Search results.
We identified 1762 articles using the previously stated databases. After excluding 948 duplicated studies, a total of 814 articles were screened based on titles and abstracts, leading to further 765 articles excluded due to study location other than Malaysia, irrelevant topics and non-English written articles. Forty-nine full text articles were screened, of which 40 articles were further excluded for the following reasons: irrelevant outcomes (22), experimental studies (7), study population aged more than 19 years old (10) and articles with uncertain statistical analysis (1). A total of nine studies were included in this review [10–18]. Three studies were included in the qualitative analysis compared to seven studies in the quantitative analysis, with quantitative and qualitative findings of the mixed methods articles were separated accordingly for the purpose of this review. Figure 1 shows the PRISMA flowchart.
Characteristics of included studies.
A total of 41 939 adolescents aged between 12 to 19 years old were included in this review. Seven studies were conducted at various states in the peninsular of Malaysia, one article was published based on the National Health Morbidity Survey 2012 data and the other article was published based on a national health screening data among adolescents conducted in 2010. A total of six studies conducted among secondary school adolescents [10, 12, 14, 15, 16] and another three were among institutionalized adolescents such as National Service Training Program (PLKN) and rehabilitation homes [11, 18]. Among all, two studies recruited only female participants [10, 16].
Quality assessment.
Quality assessment for each study was conducted using Crowe Critical Analysis Tool; an established and validated tool used in assessing quality of observational studies [8]. A total of seven studies were rated as of high-quality with percentage scores ranged between 75 to 85% and the remaining two were rated as of acceptable quality (total score ranged between 51–74%) [9] as tabulated in Table 2.
Table 2
Crowe Critical Analysis Tool Result
Category
|
Wong, L., P. et al (2012)
|
Nik Farid, N., D., et al (2013)
|
Ahmadian et al., (2014)
|
Abdul Manaf, et al (2014)
|
Ahmad et al (2014)
|
Awaludin et al (2015)
|
Nik Farid et al (2015)
|
Cheah (2016)
|
Nawi et al (2017)
|
Preliminaries (/5)
|
5
|
5
|
5
|
4
|
4
|
4
|
5
|
5
|
5
|
Introduction (/5)
|
4
|
4
|
4
|
3
|
5
|
5
|
4
|
4
|
4
|
Design (/5)
|
4
|
5
|
5
|
3
|
5
|
4
|
3
|
4
|
5
|
Sampling (/5)
|
5
|
4
|
4
|
3
|
4
|
3
|
4
|
3
|
4
|
Data collection (/5)
|
4
|
4
|
4
|
3
|
4
|
4
|
4
|
3
|
4
|
Ethical matters (/5)
|
5
|
5
|
5
|
3
|
5
|
4
|
4
|
3
|
4
|
Results (/5)
|
4
|
4
|
4
|
4
|
4
|
3
|
3
|
3
|
4
|
Discussion (/5)
|
5
|
5
|
5
|
3
|
5
|
3
|
4
|
2
|
4
|
Total score (/40)
|
36
|
36
|
36
|
26
|
36
|
30
|
31
|
27
|
34
|
Percentage (%)
|
90
|
90
|
90
|
65
|
90
|
75
|
77.5
|
67.5
|
85
|
Prevalence of premarital sexual behaviours among Malaysian adolescents.
Prevalence of premarital sexual behaviours among the Malaysia adolescents as reported by history of ever had sex, ranged from 2.9–8.3% among secondary school adolescents [10, 12, 14, 15, 16] and as high as 62.3% among those that were institutionalised [18]. Two studies were conducted in Selangor which recorded prevalence of 4.6% in 2014 [11] and 2.9% in 2017 [15]. Other studies did not specifically mention their study location but were being generalized to either peninsular or east Malaysia. On average, the mean age of was 14 years old [10, 12, 18].
Contributing factors of premarital sexual behaviours among Malaysian adolescents.
All quantitative studies included in this review used questionnaires as their study aimed to measure the association between contributing factors and adolescents’ premarital sexual behaviours, presented as odds ratio (OR) or adjusted odds ratio (AOR). We have specifically categorized the factors identified in this review according to the constructs of the Social Cognitive Theory, personal, behaviour and environmental factors.
a. Personal factors
All the studies included reported mixed findings related to the role of personal factors predicting premarital sexual behaviours among adolescents. Religiosity was mentioned in two of the cross-sectional studies and both qualitative studies [11, 13, 16, 17], with low religiosity was reported to associated with higher risk of premarital sexual behaviours among adolescents. Abdul Manaf et al. [11] reported the highest odds of 11.7 likelihood towards sexual behavior among adolescent due to religiosity (AOR 11.7, 95% CI: 1.3-107.1).
b. Behaviour factors
The review found that most of the articles emphasized the role of behavioural factors predicting premarital sexual behaviours, particularly attitude and involvement in high-risk behaviours. Attitude towards sexual urge, which was also reported by the act of watching and reading pornography and masturbation significantly predict sexual behavior in three of the cross-sectional studies and also in the mixed methods study [10, 11, 13, 18]. Meanwhile, high-risk behaviours such as bullying, smoking and substance intake (alcohol and drugs) were also significantly predicted sexual behaviours among Malaysian adolescents in five of the cross-sectional studies [11, 12, 13, 14, 15]. History of ever used drug predicted the highest likelihood of 7.71 odds towards sexual behaviours among adolescents [12], compared to 6.1 odds by bullying [11].
c. Environmental factors
Meanwhile, family and peers related factors were identified under environmental factors that were associated with sexual behaviours among adolescents. The influence of family, particularly parental role on involvement of adolescents in sexual behaviours were reported in three of the cross-sectional studies [12, 14, 15], one qualitative study [16] and the qualitative findings of the mixed methods study [18]. Having both parents who are still married served as the strongest protective factor (OR 0.41, 95% CI; 0.215–0.789) among Malaysian adolescents, with 59% less likelihood to be involved in sexual behaviours [14]. Meanwhile, the role of peers in influencing sexual behaviours among adolescents were more prominent in the qualitative findings in both qualitative studies [16, 17] and the mixed methods study [18]. Only two of the cross-sectional studies reported the role of peer in influencing sexual behaviours among Malaysian adolescents [10, 12].