Development of a vaccine hesitancy scale for childhood immunization in China

Xuelin Yao; Jin Peng; Yue Ma; Mao Fu; Yu Fang; Hai Fang; Minghuan Jiang

doi:10.1016/j.vaccine.2023.09.057

Development of a vaccine hesitancy scale for childhood immunization in China

Vaccine. 2023 Oct 9:S0264-410X(23)01154-4. doi: 10.1016/j.vaccine.2023.09.057. Online ahead of print.

Authors

Xuelin Yao¹, Jin Peng¹, Yue Ma¹, Mao Fu¹, Yu Fang², Hai Fang³, Minghuan Jiang⁴

Affiliations

¹ Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
² Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China. Electronic address: yufang@xjtu.edu.cn.
³ China Center for Health Development Studies, Peking University, Beijing, China; Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China. Electronic address: hfang@hsc.pku.edu.cn.
⁴ Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Institute for Global Health and Development, Peking University, Beijing, China. Electronic address: jiangmh2017@xjtu.edu.cn.

PMID: 37821318
DOI: 10.1016/j.vaccine.2023.09.057

Abstract

Objective: Vaccine hesitancy is a primary factor that influences vaccine uptake; however, no specific measurement tool to accurately assess vaccine hesitancy is available in China. This study aimed to develop a general vaccine hesitancy scale for childhood immunization.

Methods: We adopted a three-phase process with nine steps to develop and finalize our scale. The scale framework and initial item pool were determined by a literature review. Expert consultation and cognitive interviews with parents were conducted to evaluate content validity. Questionnaire surveys involving parents of children aged <6 years were conducted to select items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to identify and validate the scale factor structure. The scale's reliability and validity were assessed using multiple indicators.

Results: Of the initial 38 items, 21 were retained after expert consultation and cognitive interviews. In survey 1, the number of scale items decreased to 16 following item analysis and EFA. In survey 2, four items were added and EFA identified four factors. In survey 3, CFA confirmed the four-factor structure and the reliability indicators were satisfactory for the total scale. The level of vaccine hesitancy assessed by our scale was positively associated with vaccination refusal behavior and the Vaccine Hesitancy Scale score. The final scale comprised four dimensions (confidence, complacency, convenience, and calculation) with 17 items.

Conclusions: We developed a validated and reliable measurement to assess vaccine hesitancy among parents of children, which promises to be suitable for wide use in China.

Keywords: Children; China; Vaccine acceptance; Vaccine hesitancy; Vaccine hesitancy scale.