HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties

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However, there are only a few developed scales among MSM in Thailand and they are not up to date. The objective of this study is to examine the reliability and validity of the HIV preventive behavior measure among Thai men who have sex with men (MSM). Methods The sample comprised 424 Thai MSM aged 25 years or older who had at least one sexual encounter in the past six months. The total sample was randomly divided into two equal subsamples: one used for exploratory factor analysis (EFA) to identify underlying structures, and the other for confirmatory factor analysis (CFA) to verify model fit. Cronbach’s alpha was employed as the primary reliability coefficient because it reflects internal consistency, and the data collection was conducted only once. Convergent and discriminant validity were examined through Pearson’s correlation coefficients with theoretically related and unrelated constructs to assess coherence and distinctiveness of the measure. Results The measure comprised nine items forming two components: (1) denial and avoidance of HIV risk, and (2) self-protective actions before and during sexual activity. CFA indicated an excellent model fit (χ2 = 36.56, p = .06, χ2/df = 1.46, GFI = 0.96, CFI = 0.98, RMSEA = 0.05), meeting recommended criteria for a valid psychometric model. Internal consistency was acceptable (Cronbach’s α = .77). Significant correlations with related scales (he AIDS risk behavior avoidance scale and the AIDS prevention scale) (r = .21 and.16, p < .01) and the absence of correlation with an unrelated measure (Thai Learning Attitude Scale) supported convergent and discriminant validity. Conclusions The scale demonstrated sound psychometric properties and is applicable for future interventions to promote HIV preventive behaviors among Thai MSM." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/12-513", "name": "HIV preventive behavior scale for Thai men who have sex with men (MSM):..." } } ] } Home Browse HIV preventive behavior scale for Thai men who have sex with men (MSM):... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Koomsiri P and Sakunpong N. HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.12688/f1000research.133299.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] Passakorn Koomsiri https://orcid.org/0009-0009-3757-5514 1 , Nanchatsan Sakunpong https://orcid.org/0000-0002-2484-3702 1 Passakorn Koomsiri https://orcid.org/0009-0009-3757-5514 1 , Nanchatsan Sakunpong https://orcid.org/0000-0002-2484-3702 1 PUBLISHED 18 Mar 2026 Author details Author details 1 Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, 10110, Thailand Passakorn Koomsiri Roles: Conceptualization, Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing Nanchatsan Sakunpong Roles: Methodology, Supervision, Validation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Global Public Health gateway. Abstract Background In foreign countries, many scales have been developed to measure HIV prevention behavior. However, there are only a few developed scales among MSM in Thailand and they are not up to date. The objective of this study is to examine the reliability and validity of the HIV preventive behavior measure among Thai men who have sex with men (MSM). Methods The sample comprised 424 Thai MSM aged 25 years or older who had at least one sexual encounter in the past six months. The total sample was randomly divided into two equal subsamples: one used for exploratory factor analysis (EFA) to identify underlying structures, and the other for confirmatory factor analysis (CFA) to verify model fit. Cronbach’s alpha was employed as the primary reliability coefficient because it reflects internal consistency, and the data collection was conducted only once. Convergent and discriminant validity were examined through Pearson’s correlation coefficients with theoretically related and unrelated constructs to assess coherence and distinctiveness of the measure. Results The measure comprised nine items forming two components: (1) denial and avoidance of HIV risk, and (2) self-protective actions before and during sexual activity. CFA indicated an excellent model fit (χ 2 = 36.56, p = .06, χ 2 /df = 1.46, GFI = 0.96, CFI = 0.98, RMSEA = 0.05), meeting recommended criteria for a valid psychometric model. Internal consistency was acceptable (Cronbach’s α = .77). Significant correlations with related scales (he AIDS risk behavior avoidance scale and the AIDS prevention scale) ( r = .21 and.16, p < .01) and the absence of correlation with an unrelated measure (Thai Learning Attitude Scale) supported convergent and discriminant validity. Conclusions The scale demonstrated sound psychometric properties and is applicable for future interventions to promote HIV preventive behaviors among Thai MSM. READ ALL READ LESS Keywords HIV, MSM, Preventive Behavior, Psychometric Properties, Scale Corresponding Author(s) Nanchatsan Sakunpong ( [email protected] ) Close Corresponding author: Nanchatsan Sakunpong Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Koomsiri P and Sakunpong N. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Koomsiri P and Sakunpong N. HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.12688/f1000research.133299.2 ) First published: 18 May 2023, 12 :513 ( https://doi.org/10.12688/f1000research.133299.1 ) Latest published: 18 Mar 2026, 12 :513 ( https://doi.org/10.12688/f1000research.133299.2 ) Revised Amendments from Version 1 Major differences between this version and the previously published version include: (1) Abstract strengthened and made more specific. The abstract now states clearer aims, provides fuller methodological detail (including the random split for EFA/CFA), and reports psychometric evidence more explicitly (reliability, validity, and model-fit interpretation), making the contribution and key results easier to understand. (2) Introduction restructured with clearer theoretical positioning. The revised introduction tightens the narrative link between minority stress and HIV vulnerability among MSM, then connects this to the preventability of HIV through protective behaviors. It more clearly justifies why an updated Thai measure is needed in the current social and service context, and it integrates relevant behavioral theories (e.g., health belief/behavioral intention perspectives) more coherently. (3) Methods expanded for transparency and replicability. This version provides more detailed descriptions and rationale for the design and sampling approach, clarifies eligibility criteria, strengthens sample size justification, and substantially elaborates the scale development process (item sources, cognitive interviews/expert review, refinement steps). Ethical procedures and data handling are also described more fully. (4) Psychometric reporting and interpretation improved. The revised manuscript clarifies factor-analytic decision rules, reports and interprets fit indices against standard benchmarks, explains factor/item allocation decisions more clearly, and improves presentation of validity evidence. (5) Discussion deepened to highlight contribution and use. The discussion more explicitly compares findings with prior literature, clarifies implications for HIV prevention practice and intervention design, and expands limitations and directions for future research in the Thai context. Major differences between this version and the previously published version include: (1) Abstract strengthened and made more specific. The abstract now states clearer aims, provides fuller methodological detail (including the random split for EFA/CFA), and reports psychometric evidence more explicitly (reliability, validity, and model-fit interpretation), making the contribution and key results easier to understand. (2) Introduction restructured with clearer theoretical positioning. The revised introduction tightens the narrative link between minority stress and HIV vulnerability among MSM, then connects this to the preventability of HIV through protective behaviors. It more clearly justifies why an updated Thai measure is needed in the current social and service context, and it integrates relevant behavioral theories (e.g., health belief/behavioral intention perspectives) more coherently. (3) Methods expanded for transparency and replicability. This version provides more detailed descriptions and rationale for the design and sampling approach, clarifies eligibility criteria, strengthens sample size justification, and substantially elaborates the scale development process (item sources, cognitive interviews/expert review, refinement steps). Ethical procedures and data handling are also described more fully. (4) Psychometric reporting and interpretation improved. The revised manuscript clarifies factor-analytic decision rules, reports and interprets fit indices against standard benchmarks, explains factor/item allocation decisions more clearly, and improves presentation of validity evidence. (5) Discussion deepened to highlight contribution and use. The discussion more explicitly compares findings with prior literature, clarifies implications for HIV prevention practice and intervention design, and expands limitations and directions for future research in the Thai context. To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table. READ REVIEWER RESPONSES Introduction Men who have sex with men (MSM) constitute a sexual-minority group that is exposed to stigma and discrimination, which can adversely affect health. The Minority Stress Model shows that sexual-minority individuals experience stress arising from distal stressors (e.g., prejudice and discrimination) and proximal processes (e.g., internalized homophobia and concealment), which, in turn, elevate risk for mental and physical health problems, including HIV-related vulnerabilities. 1 , 2 In Thailand, recent reports underscore the magnitude of the problem: sexually transmitted infections were found in 7.2% to 21.4% of MSM samples between 2014–2018. 3 This epidemiologic patterns highlight the continuing need to understand and strengthen HIV prevention behaviors in Thai MSM. HIV infection, if untreated, progressively depletes CD4 cells and leads to opportunistic infections and AIDS; while early treatment markedly improves outcomes, prevention remains essential for both people living with HIV and those at risk. 4 , 5 In this study, HIV prevention behavior refers to actions undertaken to reduce acquisition and transmission risk (e.g., safer sex practices, regular testing, and uptake/adherence to biomedical prevention). Conceptually, prevention behavior can be framed by health-behavior theories. The Health Belief Model (HBM) emphasizes perceived susceptibility and severity, perceived benefits and barriers, and self-efficacy as drivers of preventive action, while the Theory of Reasoned Action (TRA) links attitudes and subjective norms to behavioral intentions. 6 Self-efficacy is another key psychological factor influencing HIV prevention behaviors; people who believe in their ability to protect themselves are more likely to practice safer sex and seek testing. 7 These frameworks align with current HIV prevention options (e.g., PrEP and PEP) and underscore psychological determinants of consistent preventive behavior. 8 , 9 Measurement of HIV prevention behavior has advanced internationally, with multiple self-report scales demonstrating psychometric support (e.g., Perceived Risk of HIV Scale and instruments assessing knowledge, motivation, and self-efficacy for PrEP). 10 – 12 However, in Thailand, being used scales for MSM, such as the AIDS Risk Behavior Avoidance Scale and the AIDS Preventive Behavior Scale, were developed over a decade ago, 13 , 14 preceding major shifts in the prevention landscape (e.g., promoting sexual well-being, changes in social contexts and service delivery). 8 , 9 This temporal gap raises concerns about content relevance and construct alignment for contemporary Thai MSM. Accordingly, we developed an updated HIV preventive behavior scale tailored to Thai MSM and evaluated its psychometric soundness within the Thai sociocultural context (including cognitive interviewing for content relevance). Specifically, we examined reliability and construct validity and tested convergent and discriminant validity against theoretically related and unrelated constructs. Our goal is to provide a brief, theory-informed, and context-appropriate measure that can inform surveillance, research, and the design and evaluation of future HIV prevention interventions for Thai MSM. Methods This cross-sectional study examined the psychometric properties of the HIV preventive behavior scale among MSM. A total of 424 participants completed an online questionnaire between August and November 2022. A cross-sectional, single administration is sufficient for initial validation to evaluate internal consistency, dimensionality (EFA/CFA), and convergent/discriminant validity, consistent with established guidance for scale development. 15 Ethical approval was granted by the Srinakharinwirot University Human Research Ethics Committee (SWUEC-G-512/2564E; January 19, 2022). Sampling Snowball sampling was employed to access MSM who are difficult to reach via probability frames and to trusted peer networks for online recruitment about HIV-preventive behaviors. This approach is commonly used in studies of stigmatized or hard-to-reach populations due to feasibility and rapid data collection. Recognized limitations include selection bias, over-representation of homogeneous peer clusters, and unknown sampling probabilities. To mitigate these concerns, multiple heterogeneous “seeds” were initiated across venues and communities, namely (1) the Thai Red Cross AIDS Research Centre; (2) the Institute of HIV Research and Innovation (IHRI); (3) Community-Based Treatment (CBTx) and the Community-based Harm Reduction and Rehabilitation Service at Public Health Service Center 41 Khlong Toei, Bangkok Metropolitan Administration; (4) the Rainbow Sky Association of Thailand; and (5) the Mplus Foundation, Chiang Mai. Standardized eligibility screening was applied, referrals per participant were capped, and sample composition was monitored throughout data collection to minimize dominance of any single network. Eligibility was limited to MSM aged ≥25 to target working-age adults in Thailand with independent income and greater autonomy in health decisions, which shape HIV-preventive behaviors and service access differently from younger student populations. This enhances relevance to community/clinical use. The subjects identified themselves as MSM at least once within the previous six months, and were willing to answer the online HIV preventive behavior scale using a Google form. A total of N = 424 respondents was recruited and randomly split into two independent subsamples for factor analysis: Exploratory factor analysis (n = 212) and Confirmatory factor analysis (n = 212). An item-to-sample ratio of approximately 20:1 was used for initial validation. With 9 items of HIV preventive behavior scale, this yields a minimum of 180 participants per analysis, exceeding this benchmark and aligning with guidance that typically recommends 10–20 participants per item for factor models and absolute N ≥ 200 for stable factor recovery and fit evaluation. 16 , 17 Instruments HIV preventive behavior scale . A brief, context-appropriate scale was developed for Thai MSM to capture contemporary prevention practices not fully reflected in adult Thai measures. Items were adapted from the instruments of Pimthong and Bhanthumnavin 13 , 14 and refined through cognitive interviewing 18 with three experts who each had ≥5 years of experience in HIV prevention among Thai MSM. Each expert completed two interview sessions (60–90 minutes per session). Interviews assessed item comprehension, appropriateness for Thai MSM, and alignment with HIV-prevention behaviors, using think-aloud and probing techniques to identify ambiguous or double-barreled wording; revisions prioritized clear Thai phrasing and domain alignment. Qualitative analysis of the cognitive-interview data yielded three thematic categories (reported in the Results), which informed an initial 34-item pool mapped to key HIV-prevention behaviors. Content validity was quantified using the Index of Item Congruence (IOC) 19 based on ratings from another three independent experts. Items with IOC < .50 were removed or revised, and those with corrected item–total correlations < .30 were further refined to enhance content relevance and internal coherence prior to field testing. The final instrument comprised 9 items loading on two components: risk avoidance for HIV infection and self-protection behavior before and during sexual activity . All items are positively keyed on a five-point frequency scale (1 = never to 5 = routinely), referencing behaviors over the preceding six months, with higher total scores indicating higher HIV-preventive behavior. The construct is defined as self-protective actions enacted before and during sexual activity, together with effective regulation of sexual emotions, to reduce acquisition and transmission risk. AIDS risk behavior avoidance scale , developed by Pimthong in 2011, 13 , 14 it measures behavioral intent or a person’s readiness to attempt to avoid actions or activities that lead to AIDS risk. By choosing to act or not to act, such as changing sexual partners often taking drugs or intoxicants watching porn, and choosing places that should or should not go, such as entertainment venues, and gay saunas, a total of 12 items, with 7 positive items and 5 negative items. The responses are rated on a 6-point scale ranging from the truest to not true at all. Scores were calculated using a total score of 12–72. If the score was high, it indicated that there was a high risk of AIDS avoidance behavior. For the psychometric characteristics, the discriminant power ranged from 4.74 to 8.93, the item correlation coefficient with the total score was .32 to.64, and the reliability for the whole version with the alpha coefficient was.83. with empirical data with a χ 2 = 34.70, df = 46, p -value = .89, NFI = .94, GFI = .95, AGFI = .91, SRMR = .049, CFI = 1.00, and RMSEA = 0.0. This scale was used to examine convergent validity with the HIV prevention behavior scale. AIDS prevention scale , developed by Pimthong in 2011, 13 , 14 it is a model to measure a person’s sexual behavior. By considering the method of sexual intercourse, such as using a condom with lubricant every time you have anal sex. Not swallowing partner’s semen, etc. There were a total of 10 items, 4 positive and 6 negative items. Each item had a 6-point evaluation scale ranging from very true to absolutely false by measuring 3 behavioral components. The aspects related to the risk of HIV infection during sex were 1) no risk, 2) moderate risk, and 3) high risk. The score is calculated using a total score of 10–60. If the score is high, it indicates that AIDS prevention behaviors while having sex are high. For the psychometric characteristics, the discriminant power ranged from 4.09 to 9.90, the item correlation coefficient with the total score was .20 to.62, and the reliability for the whole version with the alpha coefficient was.77. with empirical data with a χ 2 = 23.52, df = 30, p -value = .70, NFI = .93, GFI = .96, AGFI = .92, SRMR = .049, CFI = 1.00, and RMSEA = 0.0. This scale was used to examine convergent validity with the HIV prevention behavior scale. Thai Language Learning Attitude Scale , developed by Samrongthong in 2011 20 as a model to measure the attitude towards learning the Thai language. There are a total of 20 items. Answers are self-exploratory. Questions are both positive and negative items. Then choose a response from 5 levels: strongly disagree, disagree, not sure, agree, and strongly agree. There was reliability from internal consistency analysis with Cronbach’s reliability coefficient of. 85. This scale was used to examine discriminant validity with the HIV prevention behavior scale. Data analysis Qualitative data analysis Transcripts were de-identified and content-coded by item–probe segments. Codes were iteratively grouped and synthesized into categories with brief verbatim excerpts as evidence. Categories were summarized in an item-by-category matrix to guide revision, cut-off decisions (rewording, examples, response options) or generate new items. Quantitative data analysis After developing the draft HIV preventive behavior scale from cognitive interviewing, we first examined corrected item–total correlations (target ≥ 0.30) and internal consistency via Cronbach’s alpha (acceptable ≥ 0.70). Construct validity was assessed in two stages. For the EFA, we used principal axis factoring with varimax rotation; factorability was verified (KMO ≥ 0.70; Bartlett’s p 0.80) were removed. For the CFA, model fit was evaluated against conventional thresholds (χ 2 /df < 3.0, CFI ≥ 0.90, TLI ≥ 0.90, RMSEA ≤ 0.08, SRMR ≤ 0.08). 21 To examine convergent/discriminant patterns, we computed Pearson correlations with theoretically related measures (AIDS Risk Behavior Avoidance Scale, AIDS Preventive Behavior Scale) and an unrelated construct (Thai Language Learning Attitude Scale), expecting significant correlation with the former and no significant correlation with the latter. Procedures and consent Data were collected via a secure google form which need to use password to log-in. The landing page of the form presented an information sheet describing the study purpose, procedures, inclusion criteria (≥25 years), expected time, potential risks/benefits, voluntary nature of participation, and contacts for questions or concerns. Participants provided explicit electronic consent by ticking an “I agree to participate” box before any survey items were shown; those who did not consent were automatically exited from the survey. Participants could skip any item and withdraw at any time prior to submission without penalty. To maintain anonymity, the survey did not request names, phone numbers, or other direct identifiers. IP addresses and device metadata were not retained in the analytic dataset. Responses were stored under randomly generated codes and exported in de-identified form. To ensure confidentiality, data were kept on encrypted, password-protected drives with access limited to the principal investigator and authorized research staff; reporting used only aggregated results and non-identifiable quotes. Data handling adhered to the Institutional Review Board (IRB) requirements and applicable national regulations. The procedures complied with the Declaration of Helsinki and guidance for research involving vulnerable populations. For the cognitive interviews with experts, participants received a formal request letter via their affiliations along with an information sheet. Written (or recorded verbal) consent was obtained before the session; permission to audio-record was sought separately. Experts could decline or stop the interview at any point, and any illustrative quotations were anonymized in dissemination. Results Qualitative item refinement and domain structure Cognitive interviewing yielded three categories of HIV preventive behaviors among MSM: 1. Denial and avoidance of HIV risk; behaviors that minimize or steer away from situations with elevated exposure (e.g., downplaying susceptibility, ignoring risk cues, avoiding venues/partners/substances linked to condomless sex or chemsex. “Outdoor activities should be avoided because they can increase sexual risk” (Participant 1) “Avoiding transient partnerships helps minimize risk, frequent partner changes markedly increase the likelihood of infection.” (Participant 2) “When friends start mixing drugs at parties, I need to head home before it gets risky.” (Participant 1) 2. Self-protective actions before and during sexual activity; concrete risk-reduction practices (e.g., PrEP/PEP uptake and adherence, consistent condom and lubricant use, STI testing before new partners, discussing HIV/PrEP status and safer-sex preferences, negotiated safety). “Condoms plus lubricant remain foundational; they prevent breakage and increases consistency..” (Participant 1) “Before a new partner, STI/HIV testing and discussing recent results set a safety baseline for both parties.” (Participant 3) 3. Appropriate sexual response; communication and regulation of sexual needs, emotions, and boundaries that protect one’s own and partners’ wellbeing (e.g., stating consent and limits, refusing unwanted practices, seeking mutual pleasure without pressure, and drawing on self-care such as mindfulness/spirituality/self-acceptance to support safer choices). “ … Less focus on sexual cues and more on other life pleasures; having a mental anchor may reduce sexual preoccupation.” (Participant 1, follow-up) “Activities like aerobic dance, exercise, and running can reduce sexual drive and help people stay safe in love with acceptable arousal.” (Participant 2) The categories that emerged from the cognitive interviews were generated through an iterative and systematic analytic process. First, all interview data were transcribed verbatim and reviewed multiple times to achieve familiarization with participants’ interpretations and response processes. Meaning units related to how participants understood, interpreted, and responded to each item were then identified and coded. Next, similar codes were grouped together to identify recurring patterns in participants’ comprehension, perceived relevance, and suggested revisions. Through constant comparison across cases, these patterns were refined into broader conceptual categories. The research team engaged in discussion to reach consensus on the boundaries and definitions of each category, ensuring that the categories accurately reflected participants’ cognitive processes and were grounded in the data. These categories subsequently informed item refinement and conceptual clarification of the measure. Quotations under denial and avoidance of HIV risk demonstrate how participants appraise and minimize exposure (e.g., avoiding high-risk venues/contexts, recognizing partner turnover and substance-linked encounters), thereby justifying items in the risk-avoidance component. Quotations under self-protective actions before and during sexual activity specify concrete practices (e.g., condom negotiation/use, testing routines, and avoiding intoxicated sex to preserve adherence), directly informing items in the self-protection component. Quotations related to appropriate sexual response clarify mechanisms of boundary-setting and emotion regulation that support consistent prevention and sexual well-being. Sample characteristics and item screening The psychometric sample comprised 424 MSM reporting sex with a man in the past six months (mean age = 32.08, SD = 6.42). Content validity, assessed by three expert reviewers, showed item–objective congruence (IOC) ranging 0.66–1.00 across 19 items. Items were then screened via corrected item–total correlations (CITC) using a retention threshold of ≥0.30. Only nine retained items exhibited CITC values 0.33–0.47. Assumptions of univariate normality were acceptable (skewness and kurtosis within ±2), supporting subsequent factor analyses. Construct validity Pairwise associations among the nine items (N = 424) were examined using Pearson correlations; 35 of 36 pairs were significant at p < .05 (range r = .11–.58; no pair exceeded.90), with one nonsignificant pair (items 2 and 4). Sampling adequacy was acceptable (KMO = .78) and Bartlett’s test of sphericity was significant (χ 2 (36) = 843.73, p 1, inspection of the scree plot for an elbow, simple structure/interpretability, and consistency with the a priori content framework. Items were retained on a component when primary loadings ≥.40 and cross-loadings 1. Component 1 (denial/avoidance of HIV risk) showed loadings .75–.83 for its three items. Component 2 (self-protective actions before/during sexual activity) showed loadings .46–.73 for items 5–9. Item 4 emerged as a singleton on Component 3, with insufficient item count for a stable factor and content overlap with self-protective actions. Given its acceptable conceptual alignment (pre-sex planning/safer-sex enactment), item 4 was reassigned to Component 2, yielding a two-component structure consistent with the theoretical model: (1) denial/avoidance of HIV risk and (2) self-protection before/during sexual activity. Details are in Table 1 . Table 1. Factor loading, Eigenvalues, % of Variance, and Cumulative % (n=212). Items Component 1 Component 2 Component 3 Item 1 You avoid having sexual contact. When it is discovered that your partner is not protected by wearing a condom. คุณหลีกเลี่ยงที่จะมีเพศสัมพันธ์ เมื่อพบว่าคู่นอนของตนไม่ป้องกันด้วยการสวมถุงยางอนามัย .75 Item 2 You decline when a buddy invites you to a potentially risky sex activity, such as group sex or traveling to a meeting spot for sex. Substance Dependency. คุณปฏิเสธเมื่อเพื่อนชวนไปร่วมกิจกรรมที่อาจมีความเสี่ยงต่อการมีเพศสัมพันธ์ที่ไม่ปลอดภัย เช่น เซ็กส์หมู่ การไปแหล่งนัดพบเพื่อมีเพศสัมพันธ์ การใช้สารเสพติด .83 Item 3 You consistently refuse to switch partners. คุณปฏิเสธการเปลี่ยนคู่บ่อย ๆ .76 Item 4 You use a condom during sexual activity. คุณใช้ถุงยางอนามัยเมื่อมีเพศสัมพันธ์ .89 Item 5 You use oil-free lubricants during sexual activity. คุณใช้สารหล่อลื่นที่ไม่มีส่วนผสมของน้ำมันในขณะมีเพศสัมพันธ์ .46 Item 6 You avoid touching the wound immediately after sexual activity. คุณพยายามไม่สัมผัสบาดแผลโดยตรงหลังจากมีเพศสัมพันธ์ .54 Item 7 When you need to, you can show your sexual feelings in many ways, such as masturbation, spiritual activities, and recreational activities. เมื่อมีความต้องการ คุณระบายความรู้สึกทางเพศด้วยวิธีการต่าง ๆ ได้ เช่น การสำเร็จความใคร่ด้วยตนเอง กิจกรรมเสริมสร้างจิตวิญญาณ กิจกรรมนันทนาการ .59 Item 8 You engage in sexual action while avoiding being harmed or producing blood or lymph. คุณมีเพศสัมพันธ์โดยพยายามไม่ทำให้เกิดบาลแผล เลือด น้ำเหลือง .66 Item 9 You engage in sexual activity without causing physical harm to your partner. คุณมีเพศสัมพันธ์โดยไม่ใช้ความรุนแรงด้านร่างกายที่จะทำให้เ กิดบาดแผลกับคู่นอน .73 Eigenvalues 2.61 1.49 1.01 % of Variance 29.01 16.60 11.30 Cumulative % 29.01 45.60 56.90 The two-component structure was tested in the another half-sample (n = 212) using CFA and showed adequate global fit, meeting or exceeding conventional benchmarks: nonsignificant χ 2 (χ 2 = 36.56, p = .06), χ 2 /df = 1.46 (≤3.0), GFI = .96 (≥.90), CFI = .98 (≥.95), TLI = .96 (≥.95), RMSEA = .05 (≤.06), and RMR = .07 (≈ ≤ .08), 17 supporting the adequacy of the model. At the item level, Component 1: denial and avoidance of HIV risk comprised items 1–3 with standardized loadings (β) = .60–.85, SE = .15–.20, t = 7.32–7.55, p < .01, and R 2 = .36–.73. Component 2: self-protective actions before and during sexual activity comprised items 4–9 with β = .41–.74, SE = .17–.26, t = 4.15–6.29, p < .01, and R 2 = .13–.54. The latent correlation between the two components was.58, indicating related but distinct constructs ( Table 2 ). Together, the fit indices and item-level criteria justify the allocation of items to the two reported components and the reassignment of item 4 based on statistical thresholds and construct coherence. 1 Table 2. Factor loading, Standard Error, t Values, Coefficient of Determination by CFA (n = 212). Items b SE t R 2 Dimension 1, Denying and avoiding the risk of contracting HIV (F1) Item 1 You avoid having sexual contact. When it is discovered that your partner is not protected by wearing a condom. (X1) .60 - - .36 Item 2 You decline when a buddy invites you to a potentially risky sex activity, such as group sex or traveling to a meeting spot for sex. Substance Dependency. (X2) .85 .20 7.55 ** .73 Item 3 You consistently refuse to switch partners. (X3) .66 .15 7.32 ** .44 Dimension 2, Self-protective behavior before and during sex (F2) Item 4 You use a condom during sexual activity. (X4) .49 - - .24 Item 5 You use oil-free lubricants during sexual activity. (X5) .37 .21 4.15 ** .13 Item 6 You avoid touching the wound immediately after sexual activity. (X6) .74 .26 6.29 ** .54 Item 7 When you need to, you can show your sexual feelings in many ways, such as masturbation, spiritual activities, and recreational activities. (X7) .41 .17 4.51 ** .17 Item 8 You engage in sexual action while avoiding being harmed or producing blood or lymph. (X8) .72 .26 6.26 ** .52 Item 9 You engage in sexual activity without causing physical harm to your partner. (X9) .63 .26 5.88 ** .39 ** p < .01. Consistent with empirical data, the following two components of the HIV Preventive Behavior scale model were identified by CFA: Chi-square: χ 2 = 36.56, p = .06, Relative Chi-square: χ 2 /df = 1.46, Goodness of Fit Index: GFI = .9, 6, Comparative Fit Index: CFI = .8, Adjusted goodness of fit index: AGFI = .94, Root Mean Square Residual: RMR = .07, Root Mean Square Error of Approximation: RMSEA = .05, Root mean square residual: TLI = .96. Overall, the model matches the empirical data well (good fit). Reliability, convergent, and discriminant validity Internal consistency from Cronbach’s reliability coefficient was used to determine that the 9-item HIV Preventive Behavior Scale’s reliability was equivalent to .77 Pearson product-moment correlation coefficients, which were used to examine convergent and discriminant validity among 424 individuals Thai MSM. There are positive correlations between the HIV Preventive Behavior Scale (SUMPHIV) with the AIDS risk behavior avoidance scale (SUML), and the AIDS prevention scale (SUMA) were statistically significant at the .01 level, with correlations of .21 and .26, respectively. There was no correlation between the HIV Preventive Behavior Scale and the Thai Language Learning Attitude Scale (SUMT) (see Table 3 ). Table 3. Relationship between HIV Preventive Behavior Scale and AIDS Risk Scale, AIDS prevention measure, and attitude measure toward learning the Thai language (n = 424). Scales SUMPHIV SUML SUMA SUMT SUMPHIV - 21 ** .26 ** .08 SUML - .25 ** .16 ** SUMA - .18 ** SUMT - Mean 32.21 43.40 36.44 70.65 Standard deviation 6.39 7.09 6.28 17.43 ** p < .01. Discussion This study advances Thai measurement work on HIV prevention by updating content and structure beyond earlier instruments by Pimthong and Bhanthumnavin 13 , 14 to reflect contemporary practices (adding risk situations and sexual well-being) that were not widely captured when prior tools were developed. In addition, the scale integrates constructs previously assessed by two separate instruments into a single, brief measure, thereby reducing respondent burden and administration time while preserving coverage of both risk-avoidance and self-protective behaviors. The resulting two-component model (1) denial/avoidance of HIV risk and (2) self-protective actions before and during sexual activity, showed strong fit, convergent and discriminant validity (see Results). The moderate latent correlation between components (.58) indicates related but distinct facets: minimizing exposure opportunities versus enacting concrete protective routines. This structure converges with other two-factor solutions in HIV-related constructs, e.g., HIV risk perception among Hispanic-American youth. 11 Relative to earlier Thai measures, 13 , 14 the present scale foregrounds biomedical-era prevention while preserving the dual emphasis on risk minimization and protective behavior, thereby offering a concise, behavior-proximal assessment aligned with current service landscapes. The two components are theoretically coherent within established health-behavior frameworks. Denial/avoidance corresponds to Health Belief Model (HBM) constructs of perceived susceptibility/severity and barriers (e.g., steering clear of venues/partners/substances linked to condomless sex), and is also consistent with Theory of Reasoned Action/Planned Behavior pathways from attitudes, norms, and perceived control to intentions and behavior (e.g., condom and lubricant negotiation). 6 , 7 The emphasis on emotion/impulse regulation during sexual decision-making is compatible with self-regulatory and dual-process perspectives, 7 linking momentary control to sustained prevention. Taken together, the model can be situated within the Information–Motivation–Behavioral Skills (IMB) framework 22 : denial/avoidance indexes risk appraisal and environmental management, while self-protection indexes motivation/skills for enactment. Cultural context in Thailand likely shapes both dimensions. Social norms around masculinity, discretion, and HIV-related stigma may encourage denial or avoidance (e.g., downplaying risk when a guy appears good-looking and healthy; avoiding settings associated with chemsex or condomless encounters.). At the same time, self-protective actions are facilitated or constrained by interpersonal scripts such as kreng-jai (reluctance to impose in Thai culture) that can complicate condom/lubricant negotiation. These sociocultural levers clarify why both components are necessary: avoidance strategies reduce exposure opportunities, whereas intentional protective actions translate prevention goals into everyday sexual contexts. Psychometrically, internal consistency (α = .77) and convergent/discriminant patterns support initial reliability and structural validity in Thai MSM. This suggests structural generalizability, while differences in stigma intensity, service systems, and sexual-script norms may underscore the importance of context-sensitive implementation. A practical implication is to embed the two-component model directly into program design and policy for MSM. First, use the 9-item scale as a brief screening tool in community clinics, and online outreach to segment clients: higher denial/avoidance scores trigger modules on risk-cue literacy; higher self-protection gaps trigger skills-based supports (low-conflict condom scripts compatible with kreng-jai , pre-sex planning checklists, communication “micro-scripts,”. Second, integrate both components into IMB-consistent packages, 22 information (myth-busting, visual risk cues), motivation (normative messaging from MSM peers), and behavioral skills (condom/lube demonstrations, brief negotiation practice) to initiate HIV preventive intervention. Third, operationalize delivery through peer navigators and digital tools (chat/app prompts before high-risk time windows). Finally, align monitoring with the scale: set component-specific thresholds to trigger referrals, track pre–post change for each subscore, and include indicators (e.g., PrEP uptake/adherence, timely testing) in routine dashboards to inform continuous quality improvement and resource allocation. Limitations Several limitations warrant consideration. First, recruitment via an online, snowball-based survey introduces selection bias (internet access, network homophily) and unknown sampling probabilities, which can limit generalizability beyond MSM engaged with digital/community networks. Second, reliance on self-reported behaviors over a six-month window is vulnerable to recall error and social desirability, potentially inflating protective reports (e.g., condom use) and underreporting risk contexts (e.g., chemsex). Third, the sample’s age composition (≥25 years) and sexual-orientation profile may yield sample homogeneity, constraining applicability to younger MSM and other subgroups (e.g., bisexual-identified men, gender-diverse partners). Fourth, the cross-sectional design precludes test–retest reliability, temporal stability, and predictive validity (e.g., incident STI/HIV). Future research should broaden sampling frames (e.g., respondent-driven or venue-based strategies, multiple regions) and include younger MSM to assess age-related differences. Methodological refinements include test–retest assessment, longitudinal designs for predictive validity, incorporation of social desirability scales, ecological momentary assessment to reduce recall bias, and triangulation with clinic/biomarker data (testing history, PrEP dispensing, STI diagnoses). Cross-cultural studies should examine how sexuality norms, masculinity scripts, stigma, and service access shape the two domains in other Thai regions and countries. Finally, intervention trials can use the 9-item scale to tailor content, addressing denial/avoidance (risk-cue literacy, venue/substance harm-reduction) and enhancing self-protection (condom negotiation, PrEP/PEP adherence), and to track component-specific change as part of routine program monitoring. Conclusions The 9-item HIV Preventive Behavior Scale developed for Thai MSM demonstrates sound psychometric performance and a parsimonious two-component structure; denial/avoidance of HIV risk and self-protective actions before and during sexual activity, supported by satisfactory model fit, acceptable internal consistency (α = .77), and coherent convergent/discriminant patterns. By integrating constructs previously assessed across separate Thai instruments into a single brief measure, the scale reduces respondent burden while preserving coverage of contemporary prevention practices (e.g., condom/lubricant use, risk-context management). The tool is suited for screening, program tailoring, and monitoring within community and clinical settings, and its theory-aligned domains map readily onto IMB/HBM and related behavioral frameworks to guide intervention content. Acknowledging limitations of online snowball sampling and self-report, further work should examine measurement invariance, test–retest and predictive validity, and applicability to younger MSM and diverse regional contexts. Overall, the scale offers a concise, culturally grounded metric to inform HIV prevention policy and practice for MSM in Thailand. AI-assisted writing statement The authors used ChatGPT (GPT-5.2; OpenAI) to support Thai to English translating of content, editing and grammar checking across the manuscript. The tool was used solely to improve clarity, readability, and grammar; it was not used to generate or alter the study design, data, analyses, results, or interpretations. The authors reviewed and verified all edits and take full responsibility for the content. Data availability Figshare: Raw data of psychometric properties’ HIV Preventive Behavior Scale among Thai MSM, https://doi.org/10.6084/m9.figshare.22491319.v6 . 23 This project contains the following underlying data: 1. CFA 9 item.docx (CFA analysis results) 2. EFA.docx (EFA analysis results) 3. Reli_corre.docx (analysis results of reliability, convergent and discriminant validity) 4. Raw data.sav (raw data file) 5. 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Pimthong S: Psycho-Social Factors Correlated with HIV/AIDS Preventive Behavior in Men Who Have Sex with Men.Bangkok, Thailand: National Institute of Development Administration; 2011. Dissertation (Social and Environmental Development). 15. Boateng GO, Neilands TB, Frongillo EA, et al. : Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Front. Public Health. 2018; 6 : 149. PubMed Abstract | Publisher Full Text | Free Full Text 16. Hair JF, Black WC, Babin BJ, et al. : Multivariate data analysis. 8th ed. Boston: Cengage; 2019. 17. Comrey AL, Lee HB: A first course in factor analysis. 2nd ed. New York: Psychology Press; 2013. 18. Willis GB: Analysis of the Cognitive interview in questionnaire design New York, United State: Oxford University Press;2015. 19. Tuntavanitch P, Jindasri P: The Real Meaning of IOC. J. Educ. Measur. Mahasarakham Univ. 2018; 24 (2): 3–12. 20. 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Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 18 May 2023 ADD YOUR COMMENT Comment Author details Author details 1 Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, 10110, Thailand Passakorn Koomsiri Roles: Conceptualization, Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing Nanchatsan Sakunpong Roles: Methodology, Supervision, Validation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 18 Mar 2026, 12:513 https://doi.org/10.12688/f1000research.133299.2 version 1 Published: 18 May 2023, 12:513 https://doi.org/10.12688/f1000research.133299.1 Copyright © 2026 Koomsiri P and Sakunpong N. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Koomsiri P and Sakunpong N. HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.12688/f1000research.133299.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 18 Mar 2026 Revised Views 0 Cite How to cite this report: Nooripour R. Reviewer Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.197233.r468631 ) The direct URL for this report is: https://f1000research.com/articles/12-513/v2#referee-response-468631 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 17 Apr 2026 Roghieh Nooripour , Alzahra University, Tehran, Tehran Province, Iran Approved VIEWS 0 https://doi.org/10.5256/f1000research.197233.r468631 After careful review, I confirm that the authors have addressed all previously raised concerns in a thorough and scientifically appropriate manner. The revisions have improved clarity, methodological transparency, and consistency across sections, particularly in the alignment between results and conclusions. ... Continue reading READ ALL After careful review, I confirm that the authors have addressed all previously raised concerns in a thorough and scientifically appropriate manner. The revisions have improved clarity, methodological transparency, and consistency across sections, particularly in the alignment between results and conclusions. No major issues remain that would compromise the scientific soundness of the study. The manuscript now meets the standards for indexing. I appreciate the authors’ careful and responsive revisions, which have strengthened the overall quality and credibility of the work. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Counselling psychology; clinical psychology; adolescent mental health; mindfulness-based interventions; cognitive behavioural therapy (CBT); neurofeedback and cognitive rehabilitation; emotion regulation and executive functions; high-risk behaviours and addiction; cyberbullying and digital mental health; psychometrics, scale development, and validation; quantitative and qualitative research methods; longitudinal and intervention study design; psychological well-being and resilience; health psychology (including psycho-oncology and chronic illness populations). I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Nooripour R. Reviewer Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.197233.r468631 ) The direct URL for this report is: https://f1000research.com/articles/12-513/v2#referee-response-468631 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: li Q. Reviewer Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.197233.r469526 ) The direct URL for this report is: https://f1000research.com/articles/12-513/v2#referee-response-469526 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Mar 2026 Qingyu li , Vanke School of Public Health, Tsinghua University, Beijing, China Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.197233.r469526 Overall, my judgment is that the manuscript addresses an important topic and has clear public health relevance, but it still has substantive problems in construct definition, content validity, and psychometric interpretation. In its current form, I would lean toward ... Continue reading READ ALL Overall, my judgment is that the manuscript addresses an important topic and has clear public health relevance, but it still has substantive problems in construct definition, content validity, and psychometric interpretation. In its current form, I would lean toward major revision rather than acceptance. The paper does present a reasonable first attempt at a Thai MSM-specific prevention behavior scale, based on 424 participants split evenly for EFA and CFA, with acceptable internal consistency and apparently good global CFA fit. However, the final 9-item scale does not fully match the broader construct that the manuscript claims to measure, namely contemporary HIV prevention behavior among Thai MSM. General assessment This manuscript addresses an important and timely topic: the development of a brief HIV preventive behavior scale for Thai men who have sex with men. The effort to update older Thai measures is meaningful, especially given changes in HIV prevention, including biomedical strategies and shifts in service delivery. The study also has several strengths, including a clearly defined target population, split-sample EFA/CFA, and reporting of internal consistency and convergent/discriminant validity. The reported CFA indices are favorable, and the authors have made visible efforts to strengthen the revised version. That said, I have several major concerns. The most important issue is conceptual: the manuscript defines HIV prevention behavior broadly, including safer sex, regular testing, and uptake/adherence to biomedical prevention such as PrEP and PEP, yet the final 9-item scale is much narrower and is largely centered on partner avoidance, condom/lubricant use, injury avoidance, and regulation of sexual feelings. This creates a mismatch between the stated construct and the actual item content. In addition, the factor-analytic decisions need clearer justification, especially because the initial solution yielded three components and one item was reassigned on conceptual grounds. The validity evidence is also still fairly limited for a new scale that is proposed for intervention and program use. For these reasons, I think the manuscript has potential, but it needs substantial revision before it can be considered psycho metrically convincing and fully informative for HIV prevention research and practice. Major comments 1. Abstract The abstract is clearer than a minimal draft, but it still overstates what the study has established. The manuscript reports acceptable internal consistency, a two-factor solution, and modest convergent correlations with related measures. However, the conclusion that the scale demonstrated “sound psychometric properties” and is ready for future interventions feels stronger than the presented evidence. The abstract should more cautiously describe this as an initial validation or preliminary psychometric evaluation , especially because test-retest reliability, criterion validity, predictive validity, and in variance testing were not performed. A second issue is construct clarity. The introduction defines HIV prevention behavior as including regular testing and biomedical prevention uptake/adherence, but the abstract does not alert the reader that the final 9-item scale captures only a subset of this wider domain. That gap should be acknowledged even in the abstract, so the reader does not assume that the measure comprehensively covers contemporary HIV prevention practices. 2. Introduction The introduction identifies a relevant gap, namely that older Thai MSM scales may no longer reflect the current prevention context. That rationale is reasonable. However, the manuscript still does not fully bridge the distance between the broad prevention framework introduced in the text and the narrower behavioral content represented in the final measure. The manuscript explicitly defines HIV prevention behavior to include regular testing and PrEP/PEP-related practices, and it cites literature on PrEP-related constructs, but those elements are not retained in the final scale. This creates a conceptual problem: the paper is framed as a modern HIV prevention behavior measure, but the final scale remains closer to a traditional sexual risk reduction instrument. The theoretical framing also needs tightening. The introduction mentions the Minority Stress Model, the Health Belief Model, the Theory of Reasoned Action, and later the Information–Motivation–Behavioral Skills framework. At present, these models feel more appended than integrated. The authors should decide whether the scale is primarily behavioral, psycho-social, or both, and then explain more directly how the proposed dimensions arise from that theory. Otherwise, the introduction risks sounding broader and more theoretically complete than the measure itself supports. 3. Methods The methods section is more detailed than in a minimal scale-development report, but several concerns remain. First, the scale-development process still needs stronger transparency. The paper states that an initial 34-item pool was mapped to key HIV prevention behaviors, then reduced using IOC and corrected item-total correlations, with a final 9-item scale. However, the reader is not given enough detail about which domains were dropped and why. This is especially important because the qualitative categories explicitly include PrEP/PEP uptake and adherence, HIV/STI testing, and status discussion, yet none of these are clearly represented in the final item set. A table showing domain-to-item mapping from initial pool to final scale would greatly strengthen content-validity claims. Second, the use of cognitive interviewing with only three experts raises a methodological concern. Cognitive interviewing is most often used with members of the target population to examine comprehension, response processes, and cultural relevance. Here, the interviews appear to have been conducted with experts, not end users, which limits the strength of the evidence for target-population comprehensibility. The paper should justify this choice much more explicitly and avoid presenting it as a full substitute for user-based qualitative item development. Third, the sampling strategy is understandable for a stigmatized population, and the authors do acknowledge limitations of snowball sampling. Still, the decision to include only participants aged 25 years or older substantially narrows the target population. Younger MSM are a key HIV prevention population in many settings. The authors should therefore avoid general language implying applicability to all Thai MSM, unless they can justify why the construct should operate similarly in younger groups. Fourth, there is an inconsistency in factor-analytic terminology. In the methods, the authors state that EFA used principal axis factoring with varimax rotation. In the results, the text refers to PCA with varimax rotation. These are not interchangeable procedures. This inconsistency needs correction, and the authors should clearly report which method was actually used. 4. Results The results section is where the main psychometric concerns become most visible. The qualitative section identifies three categories: denial and avoidance of HIV risk, self-protective actions before and during sexual activity, and appropriate sexual response. These categories include modern prevention content such as PrEP/PEP use, testing, and HIV/PrEP status discussion. However, the final 9 items do not visibly preserve this breadth. Instead, the retained items focus on condom use, lubricant use, partner switching, risky invitations, injury/wound avoidance, and sexual feeling regulation. This weakens the argument that the final scale adequately reflects the broader domain identified in the qualitative phase. The factor analysis also needs more careful interpretation. The exploratory solution initially yielded three components with eigenvalues above 1, and item 4 loaded alone on the third component. The authors then reassigned item 4 to component 2 because it conceptually aligned with self-protective actions. That may be reasonable, but it also means the final two-factor model was not the most direct empirical solution. This should be described more cautiously. The current wording makes the final structure sound more naturally supported by the data than it actually was. Some item content also raises concern about construct purity. For example, the item about expressing sexual feelings through masturbation, spirituality, or recreation, and the items about avoiding wounds or not physically harming a partner, may reflect broader sexual self-regulation or interpersonal conduct rather than core HIV prevention behavior. These items may be culturally meaningful, but the authors need to explain more clearly why they belong in a scale presented as an HIV prevention behavior measure, especially when more central contemporary prevention behaviors were not retained. Finally, the validity evidence is limited. Cronbach’s alpha is acceptable at 0.77, but the convergent validity coefficients are small to modest, and there is no criterion-related validity, known-groups validity, predictive validity, or test-retest reliability. The paper therefore supports preliminary structural validity, not full psychometric maturity. 5. Discussion The discussion is thoughtful in places, especially where it tries to situate the two factors within health-behavior frameworks and Thai sociocultural context. However, it still overstates the scale’s scope and readiness. Most importantly, the discussion claims that the present scale “foregrounds biomedical-era prevention,” yet the final retained items do not convincingly do so. The manuscript itself introduces PrEP, PEP, and regular testing as key parts of HIV prevention behavior, and these were mentioned in the qualitative categories, but they are not reflected in the reported 9-item measure. The authors should either revise their claims downward or explain much more clearly why the absence of these domains does not compromise content validity. The discussion would also benefit from stronger comparison with prior literature. The paper states that the new tool updates earlier Thai instruments and combines previously separate domains into one measure, which is useful. But it does not sufficiently explain how the present two-factor structure compares with similar HIV prevention behavior instruments or whether this structure is expected to be culturally specific. I also think the practical recommendations are somewhat ahead of the evidence. The paper proposes screening, segmentation, monitoring, and intervention tailoring based on this 9-item scale. Those suggestions are interesting, but without known-groups validity, predictive validity, or threshold validation, they remain hypothetical. The discussion should present these as future possibilities rather than current implementation recommendations. Minor comments Abstract Please check small wording and numerical consistency in the abstract. In one place the convergent correlations are reported as 0.21 and 0.16, whereas the main text/table later report 0.21 and 0.26. This needs to be harmonized. Introduction There are still multiple language issues and awkward phrases in the introduction, for example “being used scales for MSM” and “This epidemiologic patterns.” These do not prevent understanding but reduce the professional tone of the paper. Methods Please provide a flow of item reduction from 34 items to 19 items to 9 items, with reasons for removal at each step. This would make the development process much more transparent. Please also clarify whether the scale was developed in Thai and then translated into English for the manuscript, and if so, whether any translation/back-translation procedures were used for reporting item content. The current bilingual presentation is useful, but the language handling process is not fully clear. Results Please define the factor labels more carefully. “Denial and avoidance of HIV risk” may not be the clearest label, because the retained items seem to reflect deliberate avoidance of risky situations rather than psychological denial in the usual sense. A label such as “risk avoidance” may be more precise. Please review all statistical reporting for consistency. The manuscript gives fit indices twice, and one repeated sentence appears to contain typographic errors, including “CFI = .8” and mislabeling TLI as “Root mean square residual.” Discussion The cultural discussion is promising, especially the mention of stigma, masculinity, discretion, and kreng-jai . However, it would be stronger if more directly tied back to specific items rather than discussed at a general level. The future research section would be improved by explicitly stating the next psychometric steps: test-retest reliability, known-groups validity, predictive validity against actual prevention outcomes, and invariance across age groups and regions. The current version mentions some of these, but the sequence of priorities could be clearer. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: HIV; PrEP; adherence; digital health; intervention; health behavior I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT li Q. Reviewer Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.197233.r469526 ) The direct URL for this report is: https://f1000research.com/articles/12-513/v2#referee-response-469526 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 18 May 2023 Views 0 Cite How to cite this report: E Turpin R. Reviewer Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.146278.r409707 ) The direct URL for this report is: https://f1000research.com/articles/12-513/v1#referee-response-409707 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 Sep 2025 Rodman E Turpin , George Mason University, Fairfax, USA Approved VIEWS 0 https://doi.org/10.5256/f1000research.146278.r409707 The authors conducted a psychometric analysis of an HIV prevention behavior scale among Thai MSM. Overall the study addresses an important question, is salient with implications for large-scale public health efforts, and will be a strong contribution to the literature. ... Continue reading READ ALL The authors conducted a psychometric analysis of an HIV prevention behavior scale among Thai MSM. Overall the study addresses an important question, is salient with implications for large-scale public health efforts, and will be a strong contribution to the literature. I have a few recommendations to improve clarity and readability. 1. Minor point: You could save a lot of word space by using MSM as an acronym after its first mention in the introduction. 2. In the first paragraph, some additional discussion on some of the literature around homophobia as a stressor among MSM (with citation) will be helpful. 3. In general, review for grammatical errors throughout (such as the first sentence of the methods, where "examination of" should be "examine". 4. In the construct validity section, "The researcher used a sample of 424 people" should be removed, since the sample size was mentioned one paragraph earlier. Also, saying you used a sample of people can sound exploitative, it's generally better to say you used data rather than a sample. 5. Future research recommendations should be elaborated on more. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: HIV, STI, racial/ethnic and sexual minorities, latent variable modeling I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT E Turpin R. Reviewer Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.146278.r409707 ) The direct URL for this report is: https://f1000research.com/articles/12-513/v1#referee-response-409707 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Nooripour R. Reviewer Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.146278.r353209 ) The direct URL for this report is: https://f1000research.com/articles/12-513/v1#referee-response-353209 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 30 Dec 2024 Roghieh Nooripour , Alzahra University, Tehran, Tehran Province, Iran Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.146278.r353209 Abstract The objective stated in the abstract should be more precise. Instead of stating that the study “investigates the psychometric features,” specify the particular psychometric features you aim to assess (e.g., reliability, construct validity, etc.). This ... Continue reading READ ALL Abstract The objective stated in the abstract should be more precise. Instead of stating that the study “investigates the psychometric features,” specify the particular psychometric features you aim to assess (e.g., reliability, construct validity, etc.). This will provide the reader with a clearer understanding of the study's purpose. The description of the methods is very brief. Mention how the two-part division of the sample (for exploratory and confirmatory factor analysis) is executed, and clarify the rationale for using Cronbach’s alpha as the primary reliability measure. Also, explain the choice of convergent and discriminant validity tests, and how they are relevant to the study's goals. In the results section, the statistical values (e.g., χ2, p-values, CFI) should be explained more thoroughly. Indicate the significance level of the tests and whether the statistical results align with the expectations for a valid psychometric tool. Adding clarity on how these results support the psychometric validity of the scale would strengthen this section. The conclusion in the abstract is appropriate, but it could be more concise by directly stating that the scale is not only psychometrically valid but also relevant for future interventions. It is important to emphasize how the study’s findings can lead to practical applications in HIV prevention. Introduction introduction presents various pieces of information (minority stress, HIV prevalence, etc.), but the connection between these elements and the study’s focus on HIV prevention behavior could be more explicitly stated. Ensure the flow logically progresses from the introduction of the problem (HIV among MSM) to the significance of the psychometric tool being studied. The transition between the introduction of MSM as a vulnerable group and the prevalence of HIV among them could be more seamless. Focus on the significance of the HIV prevention behavior scale for MSM in Thailand specifically, and state why this research is necessary. The issue of outdated scales should be more directly tied to the need for an updated measure that aligns with current challenges and social contexts. Concepts like the "minority stress model," "HIV prevention behavior," and other theories mentioned should be introduced with clearer definitions. Present these theories within the context of the study, making it clear why they are central to understanding the behavior of MSM in Thailand, specifically in relation to HIV prevention. Although the introduction introduces relevant theories such as the Health Belief Model and Theory of Rational Action, it would benefit from a clearer integration of how these theories relate to the study's objectives. Expanding on the link between these theoretical frameworks and the HIV prevention behaviors in MSM would create a more robust narrative. While the introduction mentions the absence of updated scales for HIV prevention behavior in Thailand, further emphasize the gap in the literature and how this study contributes to filling that gap. It would be helpful to discuss briefly why existing scales are inadequate in the context of Thai MSM and what this study hopes to improve or provide. Methods While the cross-sectional design is stated, more information is needed on why this design is suitable for the study’s objectives. For example, explain how cross-sectional data can be used to examine psychometric properties and why longitudinal data might not have been necessary for this particular research question. The sampling method (snowball sampling) is described, but the rationale for using this method should be elaborated. Discuss the potential limitations of snowball sampling (e.g., selection bias, homogeneity of sample) and how these limitations are addressed. Moreover, clarify the justification for selecting individuals aged 25 and older, and explain if this age range reflects the target population for the HIV preventive behaviors scale. The sample size calculation based on the Central Limit Theorem and the need for a minimum of 200 participants is mentioned but needs more explanation. Why specifically was this size chosen? It would be beneficial to present the power analysis or any other statistical justification for the sample size. The section detailing the HIV Preventive Behavior Scale and other tools needs more specificity. For example, describe why the 9-item scale was developed, how the items were selected, and how they were related to the key HIV prevention behaviors. A more detailed explanation of the cognitive interview method would also be helpful, including the role of expert feedback and how this method enhanced the validity of the scale. While the statistical methods (EFA, CFA, reliability analysis) are listed, more details should be provided about the specific steps and decisions made during these analyses. For instance, explain the criteria used for determining construct validity in the CFA, the thresholds for good model fit, and how these criteria relate to the goals of the study. Discuss how you handled potential issues like multicollinearity or cross-loadings in the factor analysis. Provide more details about how participants’ consent was obtained, particularly in terms of the online survey. Discuss how anonymity was maintained, how the confidentiality of participants was ensured, and how the study complied with ethical guidelines for research with vulnerable populations. How were participants recruited, and were there any specific challenges in obtaining a diverse sample? Also, describe how the data was stored and managed to ensure integrity. Results The categorization of the HIV-preventive behaviors into three broad groups (denial and avoidance, self-protective actions, and appropriate sexual response) should be more explicitly defined. The terms “denial,” “avoidance,” and “self-protective” need to be clearly operationalized, as their meaning could vary among different readers. For example, the term “self-protective” requires further elaboration to ensure that it is understood in a way that aligns with the research context. A more detailed explanation of how these categories were derived would improve clarity. While the inclusion of participant quotes helps illustrate the themes, it would be beneficial to more systematically explain how these quotes were selected and their significance in relation to the overarching research questions. It is crucial to link the quotes directly to the themes identified in the categories (e.g., how does each participant’s quote specifically inform the "denial and avoidance" or "self-protective actions"?). Additionally, ensure that the formatting of these quotes is consistent, particularly when indicating direct statements. The details of the factor analysis (e.g., PCA, EFA, CFA) should be more transparent. Specifically, while it is stated that "the first component was denial and avoidance of HIV risk," it is not clear how the decision was made to group certain items together in this category. More explanation should be given about the thresholds or criteria used for factor loadings and why certain items (like question 4) were moved between components. Additionally, clarify how you determined the adequacy of the model fit based on the indices presented (e.g., χ², GFI, RMSEA) and how these compare to established benchmarks in the literature. The integration of demographic data with the psychometric analysis is lacking. To enhance the interpretation, demographic variables (such as age, sexual orientation, and frequency of sexual encounters) could be incorporated into the factor analyses or reliability tests to investigate whether certain variables influence the HIV preventive behavior scores. Discussion The discussion should better articulate how the study's findings build upon or diverge from previous research. For instance, while references to studies by Pimthong and Bhanthumnavin are made, the specific ways in which this study either aligns or contrasts with their findings are not clearly outlined. You should highlight the significance of the two-factor model in this study and compare it in depth with similar models used in HIV prevention research, including contrasting findings from different cultural or regional contexts. The two-component structure identified in the CFA (denial and avoidance, self-protective conduct) should be further examined in relation to the overall theory of HIV prevention behavior. How do these components relate to theoretical frameworks in sexual health and HIV prevention? Providing a more detailed theoretical underpinning for the categories would allow readers to better understand the broader implications of the findings. In particular, it would be valuable to explore whether these two components align with broader psychological theories of health behavior or HIV-related stigma. The discussion should provide more practical recommendations for HIV prevention programs. While the findings are connected to previous studies, there is less focus on how the research results can inform interventions or policies targeting MSM. More concrete suggestions on how to integrate the two components of HIV prevention behavior into public health strategies would strengthen the relevance of the study. The limitations section is briefly mentioned but should be expanded. It is essential to include a critical examination of the study’s limitations, such as the potential biases in the sampling process due to the use of online surveys, which could affect the generalizability of the findings. You should also discuss the limitations of relying solely on self-reported data, as this may introduce response biases, and the potential effects of social desirability or recall bias on the results. Additionally, the issue of sample homogeneity in terms of age or sexual orientation should be discussed, as it might limit the applicability of the findings to broader populations. While the limitations section touches on some areas for improvement, the discussion should provide a more thorough outline of potential future research. Consider recommending further studies that examine the cultural nuances in HIV preventive behaviors among MSM in other regions or countries. Also, explore how different prevention interventions might be tailored to the specific behaviors identified in this study, such as targeting denial and avoidance or enhancing self-protective behaviors. In line with the limitations, it would be beneficial to suggest methodological refinements for future studies, such as the inclusion of qualitative interviews to gain deeper insights into the underlying psychological mechanisms behind the two components identified. This would complement the quantitative data and provide a more comprehensive understanding of MSM’s HIV prevention behaviors. The discussion would benefit from a more in-depth exploration of the cultural context within Thailand, and how it might influence the reported HIV preventive behaviors. For instance, consider discussing how societal views on sexuality, masculinity, and HIV risk might shape the denial/avoidance and self-protective behavior categories identified in this study. This would provide a more nuanced understanding of the findings and their implications for HIV prevention within this specific cultural setting. Is the work clearly and accurately presented and does it cite the current literature? No Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: MindfulnessAdolescent Mental HealthStressEmotionCyberpsychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Nooripour R. Reviewer Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.146278.r353209 ) The direct URL for this report is: https://f1000research.com/articles/12-513/v1#referee-response-353209 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 18 May 2023 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 18 Mar 26 read read Version 1 18 May 23 read read Roghieh Nooripour , Alzahra University, Tehran, Iran Rodman E Turpin , George Mason University, Fairfax, USA Qingyu li , Vanke School of Public Health, Tsinghua University, Beijing, China Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Nooripour R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Apr 2026 | for Version 2 Roghieh Nooripour , Alzahra University, Tehran, Tehran Province, Iran 0 Views copyright © 2026 Nooripour R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions After careful review, I confirm that the authors have addressed all previously raised concerns in a thorough and scientifically appropriate manner. The revisions have improved clarity, methodological transparency, and consistency across sections, particularly in the alignment between results and conclusions. No major issues remain that would compromise the scientific soundness of the study. The manuscript now meets the standards for indexing. I appreciate the authors’ careful and responsive revisions, which have strengthened the overall quality and credibility of the work. Competing Interests No competing interests were disclosed. Reviewer Expertise Counselling psychology; clinical psychology; adolescent mental health; mindfulness-based interventions; cognitive behavioural therapy (CBT); neurofeedback and cognitive rehabilitation; emotion regulation and executive functions; high-risk behaviours and addiction; cyberbullying and digital mental health; psychometrics, scale development, and validation; quantitative and qualitative research methods; longitudinal and intervention study design; psychological well-being and resilience; health psychology (including psycho-oncology and chronic illness populations). I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Nooripour R. Peer Review Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.197233.r468631) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-513/v2#referee-response-468631 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 li Q. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Mar 2026 | for Version 2 Qingyu li , Vanke School of Public Health, Tsinghua University, Beijing, China 0 Views copyright © 2026 li Q. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Overall, my judgment is that the manuscript addresses an important topic and has clear public health relevance, but it still has substantive problems in construct definition, content validity, and psychometric interpretation. In its current form, I would lean toward major revision rather than acceptance. The paper does present a reasonable first attempt at a Thai MSM-specific prevention behavior scale, based on 424 participants split evenly for EFA and CFA, with acceptable internal consistency and apparently good global CFA fit. However, the final 9-item scale does not fully match the broader construct that the manuscript claims to measure, namely contemporary HIV prevention behavior among Thai MSM. General assessment This manuscript addresses an important and timely topic: the development of a brief HIV preventive behavior scale for Thai men who have sex with men. The effort to update older Thai measures is meaningful, especially given changes in HIV prevention, including biomedical strategies and shifts in service delivery. The study also has several strengths, including a clearly defined target population, split-sample EFA/CFA, and reporting of internal consistency and convergent/discriminant validity. The reported CFA indices are favorable, and the authors have made visible efforts to strengthen the revised version. That said, I have several major concerns. The most important issue is conceptual: the manuscript defines HIV prevention behavior broadly, including safer sex, regular testing, and uptake/adherence to biomedical prevention such as PrEP and PEP, yet the final 9-item scale is much narrower and is largely centered on partner avoidance, condom/lubricant use, injury avoidance, and regulation of sexual feelings. This creates a mismatch between the stated construct and the actual item content. In addition, the factor-analytic decisions need clearer justification, especially because the initial solution yielded three components and one item was reassigned on conceptual grounds. The validity evidence is also still fairly limited for a new scale that is proposed for intervention and program use. For these reasons, I think the manuscript has potential, but it needs substantial revision before it can be considered psycho metrically convincing and fully informative for HIV prevention research and practice. Major comments 1. Abstract The abstract is clearer than a minimal draft, but it still overstates what the study has established. The manuscript reports acceptable internal consistency, a two-factor solution, and modest convergent correlations with related measures. However, the conclusion that the scale demonstrated “sound psychometric properties” and is ready for future interventions feels stronger than the presented evidence. The abstract should more cautiously describe this as an initial validation or preliminary psychometric evaluation , especially because test-retest reliability, criterion validity, predictive validity, and in variance testing were not performed. A second issue is construct clarity. The introduction defines HIV prevention behavior as including regular testing and biomedical prevention uptake/adherence, but the abstract does not alert the reader that the final 9-item scale captures only a subset of this wider domain. That gap should be acknowledged even in the abstract, so the reader does not assume that the measure comprehensively covers contemporary HIV prevention practices. 2. Introduction The introduction identifies a relevant gap, namely that older Thai MSM scales may no longer reflect the current prevention context. That rationale is reasonable. However, the manuscript still does not fully bridge the distance between the broad prevention framework introduced in the text and the narrower behavioral content represented in the final measure. The manuscript explicitly defines HIV prevention behavior to include regular testing and PrEP/PEP-related practices, and it cites literature on PrEP-related constructs, but those elements are not retained in the final scale. This creates a conceptual problem: the paper is framed as a modern HIV prevention behavior measure, but the final scale remains closer to a traditional sexual risk reduction instrument. The theoretical framing also needs tightening. The introduction mentions the Minority Stress Model, the Health Belief Model, the Theory of Reasoned Action, and later the Information–Motivation–Behavioral Skills framework. At present, these models feel more appended than integrated. The authors should decide whether the scale is primarily behavioral, psycho-social, or both, and then explain more directly how the proposed dimensions arise from that theory. Otherwise, the introduction risks sounding broader and more theoretically complete than the measure itself supports. 3. Methods The methods section is more detailed than in a minimal scale-development report, but several concerns remain. First, the scale-development process still needs stronger transparency. The paper states that an initial 34-item pool was mapped to key HIV prevention behaviors, then reduced using IOC and corrected item-total correlations, with a final 9-item scale. However, the reader is not given enough detail about which domains were dropped and why. This is especially important because the qualitative categories explicitly include PrEP/PEP uptake and adherence, HIV/STI testing, and status discussion, yet none of these are clearly represented in the final item set. A table showing domain-to-item mapping from initial pool to final scale would greatly strengthen content-validity claims. Second, the use of cognitive interviewing with only three experts raises a methodological concern. Cognitive interviewing is most often used with members of the target population to examine comprehension, response processes, and cultural relevance. Here, the interviews appear to have been conducted with experts, not end users, which limits the strength of the evidence for target-population comprehensibility. The paper should justify this choice much more explicitly and avoid presenting it as a full substitute for user-based qualitative item development. Third, the sampling strategy is understandable for a stigmatized population, and the authors do acknowledge limitations of snowball sampling. Still, the decision to include only participants aged 25 years or older substantially narrows the target population. Younger MSM are a key HIV prevention population in many settings. The authors should therefore avoid general language implying applicability to all Thai MSM, unless they can justify why the construct should operate similarly in younger groups. Fourth, there is an inconsistency in factor-analytic terminology. In the methods, the authors state that EFA used principal axis factoring with varimax rotation. In the results, the text refers to PCA with varimax rotation. These are not interchangeable procedures. This inconsistency needs correction, and the authors should clearly report which method was actually used. 4. Results The results section is where the main psychometric concerns become most visible. The qualitative section identifies three categories: denial and avoidance of HIV risk, self-protective actions before and during sexual activity, and appropriate sexual response. These categories include modern prevention content such as PrEP/PEP use, testing, and HIV/PrEP status discussion. However, the final 9 items do not visibly preserve this breadth. Instead, the retained items focus on condom use, lubricant use, partner switching, risky invitations, injury/wound avoidance, and sexual feeling regulation. This weakens the argument that the final scale adequately reflects the broader domain identified in the qualitative phase. The factor analysis also needs more careful interpretation. The exploratory solution initially yielded three components with eigenvalues above 1, and item 4 loaded alone on the third component. The authors then reassigned item 4 to component 2 because it conceptually aligned with self-protective actions. That may be reasonable, but it also means the final two-factor model was not the most direct empirical solution. This should be described more cautiously. The current wording makes the final structure sound more naturally supported by the data than it actually was. Some item content also raises concern about construct purity. For example, the item about expressing sexual feelings through masturbation, spirituality, or recreation, and the items about avoiding wounds or not physically harming a partner, may reflect broader sexual self-regulation or interpersonal conduct rather than core HIV prevention behavior. These items may be culturally meaningful, but the authors need to explain more clearly why they belong in a scale presented as an HIV prevention behavior measure, especially when more central contemporary prevention behaviors were not retained. Finally, the validity evidence is limited. Cronbach’s alpha is acceptable at 0.77, but the convergent validity coefficients are small to modest, and there is no criterion-related validity, known-groups validity, predictive validity, or test-retest reliability. The paper therefore supports preliminary structural validity, not full psychometric maturity. 5. Discussion The discussion is thoughtful in places, especially where it tries to situate the two factors within health-behavior frameworks and Thai sociocultural context. However, it still overstates the scale’s scope and readiness. Most importantly, the discussion claims that the present scale “foregrounds biomedical-era prevention,” yet the final retained items do not convincingly do so. The manuscript itself introduces PrEP, PEP, and regular testing as key parts of HIV prevention behavior, and these were mentioned in the qualitative categories, but they are not reflected in the reported 9-item measure. The authors should either revise their claims downward or explain much more clearly why the absence of these domains does not compromise content validity. The discussion would also benefit from stronger comparison with prior literature. The paper states that the new tool updates earlier Thai instruments and combines previously separate domains into one measure, which is useful. But it does not sufficiently explain how the present two-factor structure compares with similar HIV prevention behavior instruments or whether this structure is expected to be culturally specific. I also think the practical recommendations are somewhat ahead of the evidence. The paper proposes screening, segmentation, monitoring, and intervention tailoring based on this 9-item scale. Those suggestions are interesting, but without known-groups validity, predictive validity, or threshold validation, they remain hypothetical. The discussion should present these as future possibilities rather than current implementation recommendations. Minor comments Abstract Please check small wording and numerical consistency in the abstract. In one place the convergent correlations are reported as 0.21 and 0.16, whereas the main text/table later report 0.21 and 0.26. This needs to be harmonized. Introduction There are still multiple language issues and awkward phrases in the introduction, for example “being used scales for MSM” and “This epidemiologic patterns.” These do not prevent understanding but reduce the professional tone of the paper. Methods Please provide a flow of item reduction from 34 items to 19 items to 9 items, with reasons for removal at each step. This would make the development process much more transparent. Please also clarify whether the scale was developed in Thai and then translated into English for the manuscript, and if so, whether any translation/back-translation procedures were used for reporting item content. The current bilingual presentation is useful, but the language handling process is not fully clear. Results Please define the factor labels more carefully. “Denial and avoidance of HIV risk” may not be the clearest label, because the retained items seem to reflect deliberate avoidance of risky situations rather than psychological denial in the usual sense. A label such as “risk avoidance” may be more precise. Please review all statistical reporting for consistency. The manuscript gives fit indices twice, and one repeated sentence appears to contain typographic errors, including “CFI = .8” and mislabeling TLI as “Root mean square residual.” Discussion The cultural discussion is promising, especially the mention of stigma, masculinity, discretion, and kreng-jai . However, it would be stronger if more directly tied back to specific items rather than discussed at a general level. The future research section would be improved by explicitly stating the next psychometric steps: test-retest reliability, known-groups validity, predictive validity against actual prevention outcomes, and invariance across age groups and regions. The current version mentions some of these, but the sequence of priorities could be clearer. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise HIV; PrEP; adherence; digital health; intervention; health behavior I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) li Q. Peer Review Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.197233.r469526) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-513/v2#referee-response-469526 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 E Turpin R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 Sep 2025 | for Version 1 Rodman E Turpin , George Mason University, Fairfax, USA 0 Views copyright © 2025 E Turpin R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors conducted a psychometric analysis of an HIV prevention behavior scale among Thai MSM. Overall the study addresses an important question, is salient with implications for large-scale public health efforts, and will be a strong contribution to the literature. I have a few recommendations to improve clarity and readability. 1. Minor point: You could save a lot of word space by using MSM as an acronym after its first mention in the introduction. 2. In the first paragraph, some additional discussion on some of the literature around homophobia as a stressor among MSM (with citation) will be helpful. 3. In general, review for grammatical errors throughout (such as the first sentence of the methods, where "examination of" should be "examine". 4. In the construct validity section, "The researcher used a sample of 424 people" should be removed, since the sample size was mentioned one paragraph earlier. Also, saying you used a sample of people can sound exploitative, it's generally better to say you used data rather than a sample. 5. Future research recommendations should be elaborated on more. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise HIV, STI, racial/ethnic and sexual minorities, latent variable modeling I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) E Turpin R. Peer Review Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.146278.r409707) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/12-513/v1#referee-response-409707 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Nooripour R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 30 Dec 2024 | for Version 1 Roghieh Nooripour , Alzahra University, Tehran, Tehran Province, Iran 0 Views copyright © 2025 Nooripour R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Abstract The objective stated in the abstract should be more precise. Instead of stating that the study “investigates the psychometric features,” specify the particular psychometric features you aim to assess (e.g., reliability, construct validity, etc.). This will provide the reader with a clearer understanding of the study's purpose. The description of the methods is very brief. Mention how the two-part division of the sample (for exploratory and confirmatory factor analysis) is executed, and clarify the rationale for using Cronbach’s alpha as the primary reliability measure. Also, explain the choice of convergent and discriminant validity tests, and how they are relevant to the study's goals. In the results section, the statistical values (e.g., χ2, p-values, CFI) should be explained more thoroughly. Indicate the significance level of the tests and whether the statistical results align with the expectations for a valid psychometric tool. Adding clarity on how these results support the psychometric validity of the scale would strengthen this section. The conclusion in the abstract is appropriate, but it could be more concise by directly stating that the scale is not only psychometrically valid but also relevant for future interventions. It is important to emphasize how the study’s findings can lead to practical applications in HIV prevention. Introduction introduction presents various pieces of information (minority stress, HIV prevalence, etc.), but the connection between these elements and the study’s focus on HIV prevention behavior could be more explicitly stated. Ensure the flow logically progresses from the introduction of the problem (HIV among MSM) to the significance of the psychometric tool being studied. The transition between the introduction of MSM as a vulnerable group and the prevalence of HIV among them could be more seamless. Focus on the significance of the HIV prevention behavior scale for MSM in Thailand specifically, and state why this research is necessary. The issue of outdated scales should be more directly tied to the need for an updated measure that aligns with current challenges and social contexts. Concepts like the "minority stress model," "HIV prevention behavior," and other theories mentioned should be introduced with clearer definitions. Present these theories within the context of the study, making it clear why they are central to understanding the behavior of MSM in Thailand, specifically in relation to HIV prevention. Although the introduction introduces relevant theories such as the Health Belief Model and Theory of Rational Action, it would benefit from a clearer integration of how these theories relate to the study's objectives. Expanding on the link between these theoretical frameworks and the HIV prevention behaviors in MSM would create a more robust narrative. While the introduction mentions the absence of updated scales for HIV prevention behavior in Thailand, further emphasize the gap in the literature and how this study contributes to filling that gap. It would be helpful to discuss briefly why existing scales are inadequate in the context of Thai MSM and what this study hopes to improve or provide. Methods While the cross-sectional design is stated, more information is needed on why this design is suitable for the study’s objectives. For example, explain how cross-sectional data can be used to examine psychometric properties and why longitudinal data might not have been necessary for this particular research question. The sampling method (snowball sampling) is described, but the rationale for using this method should be elaborated. Discuss the potential limitations of snowball sampling (e.g., selection bias, homogeneity of sample) and how these limitations are addressed. Moreover, clarify the justification for selecting individuals aged 25 and older, and explain if this age range reflects the target population for the HIV preventive behaviors scale. The sample size calculation based on the Central Limit Theorem and the need for a minimum of 200 participants is mentioned but needs more explanation. Why specifically was this size chosen? It would be beneficial to present the power analysis or any other statistical justification for the sample size. The section detailing the HIV Preventive Behavior Scale and other tools needs more specificity. For example, describe why the 9-item scale was developed, how the items were selected, and how they were related to the key HIV prevention behaviors. A more detailed explanation of the cognitive interview method would also be helpful, including the role of expert feedback and how this method enhanced the validity of the scale. While the statistical methods (EFA, CFA, reliability analysis) are listed, more details should be provided about the specific steps and decisions made during these analyses. For instance, explain the criteria used for determining construct validity in the CFA, the thresholds for good model fit, and how these criteria relate to the goals of the study. Discuss how you handled potential issues like multicollinearity or cross-loadings in the factor analysis. Provide more details about how participants’ consent was obtained, particularly in terms of the online survey. Discuss how anonymity was maintained, how the confidentiality of participants was ensured, and how the study complied with ethical guidelines for research with vulnerable populations. How were participants recruited, and were there any specific challenges in obtaining a diverse sample? Also, describe how the data was stored and managed to ensure integrity. Results The categorization of the HIV-preventive behaviors into three broad groups (denial and avoidance, self-protective actions, and appropriate sexual response) should be more explicitly defined. The terms “denial,” “avoidance,” and “self-protective” need to be clearly operationalized, as their meaning could vary among different readers. For example, the term “self-protective” requires further elaboration to ensure that it is understood in a way that aligns with the research context. A more detailed explanation of how these categories were derived would improve clarity. While the inclusion of participant quotes helps illustrate the themes, it would be beneficial to more systematically explain how these quotes were selected and their significance in relation to the overarching research questions. It is crucial to link the quotes directly to the themes identified in the categories (e.g., how does each participant’s quote specifically inform the "denial and avoidance" or "self-protective actions"?). Additionally, ensure that the formatting of these quotes is consistent, particularly when indicating direct statements. The details of the factor analysis (e.g., PCA, EFA, CFA) should be more transparent. Specifically, while it is stated that "the first component was denial and avoidance of HIV risk," it is not clear how the decision was made to group certain items together in this category. More explanation should be given about the thresholds or criteria used for factor loadings and why certain items (like question 4) were moved between components. Additionally, clarify how you determined the adequacy of the model fit based on the indices presented (e.g., χ², GFI, RMSEA) and how these compare to established benchmarks in the literature. The integration of demographic data with the psychometric analysis is lacking. To enhance the interpretation, demographic variables (such as age, sexual orientation, and frequency of sexual encounters) could be incorporated into the factor analyses or reliability tests to investigate whether certain variables influence the HIV preventive behavior scores. Discussion The discussion should better articulate how the study's findings build upon or diverge from previous research. For instance, while references to studies by Pimthong and Bhanthumnavin are made, the specific ways in which this study either aligns or contrasts with their findings are not clearly outlined. You should highlight the significance of the two-factor model in this study and compare it in depth with similar models used in HIV prevention research, including contrasting findings from different cultural or regional contexts. The two-component structure identified in the CFA (denial and avoidance, self-protective conduct) should be further examined in relation to the overall theory of HIV prevention behavior. How do these components relate to theoretical frameworks in sexual health and HIV prevention? Providing a more detailed theoretical underpinning for the categories would allow readers to better understand the broader implications of the findings. In particular, it would be valuable to explore whether these two components align with broader psychological theories of health behavior or HIV-related stigma. The discussion should provide more practical recommendations for HIV prevention programs. While the findings are connected to previous studies, there is less focus on how the research results can inform interventions or policies targeting MSM. More concrete suggestions on how to integrate the two components of HIV prevention behavior into public health strategies would strengthen the relevance of the study. The limitations section is briefly mentioned but should be expanded. It is essential to include a critical examination of the study’s limitations, such as the potential biases in the sampling process due to the use of online surveys, which could affect the generalizability of the findings. You should also discuss the limitations of relying solely on self-reported data, as this may introduce response biases, and the potential effects of social desirability or recall bias on the results. Additionally, the issue of sample homogeneity in terms of age or sexual orientation should be discussed, as it might limit the applicability of the findings to broader populations. While the limitations section touches on some areas for improvement, the discussion should provide a more thorough outline of potential future research. Consider recommending further studies that examine the cultural nuances in HIV preventive behaviors among MSM in other regions or countries. Also, explore how different prevention interventions might be tailored to the specific behaviors identified in this study, such as targeting denial and avoidance or enhancing self-protective behaviors. In line with the limitations, it would be beneficial to suggest methodological refinements for future studies, such as the inclusion of qualitative interviews to gain deeper insights into the underlying psychological mechanisms behind the two components identified. This would complement the quantitative data and provide a more comprehensive understanding of MSM’s HIV prevention behaviors. The discussion would benefit from a more in-depth exploration of the cultural context within Thailand, and how it might influence the reported HIV preventive behaviors. For instance, consider discussing how societal views on sexuality, masculinity, and HIV risk might shape the denial/avoidance and self-protective behavior categories identified in this study. This would provide a more nuanced understanding of the findings and their implications for HIV prevention within this specific cultural setting. Is the work clearly and accurately presented and does it cite the current literature? No Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? No Competing Interests No competing interests were disclosed. Reviewer Expertise MindfulnessAdolescent Mental HealthStressEmotionCyberpsychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Nooripour R. Peer Review Report For: HIV preventive behavior scale for Thai men who have sex with men (MSM): development and psychometric properties [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2026, 12 :513 ( https://doi.org/10.5256/f1000research.146278.r353209) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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