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Kantor J, Carlisle RC, Morrison M, Pollard AJ, Vanderslott S. Oxford Vaccine Hesitancy Scale (OVHS): a UK-based and US-based online mixed-methods psychometric development and validation study of an instrument to assess vaccine hesitancy. BMJ Open 2024; 14:e084669. [PMID: 39384231 DOI: 10.1136/bmjopen-2024-084669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2024] Open
Abstract
OBJECTIVES To describe the development, validation and reliability of the Oxford Vaccine Hesitancy Scale (OVHS), a new instrument to assess vaccine hesitancy in the general population. DESIGN Cross-sectional validation study. SETTING Internet-based study with participants in the UK and USA. PARTICIPANTS Demographically representative (stratified by age, sex and race) samples from the UK and USA recruited through the Prolific Academic platform. MAIN OUTCOME MEASURES To demonstrate OVHS development, exploratory factor analysis with categorical variables and a polychoric correlation matrix followed by promax oblique rotation on the UK sample was performed. Confirmatory factor analysis with a Satorra-Bentler scaled test statistic evaluating goodness of fit statistics including the root mean squared error of approximation (RMSEA), standardised root mean squared residual (SRMR) and comparative fit index (CFI) was performed on the US sample. Reliability as internal consistency was assessed using McDonald's omega. Evidence in support of the predictive, convergent and discriminant validity of the scale was assessed using logistic regression ORs of association (OR) or Pearson correlation coefficients. RESULTS Data for factor analysis were obtained from 1004 respondents, 504 in the UK and 500 in the USA. A scree plot, minimum average partial correlation analysis and parallel analysis suggested a three-factor 13-item scale with domains of vaccine beliefs (seven items), pain (three items) and personal deliberation (three items). Responses were recorded on a Likert scale ranging from disagree completely to agree completely, with higher score reflecting greater hesitancy. Potential total scores ranged from 13 to 65. Goodness of fit was excellent, with RMSEA=0.044, SRMR=0.041 and CFI=0.977. Predictive validity for COVID-19 vaccination status was excellent, with logistic regression ORs of association (95% CI) of 0.07 (0.04, 0.13), p<0.0001 for the UK sample for each SD increase in OVHS score, suggesting a 93% decrease in the odds of being vaccinated against COVID-19 for each SD increase in OVHS score. Convergent validity between the OVHS score and the 5C short version scale demonstrated a correlation coefficient of 0.32 (p<0.0001). Discriminant validity with an unrelated desire to perform outdoor activities demonstrated an OR (95% CI) of 1.06 (0.88, 1.29), p=0.523 for the UK sample for each SD increase in OVHS score. McDonald's omega was 0.86 and 0.87 in the UK and US samples, respectively. CONCLUSIONS The OVHS is a feasible, valid and reliable scale for assessing vaccine hesitancy; further testing is warranted.
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Affiliation(s)
- Jonathan Kantor
- Oxford Vaccine Group, University of Oxford, Oxford, UK
- Department of Engineering Science, University of Oxford, Oxford, UK
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Michael Morrison
- HeLEX - Centre for Health, Law and Emerging Technologies, University of Oxford, Oxford, UK
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Howard MC. Vaccine hesitancy as indecision: Creation and evaluation of the Unidimensional Vaccine Hesitancy Scale. Br J Health Psychol 2024. [PMID: 39327232 DOI: 10.1111/bjhp.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/02/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Several authors have argued that vaccine hesitancy should be conceptualized as indecision in the vaccination decision-making process, but no established measure with support for its psychometric properties and validity has been created from this operational definition. AIMS To resolve this tension, this article undergoes a four-study scale development process to create the 4-item Unidimensional Vaccine Hesitancy Scale (UVHS). MATERIALS AND METHODS We conduct four survey studies utilizing a total sample size of 884. RESULTS In Studies 1 (n = 297) and 2 (n = 298), we provide psychometric support for the measure via exploratory and confirmatory factor analysis. In Studies 3 (n = 193) and 4 (n = 106), we support the concurrent and discriminant validity of the measure by assessing its relations with relevant constructs, such as vaccination readiness and acceptance, and we also provide initial indicators of the scale's possible predictive qualities by testing its time-separated effects with vaccination willingness, receipt and word-of-mouth. DISCUSSION We leverage these results to provide a number of theoretical insights and suggestions for future practice. Of note, we highlight that different conceptualizations and operationalizations for the same construct can produce notably differing empirical findings, and vaccine hesitancy is no different. CONCLUSION Our cumulative efforts indicate that the UVHS is an appropriate measure to assess vaccine hesitancy as indecision.
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Affiliation(s)
- Matt C Howard
- The University of South Alabama, Mitchell College of Business, Mobile, Alabama, USA
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Maar M, Bourdon C, Berti J, Bisaillon E, Boesch L, Boston A, Chapdelaine J, Humphrey A, Kumar S, Maar-Jackson B, Martell R, Naokwegijig B, Preet Kaur D, Rice S, Rickaby B, Sutherland M, Reade M. Creating a Culturally Safe Online Data Collection Instrument to Measure Vaccine Confidence Among Indigenous Youth: Indigenous Consensus Method. JMIR Form Res 2024; 8:e52884. [PMID: 39133917 PMCID: PMC11347907 DOI: 10.2196/52884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/19/2024] [Accepted: 05/10/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Participating in surveys can shape the perception of participants related to the study topic. Administering a vaccine hesitancy questionnaire can have negative impacts on participants' vaccine confidence. This is particularly true for online and cross-cultural data collection because culturally safe health education to correct misinformation is typically not provided after the administration of an electronic survey. OBJECTIVE To create a culturally safe, online, COVID-19 vaccine confidence survey for Indigenous youth designed to collect authentic, culturally relevant data of their vaccine experiences, with a low risk of contributing to further vaccine confusion among participants. METHODS Using the Aboriginal Telehealth Knowledge Circle consensus method, a team of academics, health care providers, policy makers, and community partners reviewed COVID-19 vaccine hesitancy surveys used in public health research, analyzed potential risks, and created a framework for electronic Indigenous vaccine confidence surveys as well as survey items. RESULTS The framework for safer online survey items is based on 2 principles, a first do-no-harm approach and applying a strengths-based lens. Relevant survey domains identified in the process include sociodemographic information, participants' connection to their community, preferred sources for health information, vaccination uptake among family members and peers, as well as personal attitudes toward vaccines. A total of 44 survey items were developed, including 5 open-ended items to improve the authenticity of the data and the analysis of the experiences of Indigenous youth. CONCLUSIONS Using an Indigenous consensus method, we have developed an online COVID-19 vaccine confidence survey with culturally relevant domains and reduced the risk of amplifying misinformation and negative impacts on vaccine confidence among Indigenous participants. Our approach can be adapted to other online survey development in collaboration with Indigenous communities.
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Affiliation(s)
- Marion Maar
- Human Sciences Division, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada
| | - Caleigh Bourdon
- Undergraduate Medical Education, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada
| | - Joahnna Berti
- Debajehmujig Storytellers, Debajehmujig Theatre Group, Manitowaning, ON, Canada
| | - Emma Bisaillon
- Interdisciplinary Health, Laurentian University, Sudbury, ON, Canada
| | - Lisa Boesch
- Human Sciences Division, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada
| | - Alicia Boston
- Public Health Sudbury & Districts, Sudbury, ON, Canada
| | | | | | - Sandeep Kumar
- Postgraduate Medical Education, Northern Ontario School of Medicine (NOSM) University, Thunder Bay, ON, Canada
| | | | - Robert Martell
- Interdisciplinary Health, Laurentian University, Sudbury, ON, Canada
| | - Bruce Naokwegijig
- Debajehmujig Storytellers, Debajehmujig Theatre Group, Manitowaning, ON, Canada
| | - Davinder Preet Kaur
- Postgraduate Medical Education, Northern Ontario School of Medicine (NOSM) University, Thunder Bay, ON, Canada
| | - Sarah Rice
- Public Health Sudbury & Districts, Sudbury, ON, Canada
| | - Barbara Rickaby
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | | | - Maurianne Reade
- Clinical Sciences Divison, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada
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Howard MC. Investigating the Relation of Political Orientation and Vaccination Outcomes: Identifying the Roles of Political Ideology, Party Affiliation, and Vaccine Hesitancy. Psychol Rep 2024; 127:1796-1817. [PMID: 36476182 DOI: 10.1177/00332941221144604] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Popular press and academic articles alike suggest that political orientation is a primary determinant of vaccination willingness, vaccination, and vaccine word-of-mouth (i.e., sharing of information regarding vaccines). In the current article, we test the validity of these suggestions, and we also assess the differential roles of political ideology (e.g., liberal-conservative) and party affiliation (e.g., Democrat-Republican) as well as the mediating effect of vaccine hesitancy's dimensions. To do so, we perform a four-wave survey study with 223 participants that completed all waves. Our results support that political orientation indeed relates to our outcomes of interest. Our results also show that political ideology has a more pronounced effect than party affiliation, and the vaccine hesitancy dimensions of Health Risks and Healthy mediate many of these relations. From these results, we suggest many directions for future research and practice, including the integration of political discourse theories in studies on political orientations and vaccination.
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Howard MC. Gender and vaccination: understanding the multifaceted role of a multidimensional conceptualization of vaccine hesitancy. PSYCHOL HEALTH MED 2024; 29:1055-1062. [PMID: 38017635 DOI: 10.1080/13548506.2023.2280462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
Popular press and academic articles alike speculate that gender influences vaccine receipt, but they often disagree whether men or women are less likely to become vaccinated. In the current article, we further test the relation of gender and vaccination in four datasets, and we assess the mediating role of vaccine hesitancy dimensions. Our results demonstrate that: (1) gender has significant relations with several vaccine hesitancy dimensions, which are mixed between both women and men having negative perceptions regarding vaccination; (2) gender does not significantly relate to flu and COVID-19 vaccination willingness or receipt, but women were more likely to receive other vaccines; and (3) a significant indirect effect did emerge in the two datasets collected after widespread access to the COVID-19 vaccine, such that the perception that vaccines cause health risks mediates the relation of gender with flu vaccination willingness as well as COVID-19 vaccination willingness and receipt. Our discussion integrates these findings with models of preventative behaviors and identifies directions for future research.
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Affiliation(s)
- Matt C Howard
- University of South Alabama, Mitchell College of Business, Mobile, AL, USA
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Howard MC. Relations of behavioral inhibition and activation system sensitivities with vaccination outcomes: Investigating the mediating role of vaccine hesitancy in older adults. J Health Psychol 2024; 29:28-41. [PMID: 37691413 DOI: 10.1177/13591053231197645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
The study of behavioral inhibition system (BIS) and behavioral activation system (BAS) sensitivities has produced a multitude of models and frameworks to better understand decision-making and behavior. We extend this research to the study of a vaccination by exploring the relation of BIS and BAS sensitivities with vaccination willingness, receipt, and word-of-mouth. We also assess whether dimensions of vaccine hesitancy mediate these relations, testing whether they are viable explanatory mechanisms. By conducting a multi-wave survey study, our results support that BIS sensitivity does not meaningfully relate to vaccine hesitancy or vaccination outcomes. On the other hand, BAS sensitivity related to detrimental vaccination outcomes, and these effects were mediated by vaccine hesitancy dimensions associated with perceptions that vaccines cause health risks and are not needed for healthy individuals. Based on extant BIS and BAS theory, these results suggest that certain people may see refraining from vaccination as a nonpunishment.
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Yao X, Peng J, Ma Y, Fu M, Fang Y, Fang H, Jiang M. Development of a vaccine hesitancy scale for childhood immunization in China. Vaccine 2023; 41:6870-6877. [PMID: 37821318 DOI: 10.1016/j.vaccine.2023.09.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
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.
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Affiliation(s)
- Xuelin Yao
- 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
| | - Jin Peng
- 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
| | - Yue Ma
- 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
| | - Mao Fu
- 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
| | - Yu Fang
- 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.
| | - Hai Fang
- 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.
| | - Minghuan Jiang
- 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.
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Hill AV, Dyer HP, Gianakas J, Howze R, King A, Gary-Webb TL, Méndez DD. Correlates of COVID-19 Vaccine Uptake in Black Adults Residing in Allegheny County, PA. Health Equity 2023; 7:419-429. [PMID: 37638118 PMCID: PMC10457607 DOI: 10.1089/heq.2022.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Efforts to address vaccine uptake and access among black adults will be relevant for continued coronavirus disease 2019 (COVID-19) eradication efforts and can be transferable to other prevention efforts in future pandemics. This study investigated factors related to COVID-19 vaccine uptake and access among black residents in Allegheny County, PA. Methods Surveys were administered electronically from October 2021 to January 2022 to black Allegheny County residents aged 18 and older. Questions included thoughts on COVID mitigation strategies (e.g., masking, social distancing), vaccination status, intention to vaccinate children, trust of COVID-19 information sources and vaccines, family needs, access to support services, and social media use to access information. Descriptive statistics and significant correlates of being vaccinated using adjusted logistic regression models are reported. Results Of the overall sample (N=397), the majority were fully vaccinated (n=306, 77%). Fully vaccinated participants were more likely to be female (62.5%, p=0.010), age 60 years or older (34.3%, p=0.0002), have some college education (23.2%, p<0.0001), and be employed full time (50.0%, p=0.0001) compared with nonvaccinated individuals. Among the unvaccinated participants (n=91), the primary reason was fear of illness (8.9%), long-term effects (6.5%), mistrust in the vaccine (6.3%), and needing more information (4.5%). Vaccine-hesitant participants were more likely to be unvaccinated (adjusted odds ratio=2.3, 95% confidence interval 1.25-4.14) after adjusting for age, education, employment, insurance, health status, and income. Conclusion Vaccine hesitancy may be improved by directly addressing fear of illness resulting from vaccines and improving clarity in the vaccine development and approval process to improve uptake among black adults.
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Affiliation(s)
- Ashley V. Hill
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
| | - Harika P. Dyer
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
| | - John Gianakas
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ruth Howze
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
| | - Ayanna King
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
| | - Tiffany L. Gary-Webb
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
| | - Dara D. Méndez
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Black Equity Coalition, Pittsburgh, Pennsylvania, USA
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Su Y, Li S, Xue J, Li A, Zhu T. Measuring the importance of influencing factor for COVID-19 vaccination intention in China. Front Public Health 2023; 11:1191401. [PMID: 37441653 PMCID: PMC10335563 DOI: 10.3389/fpubh.2023.1191401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Background Vaccination is considered an effective approach to deter the spread of coronavirus disease (COVID-19). However, vaccine hesitancy is a common issue that makes immunization programs more challenging. To promote vaccination in a targeted and efficient way, this study aims to develop and validate a measurement tool for evaluating the importance of influencing factors related to COVID-19 vaccination intention in China, and to examine the demographic differences. Methods In study 1, we developed a Factor Importance Evaluation Questionnaire (FIEQ) based on semi-structured interview results and used exploratory factor analysis (EFA) to explore its factor structure. In study 2, we verified the four-factor structure of FIEQ by confirmatory factor analysis (CFA). We then administered FIEQ to Chinese participants and conducted a student t-test and analysis of variance to examine the differences in the importance evaluation of factors based on gender and educational level. Results In study 1, we developed a four-factor construct and retained 20 items after EFA (N = 577), with acceptable reliability (alpha = 0.87) and validity. In study 2, we found that the model fit was good (χ2 = 748.03 (162), p < 0.001, GFI = 0.949, RMSEA = 0.049, SRMR = 0.048, AGFI = 0.934), and reliability was acceptable (alpha = 0.730) (N = 1,496). No gender difference was found in factor importance. However, individuals with different educational levels reported significantly different importance evaluations of three factors, including perceived benefits and social norms (F = 3.786, p = 0.005), perceived influences from reference groups (F = 17.449, p < 0.001), and perceived risks (F = 2.508, p = 0.04). Conclusion This study developed and validated FIEQ for measuring the importance of influencing factors related to the COVID-19 vaccination intention in Chinese participants. Moreover, our findings suggest that the educational level may play a role in how individuals evaluate the importance of factors. This study provides insights into the concerns that individuals have regarding vaccination and offers potentially effective and targeted strategies for promoting COVID-19 vaccination.
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Affiliation(s)
- Yue Su
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Sijia Li
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jia Xue
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Faculty of Information, University of Toronto, Toronto, ON, Canada
| | - Ang Li
- Department of Psychology, Beijing Forestry University, Beijing, China
| | - Tingshao Zhu
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Howard MC. Integrating the person-centered approach with the study of vaccine hesitancy: Applying latent profile analysis to identify vaccine hesitancy subpopulations and assess their relations with correlates and vaccination outcomes. Vaccine 2023:S0264-410X(23)00742-9. [PMID: 37357075 DOI: 10.1016/j.vaccine.2023.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/26/2023] [Accepted: 06/15/2023] [Indexed: 06/27/2023]
Abstract
In scholarly and popular discussions of vaccine hesitancy, authors have repeatedly referred to different "types" of vaccine hesitant individuals; however, almost all modern research on vaccine hesitancy utilizes variable-centered approaches to identify the relation of variables rather than a person-centered approach to identify subpopulations, which suggests that a discrepancy exists between conceptual discussions and empirical research on vaccine hesitancy. For this reason, the current article conducts a latent profile analysis (LPA) on the dimensions of a well-supported vaccine hesitancy measure, which assess hesitancy towards vaccines in general. We also assess the relations of the resultant profiles (e.g., subpopulations) with relevant self-reported outcomes and correlates, wherein most of our outcomes are associated with COVID-19 and flu vaccines. Our LPA results support the existence of eight vaccine hesitancy profiles. The profile with the most unfavorable vaccination outcomes (e.g., willingness, receipt, and word-of-mouth) was associated with greater perceptions that vaccines cause health risks and unneeded when healthy; the profile with the most favorable vaccination outcomes was associated with low levels of all vaccine hesitancy dimensions. The other profiles produced a clear gradient between these two extremes. The profiles also differed regarding their standing on correlates, but the clearest difference was their relation with political orientation. Profiles with more unfavorable vaccination outcomes were associated with conservatism, whereas profiles with more favorable vaccinations outcomes were associated with liberalism. These results provide a new perspective for current understandings of vaccine hesitancy and open several avenues for future research.
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Affiliation(s)
- Matt C Howard
- The University of South Alabama, Mitchell College of Business, United States.
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Howard MC. Why people fail to participate in annual skin cancer screening: creation of the perceptions of annual skin cancer screening scale (PASCSS). Diagnosis (Berl) 2022; 10:164-174. [PMID: 36541628 DOI: 10.1515/dx-2022-0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Abstract
Objectives
Many studies show that most people, even at-risk individuals, do not undergo routine clinical skin cancer screening, and many questions remain unanswered regarding the participation (or lack thereof) in annual skin cancer screening. Perhaps the largest unanswered question is the most essential: why do people fail to undergo annual skin cancer screening? We provide an avenue to answer this question by creating the Perceptions of Annual Skin Cancer Screening Scale (PASCSS).
Methods
In Study 1, we conduct a qualitative investigation to identify potential scale dimensions and items (n=233). In Study 2, we test the validity and psychometric properties of our initial item list via exploratory factor analysis (n=406). In Study 3, we further test the psychometric properties of our item list via confirmatory factor analysis (n=587).
Results
These three studies provide strong support for the validity and psychometric properties of our item list, resulting in the PASCSS. The PASCSS includes 48 items and 12 dimensions that each represent unique perceptions regarding annual skin cancer screening.
Conclusions
We encourage future authors to utilize the PASCSS to identify those most at risk for failing to participate in annual skin cancer screening as well as develop adaptive interventions that can target these participants.
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Affiliation(s)
- Matt C. Howard
- University of South Alabama, Mitchell College of Business , Mobile , AL , USA
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Bussink-Voorend D, Hautvast JLA, Vandeberg L, Visser O, Hulscher MEJL. A systematic literature review to clarify the concept of vaccine hesitancy. Nat Hum Behav 2022; 6:1634-1648. [PMID: 35995837 DOI: 10.1038/s41562-022-01431-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.
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Affiliation(s)
- Daphne Bussink-Voorend
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands.
| | - Jeannine L A Hautvast
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Lisa Vandeberg
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Olga Visser
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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Cogan N, Gallant AJ, Nicholls LAB, Rasmussen S, Young D, Williams L. Improving older adults' vaccination uptake: Are existing measures of vaccine hesitancy valid and reliable for older people? J Health Psychol 2022; 27:3136-3147. [PMID: 35410504 PMCID: PMC9720707 DOI: 10.1177/13591053221089104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We sought to establish whether two recently developed measures, the 5C scale and the Vaccination Attitudes Examination (VAX) were reliable and valid for use with older adults. A total of 372 UK-dwelling participants (65-92 years, M = 70.5 years, SD = 4.6) completed a cross-sectional survey measuring health and socio-demographic characteristics in relation to vaccine uptake for influenza, pneumococcal and shingles. The 5C and VAX scales were administered to test their reliability, validity and dimensionality. Both scales showed good internal reliability and convergent, discriminant and concurrent validity. Their factor structures were also confirmed, supporting their use with older adult populations.
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Affiliation(s)
- Nicola Cogan
- University of Strathclyde, UK
- Nicola Cogan, School of Psychological Sciences and Health, University of Strathclyde, 40 George Street, Glasgow G1 1QE, UK.
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The Multidimensional Vaccine Hesitancy Scale: A Validation Study. Vaccines (Basel) 2022; 10:vaccines10101755. [PMID: 36298620 PMCID: PMC9608997 DOI: 10.3390/vaccines10101755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Vaccination hesitancy (VH) is a phenomenon which increases the occurrence of vaccine-preventable diseases. The study tests the validity of the Multidimensional Vaccine Hesitancy Scale (MVHS) in the case of a sample of Romanian adults (n = 528; Meanage = 30.57). The latter filled in an online cross-sectional survey. The construct validity of MVHS was assessed by using confirmatory factor analysis (CFA), the reliability was calculated by using the internal consistency, and the convergent and discriminant validity was assessed by using the composite reliability (CR), and average variance extracted (AVE). The obtained model was invariant across gender. The structural equation model was designed for predictive validity by using the partial least square method (PLS-SEM) which analyses the relation between the MVHS dimensions and the vaccination willingness. The results show support for the 8-factor structure of the scale (χ2/df = 2.48; CFI = 0.95; RMSEA = 0.053). The Cronbach’s coefficients α > 0.70; McDonald’s ω > 0.70 and CR > 0.80 have very good values. The structural equation model shows that there are more dimensions of the scale which predict vaccination hesitancy in various types of vaccines—the main predictors remain the dimensions of health risk and healthy condition. The study’s conclusion led to the idea that the MVHS is suitable for medical practice and for research on the analysis of vaccination behaviours and intentions.
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15
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Montagni I, Ouazzani-Touhami K, Pouymayou A, Pereira E, Texier N, Schück S, Tzourio C. Who is hesitant about Covid-19 vaccines? The profiling of participants in a French online cohort. Rev Epidemiol Sante Publique 2022; 70:123-131. [PMID: 35428543 PMCID: PMC8958178 DOI: 10.1016/j.respe.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/21/2022] [Accepted: 02/25/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To report the characteristics of vaccine-hesitant individuals in a French-speaking adult population in the context of the SARS-CoV-2 pandemic; and to identify predictors of hesitancy about Covid-19-related vaccines. METHODS Between April and May 2020, 1640 French-speaking adults participating in an online cohort were classified according to their attitudes towards vaccination as: "hesitant", "anti-vaccination", and "pro-vaccination". Descriptive statistics, univariate multinomial regression models and multivariate analyses were compiled and carried out. RESULTS At the time of inclusion, compared to pro-vaccination participants, hesitant participants were more frequently females (p=0.044), not annually vaccinated against flu (p=0.026), less optimistic about the discovery of a treatment against Covid-19 in a few months (p<0.001), less ready to undergo this treatment (p<0.001), presenting less trust in the ability of public health authorities to control the pandemic (p=0.036) and reporting lower scores on knowledge-related scales (p values from <0.001 to 0.002). Univariate analyses confirmed these results with odds ratios ranging from 1.51 [1.05-2.17] to 2.19 [1.56-3.07]. In the multivariate models, the remaining variables associated with hesitant compared to pro-vaccination attitudes were discovery of a treatment against Covid-19 in a few months (OR=2.57 [1.73-3.81]), being ready to undergo this treatment (OR=7.07 [4.89-10.22]), digital vaccine literacy (OR=1.70 [1.14-2.54]) and general health literacy (OR=1.49 [1.03-2.15]). DISCUSSION In a continuum of relative acceptance of Covid-19-related vaccines, hesitant individuals were situated in between the behaviours and characteristics of pro-vaccination and anti-vaccination groups. While their characteristics were in line with the literature, this study was the first to report data on health literacy, digital vaccine literacy and capacity to detect fake news associated with vaccine hesitancy. CONCLUSIONS While failing to identify straightforward predictors, findings suggest that continued education and communication campaigns focused on improving vaccine literacy, particularly among women younger than 35 years, could heighten the proportion of persons accepting vaccination.
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Affiliation(s)
- Ilaria Montagni
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France,Corresponding author : Ilaria Montagni, PhD, 146 rue Léo Saignat, 33000 Bordeaux, France, +33 (0)6 42 19 33 63
| | - Kevin Ouazzani-Touhami
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France,Polyclinique Inkermann, groupe Elsan, 79000 Niort, France
| | - Aude Pouymayou
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France
| | - Edwige Pereira
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France
| | - Nathalie Texier
- Kap Code, F-75010 Paris, France,Kappa Santé, F-75002 Paris, France
| | - Stéphane Schück
- Kap Code, F-75010 Paris, France,Kappa Santé, F-75002 Paris, France
| | - Christophe Tzourio
- Univ.Bordeaux, Inserm, Bordeaux Population Health Research Center, U1219, F-33000, Bordeaux, France
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16
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Howard MC. The good, the bad, and the neutral: Vaccine hesitancy mediates the relations of Psychological Capital, the Dark Triad, and the Big Five with vaccination willingness and behaviors. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022; 190:111523. [PMID: 35079191 PMCID: PMC8772360 DOI: 10.1016/j.paid.2022.111523] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic has made it apparent that many people are unwilling to be vaccinated, and certain types of people seem predisposed to support or oppose vaccines. We perform a multiple-wave survey study to determine whether the Big Five, Dark Triad, and Psychological Capital (PsyCap) indirectly relate via vaccine hesitancy to vaccination willingness, vaccination, and vaccine word-of-mouth. Our results show that conscientiousness, extraversion, narcissism, psychopathy, and PsyCap each influence our outcomes via dimensions of vaccine hesitancy. PsyCap had an additional direct effect beyond these mediators. The overall effects of extraversion and PsyCap were negative on vaccine hesitancy, positive on pro-vaccination outcomes, and negative on anti-vaccination outcomes. The overall effects of conscientiousness, narcissism, and psychopathy were positive on vaccine hesitancy, negative on pro-vaccination outcomes, and positive on anti-vaccination outcomes. To conclude, we identify theoretical frameworks that can provide further insights into these relations. We suggest that the effects of conscientiousness may be understood by integrating research on overconfidence; the effects of extraversion and PsyCap may be understood by applying the situation, trait, and outcome activation model; and the effects of narcissism and psychopathy may be understood with Life History Theory.
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Affiliation(s)
- Matt C Howard
- The University of South Alabama, Mitchell College of Business, United States of America
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