Researchers developed and validated a new questionnaire measuring women’s knowledge and attitudes toward folic acid across Thailand and Yemen, involving 538 women. The tool showed strong reliability for measuring attitudes (consistency score of 0.88 in both countries) but revealed that women understand when and where to get folic acid better than why it prevents birth defects. According to Gram Research analysis, this questionnaire provides a reliable instrument for identifying knowledge gaps in diverse cultural settings.
Researchers created and tested a new questionnaire to measure how much women know about folic acid and what they think about taking it. Folic acid is a B vitamin that helps prevent serious birth defects. The study involved 538 women from Thailand and Yemen to make sure the questionnaire works across different cultures and countries. The results show the tool is reliable and can help doctors and public health workers understand women’s knowledge gaps about this important vitamin, especially in countries with fewer resources.
Key Statistics
A 2026 cross-sectional study of 538 women from Thailand and Yemen found that a newly developed folic acid knowledge and attitudes questionnaire demonstrated strong internal consistency for attitude measurement (Cronbach’s alpha = 0.88 in both populations).
The 2026 questionnaire validation study revealed that women scored highest on questions about dietary sources and timing of folic acid supplementation, but significantly lower on questions about the biological mechanisms and statistical risks of neural tube defects.
In the Yemeni sample of 434 women, the questionnaire showed excellent model fit with an RMSEA of 0.054 and CFI of 0.973, indicating the measurement tool reliably captures attitudes toward folic acid across culturally diverse populations.
The Quick Take
- What they studied: Can researchers create a reliable questionnaire that measures what women know about folic acid and their attitudes toward taking it in different countries?
- Who participated: 538 women of childbearing age (ages when they could become pregnant) from two countries: 104 from Thailand and 434 from Yemen. They answered questions online about their knowledge and beliefs regarding folic acid.
- Key finding: The questionnaire works well for measuring attitudes toward folic acid in both countries, with strong consistency scores (0.88 out of 1.0 in both groups). However, women’s knowledge about folic acid varied widely, with better understanding of food sources and timing but weaker understanding of the science behind why it matters.
- What it means for you: If you’re a woman of childbearing age, this research helps doctors create better tools to understand what you know about folic acid and design better education programs. The tool can help identify where women need more information about this important vitamin.
The Research Details
Researchers created a new questionnaire (a set of survey questions) to measure women’s knowledge and attitudes about folic acid. They started by reviewing existing research and talking to experts to decide what questions to ask. The questionnaire included questions about basic information (age, education), eight questions testing knowledge about folic acid, and ten questions about attitudes and beliefs.
They tested this questionnaire with 538 women from Thailand and Yemen using an online survey. The researchers used statistical methods to check if the questions were reliable and measured what they were supposed to measure. They used something called factor analysis, which is like sorting questions into groups based on what they’re really measuring.
The study was cross-sectional, meaning researchers collected information from women at one point in time rather than following them over months or years. This type of study is good for developing and testing new measurement tools.
Having a reliable questionnaire is important because it lets researchers and doctors accurately measure what women understand about folic acid. Without a good measurement tool, it’s hard to know if education programs are working or where to focus efforts. This questionnaire can work across different cultures and countries, which is valuable because folic acid awareness varies greatly around the world.
The study shows several signs of quality: the questionnaire was tested with two very different populations (Thailand and Yemen), the researchers checked if questions were consistent and reliable, and they used proper statistical methods to validate their tool. The attitude section of the questionnaire performed very well in both countries. However, the knowledge section was less consistent in the Yemeni sample, suggesting that knowledge questions may need adjustment for different cultural contexts. The study was published in PLoS ONE, a peer-reviewed scientific journal.
What the Results Show
The questionnaire successfully measured women’s attitudes toward folic acid in both countries, with excellent consistency (Cronbach’s alpha of 0.88 in both Thai and Yemeni groups). This means if you asked the same women the same questions again, you’d get similar answers, which shows the tool is reliable.
Women’s knowledge about folic acid showed interesting patterns. They scored highest on questions about food sources of folic acid and when to take it (timing). However, they scored lower on questions about the biological reasons why folic acid matters and statistics about birth defects. This suggests women may know the practical ‘what and when’ but not always understand the ‘why.’
The questionnaire’s structure worked well in both countries, though it performed slightly better in Yemen according to statistical measures. The tool successfully adapted to different cultural contexts while maintaining its reliability, which was the main goal of the study.
The study found that knowledge about folic acid is not uniform across different topics. Women understood dietary sources better than scientific concepts. This suggests that public health messages focusing on food sources may be more effective than messages about biological mechanisms. The questionnaire’s attitude section was particularly strong, indicating that measuring what women think and feel about folic acid is more straightforward than measuring what they know.
According to Gram Research analysis, previous studies showed that reliable tools for measuring folic acid knowledge and attitudes were limited, especially for use across different cultures. This new questionnaire fills that gap by providing a validated instrument that works in both developed and resource-limited settings. The study builds on earlier research showing that awareness and uptake of folic acid vary significantly by country and culture.
The study has several limitations to consider. The Yemeni sample was much larger than the Thai sample (434 vs. 104 women), which could affect comparisons between countries. The knowledge section of the questionnaire showed weaker consistency in Yemen, suggesting it may need adjustment for different populations. The study used online surveys, which means it may have missed women without internet access or those less comfortable with technology. Additionally, the study measured knowledge and attitudes at one point in time, so it doesn’t show whether these beliefs change over time or whether they actually predict whether women take folic acid.
The Bottom Line
Women of childbearing age should ensure they understand the importance of folic acid supplementation, particularly before and during pregnancy. Healthcare providers should use tools like this questionnaire to identify knowledge gaps and tailor education accordingly. Public health programs should focus on explaining not just what folic acid is and when to take it, but also why it matters for preventing birth defects. Confidence level: High for the reliability of the measurement tool; moderate for specific recommendations pending additional research on how knowledge translates to behavior.
This research matters most for women of childbearing age, healthcare providers, public health officials, and organizations working in Thailand, Yemen, and similar settings. It’s particularly relevant in countries where folic acid awareness is low and birth defects from folic acid deficiency are more common. Healthcare workers designing education programs should pay special attention to these findings.
The questionnaire can be used immediately in research and public health settings to assess knowledge and attitudes. However, changes in actual folic acid supplementation behavior and reductions in birth defects would take longer—typically several months to years—depending on how well education programs are implemented and how accessible folic acid supplements are.
Frequently Asked Questions
What is folic acid and why do women need to know about it?
Folic acid is a B vitamin that helps prevent serious birth defects called neural tube defects. Women of childbearing age should take folic acid supplements before and during pregnancy to protect their babies’ development. Many women don’t understand why it’s important, which is why researchers created this questionnaire.
How reliable is this new questionnaire for measuring what women know about folic acid?
The 2026 study found the questionnaire highly reliable for measuring attitudes (consistency score 0.88 out of 1.0 in both Thailand and Yemen). The knowledge section was reliable in Thailand but less consistent in Yemen, suggesting it may need cultural adjustments for some populations.
Why do women in different countries have different knowledge about folic acid?
The study showed that awareness and understanding of folic acid vary significantly between Thailand and Yemen due to differences in healthcare systems, education, cultural beliefs, and access to information. This questionnaire helps identify these gaps so public health programs can be tailored to each community’s needs.
What did the study find about what women understand least about folic acid?
Women scored lowest on questions about the biological reasons folic acid prevents birth defects and statistics about how common these defects are. They understood better where to find folic acid in food and when to take supplements, suggesting education should focus more on the ‘why.’
Can this questionnaire be used in countries other than Thailand and Yemen?
The study suggests the questionnaire can be adapted for use in other culturally diverse settings, though it may need adjustments. The tool showed it works across very different populations, making it promising for use in other low-resource countries and cross-cultural research.
Want to Apply This Research?
- Track weekly folic acid supplement intake (yes/no) and monthly knowledge self-assessment scores using the questionnaire items to monitor both behavior and understanding over time.
- Use the app to take the knowledge assessment quiz monthly, identify weak areas (such as understanding biological benefits), and receive targeted educational content addressing those specific gaps before attempting to increase supplement adherence.
- Establish a baseline knowledge score using the questionnaire, set a goal to improve understanding of folic acid’s role in preventing birth defects, and track progress quarterly while logging daily supplement intake to correlate knowledge improvements with behavior change.
This research describes the development of a measurement tool and does not provide medical advice about folic acid supplementation. Women of childbearing age should consult with their healthcare provider about appropriate folic acid supplementation, especially if planning pregnancy or currently pregnant. The findings reflect attitudes and knowledge in specific populations and may not apply universally. This article summarizes research findings and should not replace professional medical guidance.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.