Understanding what people think and feel about adult vaccinations and the associated barriers in Greece: Development and validation of the attitude towards adult vaccination (ATAVAC) scale

Zoi Tsimtsiou; Ioanna Tsiligianni; Anastasia Papaioannou; Dimitrios Gougourelas; Konstantinos Kolokas; Vasileios Gkizlis; Emmanuil Chatzimanolis; Philippe-Richard J Domeyer

doi:10.1111/hsc.13317

Understanding what people think and feel about adult vaccinations and the associated barriers in Greece: Development and validation of the attitude towards adult vaccination (ATAVAC) scale

Health Soc Care Community. 2021 May;29(3):818-828. doi: 10.1111/hsc.13317. Epub 2021 Feb 17.

Authors

Zoi Tsimtsiou^{1

2}, Ioanna Tsiligianni^{2

3}, Anastasia Papaioannou^{2

4}, Dimitrios Gougourelas^{2

5}, Konstantinos Kolokas^{2

6}, Vasileios Gkizlis^{2

7}, Emmanuil Chatzimanolis^{2

8}, Philippe-Richard J Domeyer^{2

9}

Affiliations

¹ Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
² Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.
³ Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion Crete, Greece.
⁴ Health Centre of N. Makri, Athens, Greece.
⁵ Health Centre of Goura, Goura, Greece.
⁶ 3rd Local Health Unit of Evosmos, Thessaloniki, Greece.
⁷ Rural practice of Mavrommati, Mavrommati Karditsa, Greece.
⁸ Rural Practice of Aiani, Aiani Kozani, Greece.
⁹ School of Social Sciences, Hellenic Open University, Patra, Greece.

PMID: 33595159
DOI: 10.1111/hsc.13317

Abstract

Despite the unequivocal value of vaccination in reducing the global burden of infectious diseases, the anti-vaccination movement thrives. The vast majority of the existing validated tools explore attitudes regarding vaccination in children. The aim of our study was to develop and validate a scale assessing attitudes towards adult immunisation. This national cross-sectional study included adult healthcare users who visited 23 Greek Primary Healthcare Units. The development of the scale was the result of literature review, semi-structured interviews and pilot testing of its preliminary versions. The initial version contained 15 items measuring respondents' attitudes on a 6-point Likert scale. The sample was randomly split into two halves. Exploratory factor analysis, performed in the first sample, was used for the creation of multi-item scales; confirmatory factor analysis was used in the second sample to assess goodness of fit. Moreover, concurrent validity, internal consistency reliability, test-retest reliability and ceiling and floor effects were explored. The total sample consisted of 1,571 individuals. Overall 'Cronbach's alpha' (0.821) indicated good internal consistency. The initial exploratory factor analysis resulted in a three-factor model. The subsequent confirmatory factor analysis indicated that an 11-item version of the scale provided the best fit of the model to the data (RMSEA = 0.050, SRMR = 0.053, TLI = 0.937, CFI = 0.955, AIC = 24,999.949). All subscales ('value of adult vaccination', 'safety concerns' and 'perceived barriers') demonstrated strong concurrent associations with participants' attitudes and behaviour regarding vaccination (p < .001). No ceiling or floor effects were noted for any of the subscales (0.13%, 2.61% and 0.51%; 0.13%, 0.57% and 0.45% respectively). The 11-item ATAVAC scale proved to be a reliable and valid tool, suitable for assessing attitudes towards adult vaccination.

Keywords: attitude scales; primary care research; scale development; vaccination.

MeSH terms

Adult
Attitude*
Child
Cross-Sectional Studies
Greece
Humans
Psychometrics
Reproducibility of Results
Surveys and Questionnaires
Vaccination*