Measles remains a global health threat, and rising vaccine hesitancy in Malaysia underscores the need for locally tailored communication strategies to strengthen public trust and vaccination. This current research developed and validated the Parental Health Education (PaHE)-Measles toolkit, grounded in the Health Belief Model, to support parental confidence and the uptake of measles, mumps, and rubella (MMR) vaccination in Malaysia through a four-stage process: information gathering, preliminary adaptation design, preliminary adaptation testing, and adaptation refinement. Five multidisciplinary experts validated its content both in Malay and English, and 10 health care providers confirmed overall quality. The acceptability was assessed among 30 end-users. The PaHE-Measles achieved a Content Validity Index (CVI) score of 1.0 from expert reviewers, whereas health care providers rated its understandability and actionability more than 80%. End-users reported an average score of over 9.0. In conclusion, PaHE-Measles is a valid and ready toolkit for educating parents, countering misinformation, and strengthening vaccine confidence.
Institute for Public Health (IPH). National Health and Morbidity Survey (NHMS) 2016: Maternal and Child Health. Vol. II: Findings. Vol 2. Selangor, Malaysia: Institute for Public Health, Ministry of Health Malaysia; 2016.
6.
BinnsCLowWYBeware the red spots: public health challenges of measles and World Health Day. Asia Pac J Public Health. 2025;37(4):329-331. doi:10.1177/10105395251339950
7.
Immunization Agenda 2030 Partners. Immunization agenda 2030: a global strategy to leave no one behind. Vaccine. 2024;42:S5-S14. doi:10.1016/j.vaccine.2022.11.042
8.
GastañaduyPAGoodsonJLPanagiotakopoulosLRotaPAOrensteinWAPatelM.Measles in the 21st century: progress toward achieving and sustaining elimination. J Infect Dis. 2021;224(4):S420-S428. doi:10.1093/infdis/jiaa793
9.
de FigueiredoASimasCKarafillakisEPatersonPLarsonHJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. Lancet. 2020;396(10255):898-908. doi:10.1016/S0140-6736(20)31558-0
10.
Institute for Public Health (IPH). Technical Report National Health and Morbidity Survey (NHMS) 2022: Maternal and Child Health, Malaysia. Selangor, Malaysia: National Institutes of Health, Ministry of Health Malaysia; 2023.
11.
DanchinMNolanT.A positive approach to parents with concerns about vaccination for the family physician. Aust Fam Physician. 2014;43(10):690-694.
12.
Yale Institute for Global Health UNICEF. Vaccine Messaging Guide-Evidence-Based Guidance for Fostering Demand for Immunization through Social and Behavior Change Communications. New York: UNICEF; 2020.
13.
JonesCLJensenJDScherrCLBrownNRChristyKWeaverJ.The Health Belief Model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation. Health Commun. 2015;30(6):566-576. doi:10.1080/10410236.2013.873363
14.
BarreraMCastroFG.A heuristic framework for the cultural adaptation of interventions. Clin Psychol: Sci Pract. 2006;13:311-316. doi:10.1111/j.1468-2850.2006.00043.x
15.
Health Education Division. Promotional Materials. Ministry of Health Malaysia. Accessed September 25, 2021. https://infosihat.moh.gov.my/.
16.
AwadhAIHassaliMAAl-lelaOQBuxSHElkalmiRMHadiH.Does an educational intervention improve parents’ knowledge about immunization? Experience from Malaysia. BMC Pediatr. 2014;14(1):254. doi:10.1186/1471-2431-14-254
17.
WilliamsSERothmanRLOffitPASchaffnerWSullivanMEdwardsKM.A randomized trial to increase acceptance of childhood vaccines by vaccine-hesitant parents: a pilot study. Acad Pediatr. 2013;13(5):475-480. doi:10.1016/j.acap.2013.03.011
18.
IbraheemRAkintolaMAbdulkadirMAmeenHBolarinwaOAdeboyeM.Effects of call reminders, short message services (SMS) reminders, and SMS immunization facts on childhood routine vaccination timing and completion in Ilorin, Nigeria. Afr Health Sci. 2021;21(2):951-959. doi:10.4314/ahs.v21i2.57
19.
ZamanzadehVGhahramanianARassouliMAbbaszadehAHamid AlaviMAli-RezaN.Design and implementation content validity study: development of an instrument for measuring patient-centered communication. J Caring Sci. 2015;4(2):165-178. doi:10.15171/jcs.2015.017
20.
ShoemakerSJWolfMSBrachC.Development of the Patient Education Materials Assessment Tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information. Patient Educ Couns. 2014;96(3):395-403. doi:10.1016/j.pec.2014.05.027
21.
ChanHKSoelarSAMd AliSMAhmadFAbu HassanMR. Trends in vaccination refusal in children under 2 years of age in Kedah, Malaysia: a 4-year review from 2013 to 2016. Asia Pacific J Public Health. 2018;30(2):137-146. doi:10.1177/1010539517751312
22.
Family Health Development Division. Guidelines for Managing Vaccine-Hesitant or Vaccine-Refusing Parents. 1st ed. Selangor, Malaysia: Ministry of Health Malaysia; 2021.
23.
NovillaMLBGoatesMCRedelfsAH, et al. Why parents say no to having their children vaccinated against measles: a systematic review of the social determinants of parental perceptions on MMR vaccine hesitancy. Vaccines (Basel). 2023;11(5):926. doi:10.3390/vaccines11050926
24.
WongLPWongP-FAbu BakarS.Vaccine hesitancy and the resurgence of vaccine preventable diseases: the way forward for Malaysia, a Southeast Asian country. Hum Vaccin Immunother. 2020;16:1-10. doi:10.1080/21645515.2019.1706935
25.
PolitDFBeckCTOwenSV.Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459-467. doi:10.1002/nur.20199
26.
Diez-CansecoFZavala-LoayzaJABeratarrecheaA, et al. Design and multi-country validation of text messages for an mHealth intervention for primary prevention of progression to hypertension in Latin America. JMIR Mhealth Uhealth. 2015;3(1):e19. doi:10.2196/mhealth.3874
27.
LauASYYusoffMSBLeeYYChoiSBXiaoJZLiongMT. Development and validation of a Chinese translated questionnaire: a single simultaneous tool for assessing gastrointestinal and upper respiratory tract related illnesses in pre-school children. J Taibah Univ Med Sci. 2018;13(2):135-141. doi:10.1016/j.jtumed.2017.11.003
28.
FarizanNHSutanRHodRManiK.Development and validation of a health educational booklet. J Health Res. 2020;34:233-246. doi:10.1108/JHR-05-2019-0101
29.
Otsuka-OnoHHoriNOhtaHUemuraYKamibeppuK.A childhood immunization education program for parents delivered during late pregnancy and one-month postpartum: a randomized controlled trial. BMC Health Serv Res. 2019;19(1):798. doi:10.1186/s12913-019-4622-z
