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Research Methods Measurement and Statistics

Fertility awareness among Chinese university students: scale development and cross-sectional study

Niu C, Lu X, Ren Y, Yang F, Ma S, Yu Y, Gao Y, Shen N, Shu J

Frontiers in public health, 14, 1818259, 2026
DOI 10.3389/fpubh.2026.1818259 PMID 42245376 PMC PMC13230133

RRM Academy Synopsis

Chinese university students show low to moderate fertility awareness

Chinese university students scored low to moderate on a new fertility awareness scale. The scale is called FASUS. It has 22 items and came from a literature review, interviews and expert input. 750 students in China completed it in a survey. About 4 out of 10 students reached the high fertility awareness level.

Key Findings

  • The final FASUS has 22 items in three parts: knowledge about fertility (11 items), attitudes toward reproductive health (7 items) and skills for protecting it (4 items). Cumulative variance explained was 67.952%.
  • Reliability was high: Cronbach's α was 0.970 for the total scale, split-half reliability was 0.885, and retest reliability over 2 weeks was 0.981 (n = 50).
  • The 750 surveyed students averaged 78.01 ± 16.44 points (range 22 to 110): 68 at the extremely low level (9.07%), 178 low (23.73%), 189 moderate (25.2%) and 315 high (42%).
  • Gender, ethnicity, educational level, only-child status and earlier education about fertility entered the regression model and explained 57.1% of the variance in scores.
  • The internet was the main source of fertility knowledge (74.4%). Schools were named by 42.1%, family or friends by 29%, and healthcare professionals by 14.8%.

Interpretation

This cross-sectional study surveyed 750 Chinese university students using the new 22-item scale. Most students named the internet as their main source of fertility knowledge, ahead of school and healthcare professionals. The gap points to a role for school health programs and clinicians. The authors note the sample did not fully cover ethnic minorities and some fields of study. Further studies could test the scale in more diverse student groups.

RRM Context

The paper defines fertility awareness using a 2017 glossary. That definition includes how the body makes a baby, the chance of pregnancy, and the risks to fertility. Restorative reproductive medicine takes a different approach: daily cycle charting that tracks fertility signs as they happen.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Global fertility rates are declining. In China, the total fertility rate dropped sharply from 5.59 in 1971 to 1.15 in 2021. Chinese university students often lack adequate fertility awareness, yet no validated instrument exists to assess this construct in this population, despite its recognized importance for informed reproductive decision-making.

Methods

The Fertility Awareness Scale for University Students (FASUS) was developed through literature search, semi-structured interviews, and two rounds of Delphi expert consultation. Psychometric properties were tested using exploratory and confirmatory factor analysis, Cronbach's α, split-half reliability, and test-retest reliability. A cross-sectional survey of 750 students examined fertility awareness levels and influencing factors via univariate analysis and multiple linear regression.

Results

The final FASUS Scale consisted of 22 items across three dimensions: fertility-related knowledge, reproductive health attitudes, and reproductive health skills, with a cumulative variance contribution rate of 67.952%. The scale demonstrated strong reliability (Cronbach's α = 0.97, split-half reliability = 0.885, test-retest reliability = 0.981). A survey of 750 students revealed an average fertility awareness score of 78.01 ± 16.44, indicating a low to moderate level. Key influencing factors included gender, ethnicity, education level, only-child status, and prior fertility knowledge education.

Conclusion

This study utilized a self-developed scale to assess fertility awareness among Chinese university students. The results showed that the fertility awareness level of Chinese university students was generally low. We suggest that health care institutions implement targeted intervention measures to improve reproductive health outcomes.

Topics

By this author

Related research

Research Methods › Measurement and Statistics › Instrument Development and Validation · Body Literacy › Patient Education › Fertility Knowledge and Misconceptions
Changmin Niu, Xueyu Lu, Yue Ren, Fan Yang, Shikun Ma, Yawen Yu, Yuxin Gao, Nuo Shen, Jinhua Shu
C Niu, X Lu, Y Ren, F Yang, S Ma, Y Yu, Y Gao, N Shen, J Shu
PMID 42245376 42245376 DOI 10.3389/fpubh.2026.1818259 10.3389/fpubh.2026.1818259 Niu et al. 2026, Niu 2026

Keywords

fertility awareness, influence factors, level classification, reliability and validity, university students

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