This cross-sectional, descriptive study was conducted in Pulau Pinang during January 2005 to April 2005. Pulau Pinang is one of the fourteen states located in the northwest of Malaysia and comprises of the mainland and Penang Island. Its population is 1265.1 thousand . Different ethnic groups inhabiting the state are Malays (42.5%), Chinese (46.5%), Indians (10.6%), and other minorities (0.4%) .
The stages of education system in Malaysia consist of pre-school, priAprily education, secondary education, tertiary education, and postgraduate studies. The education system is attained either through government schools or private schools mandated by Malaysian law and handled by the Ministry of Education. Secondary education comprises of 5 years of schooling known as form 1 to form 5 catering the education needs of children aged between 13 to 18 years. At the end of form 5 students are required to take the Sijil Pelajaran Malaysia (SPM) or the Malaysian Certificate of Education examination, before graduating secondary school. After form 5, students (aged between 18 to 20 years) can take up either matriculation (British 'A' levels, the Canadian matriculation etc) or form 6, comprising of two years of education before students could sit for Sijil Tinggi Persekolahan Malaysia (STPM) or Malaysian Higher School Certificate examination.
Convenience sampling technique was employed for the selection of schools in Penang Island. A total of eleven schools were approached to participate in this survey and the heads from six of the schools gave permission to conduct this study in their schools. All the students belonging to form 4, form 5 and form 6 (representing adolescents and young adults) of the six government schools were included in the study. Private schools in Malaysia mostly represent one out of the three main ethnic groups (Malays, Chinese and Indians). Majority of private schools are either representatives of Chinese population or Indian population. Therefore, in order to avoid bias only government schools were approached with the understanding that they represent all the three main ethnic groups according to their real distribution in the country.
For data collection an 18-item questionnaire was developed in English. The questionnaire was then translated into Bahasa Melayu (national language of Malaysia). Seven questions addressed socio-demographic information, one on the knowledge about different types of STIs, one on symptoms, one on preventive measures, one on the risk groups, one on complications, one on transmission route, one on causative organisms, six on sexual attitudes and history and one on knowledge source. Each knowledge question included multiple options or statements, for example the options for the question on different STIs that the respondents could be aware of included AIDS, syphilis, gonorrhoea, rheumatoid arthritis, herpes, leukemia, chlamydia, trichomoniasis and don't know. The respondents could select more than one option.
Ethical approval was obtained from the Social and Behavioural Research Ethics Committee, University Sains Malaysia. The face and content validity was done by the professionals at the Disciplines of Social and Administrative Pharmacy at University Sains Malaysia and by the Department of Biostatistics General Hospital Pulau Pinang. The reliability scale was applied to all the variables comprising the knowledge domain i.e Knowledge about the different STIs, symptoms, awareness about causes/prevention and diagnosis and therapy. The reliability and internal consistency of the tool were estimated on the basis of Cronbach's Alpha (= 0.81).
To collect data, the head masters of the schools were approached and were requested to give the permission for conducting the survey. Meetings with the students of form 4, form 5, and form 6 were arranged in their class rooms; verbal consent was taken from the students and instructions were given to fill the questionnaires. Students were asked to fold the questionnaire after filling, to maintain the privacy. All questionnaires were anonymous.
Each correct response under a question equaled one score. Maximum score that could be obtained was 33. Participants were evaluated according to the points they received from knowledge questions. Students who scored 0-10 points were designated as having low level of knowledge, 11-21 as moderate level of knowledge and 22-33 high level of knowledge. Results were analyzed statistically using Statistical Package for the Social Sciences (SPSS) for windows version (13.0). Comparisons among groups were made using appropriate inferential tests such as Student t-test, Chi square test, and ANOVA. Statistical significance level used was 0.05.