Development and Validation of a Psychometric Questionnaire to Measure Knowledge and Attitudes Towards Traditional Male Circumcision and the Links with HIV Transmission in Indonesia

Traditional male circumcision (TMC) is viewed as a rite of passage from childhood to manhood. In the Atoni Meto tribe in Indonesia, this practice requires initiates to engage in unprotected sexual intercourse with unrelated women following circumcision, thereby exposing both men and women to the risk of HIV transmission. However, there is a lack of validated questionnaires in Indonesia to measure knowledge and attitudes towards TMC and the associated risk of HIV transmission. This study aimed to develop and validate a questionnaire aimed at measuring the knowledge and attitudes of men aged 18 to 49 years in West Timor, Indonesia, regarding TMC and the risk of HIV transmission linked to the practice and subsequent sexual intercourse. A series of validations was conducted, including content validity, face validity, test-retest reliability, exploratory factor analysis, and inter-item correlation. The EFA was conducted with 140 participants. The Kaiser–Meyer–Olkin test for the knowledge factor was 0.759, and the attitudes factor was 0.797, with Bartlett’s test of sphericity p-value < 0.001 indicating that the data were suitable to proceed with further factor analysis. Cronbach’s alpha values for knowledge and attitudes were 0.861 and 0.824, respectively, suggesting good internal consistency. The questionnaire provides preliminary evidence of its validity and reliability in assessing Indonesian men’s knowledge and attitudes on TMC and HIV transmission.