Development and Validation of a Questionnaire on Socio-Cultural Factors Among the Orang Asli and General Population in Selangor

Last reviewed: March 2026

Summary

This study described the development and psychometric validation of a questionnaire designed to measure socio-cultural factors affecting health and healthcare access among the Orang Asli (indigenous peoples) and general population in Selangor, Malaysia. Recognising that standard health surveys often fail to capture the unique socio-cultural determinants of health in indigenous communities, the researchers constructed a culturally appropriate instrument through a rigorous multi-stage development process.

Background

The Orang Asli of Peninsular Malaysia comprise 18 distinct sub-ethnic groups within three main categories: the Negrito (Semang), the Senoi, and the Proto-Malay (Aboriginal Malay). With a population of approximately 200,000, they represent about 0.7% of Malaysia’s total population. Despite significant government investment in development programmes through the Department of Orang Asli Development (JAKOA), persistent health disparities between Orang Asli communities and the broader Malaysian population remain well documented. These disparities span virtually all health indicators, from infectious disease burden to nutritional status, maternal and child health outcomes, and chronic disease prevalence.

Research increasingly recognises that purely biomedical approaches to understanding these disparities are insufficient. Socio-cultural factors — including health beliefs, traditional healing practices, community social structures, language barriers, cultural attitudes toward modern medicine, and historical experiences with healthcare systems — significantly influence health-seeking behaviour, treatment adherence, and health outcomes in indigenous communities worldwide. However, measuring these socio-cultural factors requires validated instruments that are culturally sensitive, linguistically appropriate, and psychometrically sound.

At the time of this study, no validated questionnaire existed specifically for assessing socio-cultural health determinants among Malaysia’s Orang Asli population. Most studies relied on either generic health surveys (which miss indigenous-specific factors) or qualitative methods (which, while rich in detail, are difficult to scale for larger population studies). This gap motivated the development of a purpose-built instrument.

Methods

The questionnaire development followed established methodological guidelines for health measurement instruments. The process comprised several stages: first, a comprehensive literature review and qualitative formative research (including focus group discussions and key informant interviews with Orang Asli community members and healthcare providers) generated an initial item pool reflecting the full range of relevant socio-cultural constructs. Items were drafted in both Malay and English to ensure linguistic accessibility.

Second, content validation was performed by an expert panel comprising public health researchers, anthropologists with Orang Asli expertise, and community health practitioners. Experts rated each item for relevance, clarity, and cultural appropriateness, and content validity indices were calculated. Items falling below acceptable thresholds were revised or eliminated.

Third, the refined questionnaire was pilot-tested with a sample of Orang Asli and non-Orang Asli respondents to assess comprehension, response patterns, and administration feasibility. Fourth, the validated questionnaire was administered to a larger sample for psychometric evaluation including exploratory factor analysis (to examine construct validity and identify underlying factor structures), internal consistency assessment (using Cronbach’s alpha coefficients), and test-retest reliability evaluation.

Key Results

The final questionnaire encompassed several key domains identified through the development process. These included cultural health beliefs and practices (covering traditional explanatory models for illness, spiritual healing concepts, and cultural dietary practices), use of traditional and complementary medicine (including frequency, types, and perceived effectiveness of traditional remedies), social support and community networks (assessing the role of family, community leaders, and tribal structures in health decisions), barriers to modern healthcare access (including geographic, financial, linguistic, and cultural barriers), and health knowledge and information sources.

Factor analysis confirmed a coherent multi-dimensional structure consistent with the theoretical framework underpinning the instrument. Internal consistency was acceptable across all identified factors, with Cronbach’s alpha values meeting or exceeding conventional thresholds for research instruments. The questionnaire demonstrated the ability to discriminate between Orang Asli and non-Orang Asli respondents on relevant socio-cultural dimensions, supporting its criterion validity.

Discussion

The validated questionnaire fills an important methodological gap in Malaysian public health research. By providing a standardised tool for measuring socio-cultural health determinants in Orang Asli communities, it enables more systematic and comparable research across different Orang Asli sub-groups, geographic settings, and time periods. The instrument can be used to identify specific socio-cultural barriers to healthcare access, to evaluate the cultural appropriateness of health interventions, and to monitor changes in socio-cultural factors over time as communities undergo development transitions.

The development process itself yielded valuable insights into the socio-cultural landscape of Orang Asli health. The qualitative formative research highlighted the continuing importance of traditional healing practices alongside growing acceptance of modern medicine, the central role of community leaders in health decision-making, and the complex interplay between cultural identity and engagement with government health services.

Limitations

The questionnaire was developed and validated primarily with Orang Asli communities in Selangor, which include predominantly Temuan sub-ethnic populations. Its applicability to other Orang Asli sub-groups in different states — particularly the more geographically isolated Negrito and Senoi communities — requires further validation. Cross-cultural measurement is inherently challenging, and some nuances of socio-cultural experience may not be fully captured by a structured questionnaire format. The study did not assess the instrument’s sensitivity to change over time, which would be important for evaluative applications.

Implications

The availability of a validated socio-cultural health questionnaire for Orang Asli populations supports more rigorous and culturally informed research on indigenous health disparities in Malaysia. It provides a foundation for large-scale epidemiological studies that incorporate socio-cultural variables alongside biomedical measures, for the evaluation of culturally tailored health interventions, and for evidence-based advocacy to improve health services for indigenous communities.