divorce support services.
Background and Context
Divorce is increasingly recognised as a significant public health concern with far-reaching consequences for physical and mental health. The global research literature has consistently documented associations between marital dissolution and elevated rates of depression, anxiety, cardiovascular disease, immune dysfunction, unhealthy lifestyle behaviours, and increased mortality risk. Women are often disproportionately affected by the health consequences of divorce due to a combination of financial vulnerability, custodial responsibilities, social stigma, and the disruption of established social networks.
In the Malaysian context, divorce rates have been rising across all ethnic and religious communities, driven by socioeconomic changes, shifting cultural norms, and increased urbanisation. The health consequences of this trend, particularly for women, remain under-researched. A critical barrier to advancing this field of inquiry has been the absence of validated measurement instruments specifically designed to capture the health impact of divorce within the Malaysian cultural context. Most existing tools were developed in Western populations and may not adequately reflect the unique social, cultural, and religious dimensions that shape the experience of divorce among Malaysian women.
This study, conducted by researchers at the International Islamic University Malaysia and published in MJPHM in 2016, sought to address this gap by developing and validating a new questionnaire specifically designed to measure the health impact of divorce on women in Malaysia.
Study Design and Methodology
The study followed a rigorous instrument development process comprising several phases. The initial item generation phase drew upon comprehensive literature review, consultation with subject-matter experts in public health, psychology, and family medicine, and qualitative input from divorced women. This process yielded a preliminary pool of items covering multiple domains of health impact, including physical symptoms, psychological wellbeing, social functioning, economic consequences, and self-perceived health status.
Content validity was established through expert panel review, ensuring that the items comprehensively and accurately represented the intended constructs. Face validity was assessed through pilot testing with a sample of divorced women who provided feedback on the clarity, relevance, and acceptability of the items. The refined questionnaire was then administered to a larger sample of divorced women for psychometric evaluation.
Exploratory factor analysis (EFA) was employed to examine the underlying structure of the questionnaire and identify the principal dimensions of divorce-related health impact. The factorability of the data was assessed using the Kaiser-Meyer-Olkin (KMO) statistic and Bartlett’s test of sphericity. Factor extraction was performed using principal axis factoring or principal component analysis, with varimax rotation applied to achieve a simpler and more interpretable factor structure. Internal consistency reliability was evaluated using Cronbach’s alpha coefficients for each identified factor.
Factor Structure and Validation Results
The exploratory factor analysis successfully identified multiple distinct dimensions of divorce-related health impact. The factor structure that emerged reflected the multidimensional nature of divorce’s consequences, encompassing domains that aligned with the theoretical framework underlying the instrument’s development. Items loaded meaningfully onto their respective factors, with factor loadings meeting or exceeding established thresholds for acceptability. The total variance explained by the extracted factors was sufficient to support the construct validity of the instrument.
Internal consistency analysis yielded Cronbach’s alpha values that met or exceeded the conventional threshold of 0.70 for each subscale, indicating that the items within each dimension measured a coherent underlying construct. Corrected item-total correlations confirmed that individual items contributed meaningfully to their respective subscale scores.
| Psychometric Property | Assessment Method | Outcome |
|---|---|---|
| Content validity | Expert panel review | Items comprehensively represent target constructs |
| Face validity | Pilot testing with target population | Items clear, relevant, and culturally appropriate |
| Construct validity | Exploratory factor analysis | Meaningful multi-factor structure identified |
| Internal consistency | Cronbach’s alpha | Acceptable values (≥0.70) across subscales |
| Item quality | Corrected item-total correlations | Items contribute meaningfully to subscale scores |
Health Dimensions of Divorce
The multi-dimensional structure of the questionnaire underscores the complexity of divorce’s impact on women’s health. The physical health dimension captured somatic symptoms such as sleep disturbance, appetite changes, fatigue, pain, and deterioration in self-rated health. These findings are consistent with international research demonstrating that marital dissolution is associated with dysregulation of stress-responsive physiological systems, including the hypothalamic-pituitary-adrenal axis and immune function, which can manifest as diverse physical symptoms.
The psychological dimension encompassed symptoms of depression, anxiety, loss of self-esteem, feelings of failure or shame, and difficulty concentrating. These psychological consequences are particularly relevant in the Malaysian context, where divorce may carry significant social stigma that compounds the emotional distress of the dissolution itself. Research from conservative cultural settings has documented that divorced women often face social disapproval that can lead to isolation, further exacerbating psychological distress.
The social functioning dimension reflected disruptions to social relationships, changes in social activities and participation, and alterations in the woman’s role within her family and community. The economic dimension captured the financial consequences of divorce, including loss of household income, difficulty meeting basic needs, and financial dependency—a particularly salient concern in contexts where women may have limited independent earning capacity or access to financial assets.
Significance for Malaysian Research and Practice
The development of a locally validated instrument for measuring the health impact of divorce on women represents an important contribution to public health research in Malaysia. The availability of such a tool enables researchers to conduct more rigorous studies of divorce-related health outcomes in the Malaysian population, facilitating the identification of risk factors, vulnerable subgroups, and potential intervention targets. Clinicians and social workers can use the instrument to screen divorced women for health problems that might otherwise go unrecognised and to guide referrals to appropriate support services.
The study also has implications for health policy. As divorce rates continue to rise in Malaysia, the health system must be prepared to address the physical and psychological consequences that may follow. The multidimensional nature of divorce’s health impact, as captured by this questionnaire, argues for integrated support services that address physical health, mental health, social connectedness, and economic stability simultaneously, rather than treating each domain in isolation.
Broader Context: Divorce and Health
The development of this instrument sits within a growing international research effort to understand and quantify the health consequences of divorce. Meta-analytic evidence from dozens of studies across multiple countries has confirmed that divorced individuals experience higher rates of depression, poorer self-rated health, greater use of healthcare services, and elevated mortality risk compared with their married counterparts. The effects are not uniform, however; they are moderated by factors including gender, age, duration of marriage, presence of children, availability of social support, and the circumstances surrounding the divorce.
In Malaysia, where family is a central social institution across all ethnic communities, the disruption caused by divorce extends beyond the couple to affect children, extended family members, and community networks. Understanding these ripple effects through validated measurement tools is essential for developing evidence-based policies and programmes that support family wellbeing and mitigate the health consequences of marital dissolution.
Limitations
The study has several limitations that should be considered when interpreting the findings. Exploratory factor analysis is, by nature, a data-driven technique that identifies patterns within the specific sample studied; the factor structure identified should be confirmed through confirmatory factor analysis in an independent sample. The study did not report test-retest reliability, which would provide additional evidence of the instrument’s stability over time. The generalisability of the questionnaire may be limited by the demographic characteristics of the validation sample, including the ethnic, religious, and socioeconomic composition. Further validation studies across diverse Malaysian populations are recommended.
Conclusion
This study makes a valuable contribution to the field of women’s health research in Malaysia by developing and validating a new questionnaire for assessing the health impact of divorce on women. The instrument’s multidimensional structure reflects the complex interplay of physical, psychological, social, and economic consequences that follow marital dissolution. The availability of a culturally appropriate and psychometrically sound measurement tool will facilitate future research, inform clinical practice, and support the development of evidence-based policies to address the growing public health challenge of divorce in Malaysia.
Citation
Abd. Aziz KH, Abd. Aziz A, Salleh H, Ambak NJ, Ab Rahman NH, Oo SS, Abed NF, Husain R. Validation of a new questionnaire assessing the health impact of divorce on women: an exploratory factor analysis. Malaysian Journal of Public Health Medicine. 2016;16(2).
Licensed under Creative Commons Attribution-NonCommercial 4.0 (CC BY-NC 4.0)