Validation and psychometric properties of the Italian Vaccination Attitudes Examination (VAX-I) scale

Attitudes towards Maternal Immunisation of Polish Mothers: A Cross-Sectional, Non-Representative Study

INTRODUCTION

Vaccination protects pregnant women against dangerous infectious diseases and contributes to disease prevention for the child until their vaccination schedule begins. Vaccination behaviour is related to attitudes concerning vaccine prevention.

MATERIALS AND METHODS

This cross-sectional, non-representative study was conducted among Polish mothers using a diagnostic survey. We used the Vaccination Attitudes Examination (VAX) Scale. The author's questionnaire included questions concerning experiences with adult and maternal vaccinations, as well as sociodemographic data.

RESULTS

Among the 375 respondents, more than half (n = 208, 55.47%) received at least one vaccine during pregnancy. The majority of respondents had a university education (n = 356, 94.93%). There was no statistically significant difference in terms of receiving vaccines during pregnancy between respondents with and without a healthcare education (p = 0.230). A logistic regression model indicated that women who were vaccinated outside pregnancy for COVID-19 (OR 4.61, 2.60-8.22) and influenza (OR 7.14, 3.58-14.25) were statistically significantly more likely to be vaccinated during pregnancy. There were statistically significant differences between women who were vaccinated during pregnancy and those who did not receive maternal immunisation in three subscales of the VAX Scale: Mistrust of Vaccine Benefit, Concerns about Commercial Profiteering, and Preference for Natural Immunity (p < 0.001). The most frequently indicated reason for a woman's decision to be vaccinated was concern for the health and safety of the unborn child (n = 196, 94.23%). In contrast, women who were not vaccinated reported fear for the health and safety of the unborn child (n = 88, 52.69%).

CONCLUSIONS

A key point may be to contribute to the vaccinology education of healthcare professionals, who play an important role in pregnant women's decision to be vaccinated. However, our results may be disrupted because the majority of the women in our study had a university education.

Sociodemographic factors associated with vaccine hesitancy in the South Asian community in Canada

OBJECTIVE

South Asians represent the largest non-white ethnic group in Canada and were disproportionately impacted by the COVID-19 pandemic. We sought to determine the factors associated with vaccine hesitancy in South Asian Canadians.

METHODS

We conducted a cross-sectional analysis of vaccine hesitancy using data collected at the baseline assessment of a prospective cohort study, COVID CommUNITY South Asian. Participants (18 + years) were recruited from the Greater Toronto and Hamilton Area in Ontario (ON) and the Greater Vancouver Area in British Columbia (BC) between April and November 2021. Demographic characteristics and vaccine attitudes measured by the Vaccine Attitudes Examination (VAX) scale were collected. Each item is scored on a 6-point Likert scale, and higher scores reflect greater hesitancy. A multivariable linear mixed effects model was used to identify sociodemographic factors associated with vaccine hesitancy, adjusting for multiple covariates.

RESULTS

A total of 1496 self-identified South Asians (52% female) were analyzed (mean age = 38.5 years; standard deviation (SD): 15.3). The mean VAX score was 3.2, SD: 0.8 [range: 1.0‒6.0]. Factors associated with vaccine hesitancy included: time since immigration (p = 0.04), previous COVID-19 infection (p < 0.001), marital status (p < 0.001), living in a multigenerational household (p = 0.03), age (p = 0.02), education (p < 0.001), and employment status (p = 0.001).

CONCLUSION

Among South Asians living in ON and BC, time since immigration, prior COVID-19 infection, marital status, living in a multigenerational household, age, education, and employment status were associated with vaccine hesitancy. This information can be used to address vaccine hesitancy in the South Asian population in future COVID-19 waves or pandemics.

A psychometric assessment of a novel scale for evaluating vaccination attitudes amidst a major public health crisis

Despite abundant scientific evidence supporting immunization benefits, vaccine hesitancy remains a significant global health concern, particularly during public health crises. Exploring public attitudes towards vaccination is crucial. This study aimed to develop and validate a tailored Public Vaccination Attitudes Scale specifically under the unique circumstances of a public health crisis. A psychometric evaluation was conducted using a cross-sectional study during the peak of a major public health crisis. The scale was developed and its psychometric properties validated using three approaches: (1) generating the item pool through literature research and focus group discussions; (2) assessing the items through expert consultation; and (3) evaluating construct validity, content validity, and internal consistency reliability through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Data from a total of 3921 respondents were randomly divided into two subsets, one for EFA (n = 1935) and the other for CFA (n = 1986). A 22-item draft scale with five factors was created after literature research and focus group discussion. The content validity of this scale ranged between 0.88 and 1.00. EFA showed a 17-item scale with four factors (Cronbach's α > 0.7) accounting for 68.044% of the total variance. CFA showed that the values of the fit indices, including convergent validity and discriminant validity, were excellent or acceptable. The overall Cronbach's α was 0.874, and each factor ranged from 0.726 to 0.885. This study introduces a valuable tool for assessing vaccination attitudes during public health crises, aiding researchers, policymakers, and nurses in combating vaccine hesitancy. Emphasizing the importance of fostering vaccine acceptance, it enhances disease control during emergencies, contributing to the knowledge needed for more effective public health strategies and crisis responses.

Psychological variables linked to hesitation toward vaccination against COVID-19 among late adolescents and young adults: The role of magical thinking and right-wing authoritarianism

INTRODUCTION

Several studies on the predisposition to be subjected to vaccination have shown that vaccine hesitation is a global phenomenon influenced by a lack of knowledge and awareness, as well as perceived risks and benefits. The purpose of this study was to investigate the mediating role of right-wing authoritarianism in the relationship between magical thinking and positive attitudes toward COVID-19 vaccines (i.e. trust of vaccine benefits, worries over unforeseen future effects, concerns about commercial profits, preference for natural immunity).

METHOD

The sample consisted of 201 Italian young adults, 49 males (24.4%), and 152 females (75.6%), aged between 18 and 25. Data were collected during 2022.

RESULTS

The results confirmed the role of right-wing authoritarianism as a mediator for magical thinking on positive vaccine attitudes. Findings indicated a positive association between right-wing authoritarianism and magical thinking and a negative relationship of both the aforementioned variables on positive vaccine attitudes. SEM analyses showed a direct positive association from magical thinking to right-wing authoritarianism and a direct negative association from right-wing authoritarianism to trust of vaccine benefits, to low worries over unforeseen future effects, to lack of concerns about commercial profits and to low preference for natural immunity.

CONCLUSIONS

The findings highlight that common contribution of odd or magical beliefs and right-wing authoritarianism may slow the spread of vaccines among late adolescents and young adults. Our findings provide insight on what effective communication with vaccine-resistant individuals should look like in order to increase the chances of reaching vaccine-hesitant individuals.

Vaccination Attitudes Examination (VAX) Scale: a Bifactor-ESEM approach in a youth sample (15-24 years)

BACKGROUND

The Vaccination Attitudes Examination (VAX) Scale is a widely used scale designed to measure general attitudes toward vaccinations. However, evidence for the VAX's structural, convergent, and discriminant validity is still limited, especially in youth samples.

METHODS

The present study examined the psychometric multidimensionality and evidence of convergent and discriminant validity of the VAX using the bifactor-exploratory structural equation modeling approach (bifactor-ESEM). Using a sample of 803 Serbian adolescents and young adults (Mage = 18.23, SDage = 2.66, age range = 15-24 years, 59.2% female), we contrasted the original four-factor model of the VAX with alternative solutions (ESEM, bifactor-CFA, and bifactor-ESEM), and investigated associations between vaccination attitudes and a variety of external criteria.

RESULTS

The results supported the bifactor-ESEM solution with one general factor of vaccination attitudes and four specific factors (Mistrust of vaccine benefit, Worries about unforeseen future effects, Concerns about commercial profiteering, and Preference for natural immunity) as the best representation of the data. The general factor was well-defined, and three specific factors showed good validity and specificity after the general factor was taken into account. The results of convergent validity analyses showed that the general factor of vaccine attitudes and one specific factor (Mistrust of vaccine benefit) were good predictors of vaccine conspiracy beliefs, attitudes towards COVID-19 vaccination, intention to get vaccinated against COVID-19, and trust in healthcare. The remaining three specific factors' contributions to external criteria were generally weak and nonsignificant. Evidence of the discriminant validity of the VAX scores was supported by weak positive associations of the general factor with medical fears and paranoid worry.

CONCLUSIONS

The present findings indicate that distinguishing general and specific components of vaccination attitudes offers a more nuanced assessment and understanding of vaccination attitudes.

Validation of the vaccination attitudes examination scale in a South African context in relation to the COVID-19 vaccine: quantifying dimensionality with bifactor indices

BACKGROUND

The COVID-19 pandemic represented a global public health emergency. Existing studies support the view that vaccination and mass immunization are among the most effective means of containing the outbreak and promoting health. However, negative attitudes toward vaccination and the related vaccine hesitancy among many groups have created a significant barrier to effectively managing the health crisis. Having a valid and reliable tool to assess attitudes toward vaccination remains imperative so that factors underlying vaccine refusal can be identified and public health interventions can be facilitated. The current study examined the psychometric properties of the Vaccination Attitudes Examination Scale (VAX) in South Africa.

METHODS

Participants (n = 322) completed the VAX. Confirmatory factor analysis and ancillary bifactor indices were used to examine the hypothesized factor structure (a total scale and four subscales) of the scale. Inter-item correlations, factor loadings, and average variance extracted were used to examine the validity of the scale. Predictive validity was examined by comparing those who had received the COVID-19 vaccine and those who had not. The reliability of the scale was examined in terms of both Cronbach's alpha and composite reliability.

RESULTS

Confirmatory factor analysis provided support for the conceptualization of the scale as consisting of a total scale and four subscales, and ancillary bifactor indices indicated that the subscales accounted for a sufficient amount of variance (44%) after the variance explained by the total scale was considered. Overall, the analysis indicated that the scale had satisfactory reliability (alpha and composite reliability = 0.70) and provided evidence for the construct, convergent, and predictive validity of the VAX.

CONCLUSIONS

The sound psychometric qualities of the scale, when used in a low- to middle-income country, have the potential to advance research and immunization policy within these settings and facilitate more targeted interventions to promote vaccine uptake.

Strengthening the Link between Vaccine Predispositions and Vaccine Advocacy through Certainty

Background. Instruments designed to assess individual differences in predispositions towards vaccination are useful in predicting vaccination-related outcomes. Despite their importance, there is relatively little evidence regarding the conditions under which these instruments are more predictive. The current research was designed to improve the ability of these kinds of instruments to predict vaccination advocacy by considering the certainty associated with the responses to vaccination scales. Method. Across two studies, participants completed the Beliefs about Medicines Questionnaire BMQ scale (Study 1) or the Vaccination Attitudes Examination (VAX) scale (Study 2). The certainty participants had in their responses to each scale was either measured (Study 1) or manipulated (Study 2). Intentions to advocate in favor of vaccination served as the criterion measure in both studies. Results. As expected, the scales significantly predicted vaccination advocacy, contributing to enhancing the predictive validity of the instruments used in the studies. Most relevant, certainty moderated the extent to which these scales predicted vaccination advocacy, with greater consistency between the initial scores and the subsequent advocacy willingness obtained for those with higher certainty. Conclusions. Certainty can be useful to predict when the relationship between vaccination-related cognitions (i.e., beliefs or attitudes) and advocacy willingness is likely to be stronger.

COVID-19 in Pregnancy: Knowledge about the Vaccine and the Effect of the Virus. Reliability and Results of the MAMA-19 Questionnaire

BACKGROUND

Fear or mistrust of the vaccine and concern for the well-being of their unborn infants are the main reasons for COVID-19 vaccine hesitancy in pregnant women. The aim of this work was to validate a questionnaire on knowledge about COVID-19 vaccination during pregnancy and to examine the sources of information in a group of new mothers, as well as their effectiveness and intelligibility.

METHODS

A literature review was carried out to develop a questionnaire of forty-five questions, divided into six sections, called MAMA-19. The assessment of agreement and the interrater reliability was carried out using Cronbach's analysis and Cohen's kappa statistic. Data obtained from the questionnaire were analysed using descriptive and univariate statistics.

RESULTS

The total alpha values in the two sections about knowledge of vaccination during pregnancy and about the effects of disease and possible post-COVID-19 consequences for the unvaccinated showed sufficient consistency, at 0.860 and 0.725, respectively. Non-vaccinated women thought that receiving the COVID-19 vaccine during pregnancy can lead to malformations in the newborn (60% vs. 40%, p = 0.002) and to an increased risk of foetal growth restriction (61.9% vs. 38.1%, p < 0.001). The percentage of vaccinated women was significantly higher than non-vaccinated when more than one professional was consulted and consistent information was received from them (74.2% vs. 25.8%, p = 0.008).

CONCLUSION

The MAMA-19 questionnaire shows results in line with the literature and valid in the two main sections. It is quick to use for measuring communication effectiveness by healthcare professionals and institutions in the context of the COVID-19 vaccination campaign in the pregnant population. The results evidence that a physician's recommendation to get vaccinated is the most important factor in maternal decision making, regardless of geographic, social or educational context.

Examining four types of anti-vaccination attitudes prior to and during the COVID-19 pandemic

People hold different anti-vaccination attitudes. Having an understanding of how these attitudes have changed prior to and during the COVID-19 pandemic is critical for combatting anti-vaccination attitudes and increasing vaccine intention and uptake. Data were collected from different samples in the United States at three time points prior to (n = 840) and four time points during (n = 1543) the pandemic. All participants completed a multi-dimensional measure of anti-vaccination attitudes (VAX Scale) through an online platform. Results showed that, when it comes to vaccines, worries about unforeseen side effects, concerns about commercial profiteering, and preference for natural immunity were higher during the COVID-19 pandemic than they were prior to it. However, mistrust of vaccine benefit was lower during the COVID-19 pandemic than prior to it. These differences were found even after controlling for the potential effects of participant sex, education, socioeconomic status, age, and race/ethnicity. Additionally, worries about unforeseen side effects, concerns about commercial profiteering, and preference for natural immunity increased linearly alongside the persistence of COVID-19; whereas, mistrust of vaccine benefit showed no change. Although it might be intuitive to emphasize vaccines' effectiveness to increase uptake, the public's trust in vaccine effectiveness did not appear to be the major concern. Thus, public health efforts to increase uptake of vaccines should also focus on reducing concerns about potential side effects from the vaccine, tempering the attention on financial benefits to pharmaceutical companies, and rebuffing the overreliance on natural immunity.

The psychometric properties and the factorial structure of COVID-19 Vaccines Acceptance scale (VAC-COVID-19) within the Arabic language in a Palestinian contex

Background

The COVID-19 Vaccines Acceptance scale (VAC-COVID-19) is an international measure designed to evaluate vaccination acceptance against the COVID-19 virus. The current scale was translated from English to Arabic and validated within the Palestinian context.

Aims

Our study aimed to test the factorial structure and the psychotic properties of the VAC-COVID-19 within the Palestinian context using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) through 484 participants selected using online method techniques.

Findings

The VAC-COVID-19 was a reliable and valid method in assessing COVID-19 vaccine acceptance among Palestinians. Results of CFA indicated a stable construct of a two-factor solution in assessing COVID-19 vaccination acceptance in a Palestinian context. (1) Reasons for not receiving the vaccination, and (2) for receiving the vaccination.

Conclusion

The VAC-COVID-19 was a valid method to assess vaccination acceptance in the Arabic language within the Palestinian context. Therefore, it is recommended to conduct similar studies with diverse samples in Palestinian society; it would be prudent to target at-risk populations needed to develop the scale and its factorial structure. The VAC-COVID-19 can be a useful measure to assess vaccination acceptance among Palestinians, enabling health providers to implement interventions to modify negative attitudes toward not receiving vaccinations.

COVID-19 vaccine uptake among family caregivers of people with dementia: The role of attitudes toward vaccination, perceived social support and personality traits

People with dementia have an increased risk of contracting severe forms of COVID-19. Although in worldwide vaccination programs priority has been given to older people, having taken the vaccine does not totally eliminate the risk of contracting COVID-19 when one is in close contact with unvaccinated people. Thus, family caregivers’ choices to remain unvaccinated against COVID-19 could have potentially lethal consequences for their relatives. To our knowledge, this study represents the first attempt within the international literature to analyze COVID-19 vaccine uptake among family caregivers of people with dementia and to identify some of the psychological factors, related to COVID-19 and vaccination behavior, that could facilitate or hinder vaccine uptake. Contact information for family caregivers was obtained from five different centers and associations throughout the Italian territory. Data were collected from 179 respondents during July-September 2021 using a cross-sectional web-based survey design. More than 75% of the respondents indicated that had been vaccinated against COVID-19 and reported receiving vaccine information mainly from print or electronic newspapers (86%), followed by TV (81%) and families (64.2%). In multivariable logistic regression analyses, worries about unforeseen future effects was significantly related to COVID-19 vaccine uptake, indicating that family caregivers concerned about potential side effects of vaccines were less likely to have been vaccinated against COVID-19 (OR = 0.60, CI = 0.40-0.89). Openness to experience was also related to COVID-19 vaccine uptake, with family caregivers higher on this trait being less likely to have been vaccinated against COVID-19 (OR = 0.83, CI = 0.71-0.98). Implications for targeting of vaccine-related messages are discussed.