Validity and reliability study of the vaccine hesitancy scale in Turkish sample

Abstract

Objectives: This study aims to test the validity and reliability of the Vaccine Hesitancy Scale (VHS) developed by Larson for Turkish society due to the limited measures of vaccine hesitancy studies in Turkey. This scale can help advance research and vaccination policy for human well-being.

Methods: Two hundred fourty-six participants completed the first questionnaire in Turkish between September and October 2020. The sample of the study was determined to consider the number of items on the 9-item scale is more than 27 times. The retest was used to test the validity of the scale in the study.

Results: The ratio of the scale to chi-square degrees of freedom is 2.29. This can be considered as a sufficient fit. As a result of the first level Confirmatory Factor Analysis (CFA), the values ​​of the goodness of fit suggested that the two-factor model can be considered compatible with the data. The Cronbach's alpha of the total items of the scale is = .801. Factor 1 which was the ‘lack of confidence’ of Cronbach's alpha was 0.904. Factor 2 that was the ‘risks’ was 0.742. The reliability and validity of the VHS analysis revealed a two-factor structure with construct and criterion validity to detect vaccine hesitancy.

Conclusions: VHS is recommended to be used as a data collection tool in health care services to detect the level of vaccine hesitancy among the public. The adaptation of VHS into the Turkish language can help health care providers and immunization policy makers to improve effective approaches by focusing on the individuals’ confidence in vaccination.

Keywords

• vaccine hesitancy
• confidence in vaccination
• scale

References

1. 1. Haverkate M, D’Ancona F, Giambi C, Johansen K, Lopalco PL, Cozza V, et al. On behalf of the VENICE project gatekeepers and contact points. Mandatory and Recommended Vaccination in the EU, Iceland and Norway: Results of the VENICE 2010 Survey on the Ways of Implementing National Vaccination Programmes. Euro Surveill 2012;17:20183.
2. 2. Bozkurt Bekis H. [An overview of vaccine rejection and review of literature]. Kafkas J Med Sci 2018;8:71-6. [Article in Turkish]
3. 3. WHO. Immunization coverage. 2018; URL: https://www.who.int/en/news-room/fact-sheets/detail/immunization-coverage.
4. 4. Poland GA, Jacobson RM. The age-old struggle against the antivaccinationists. New Engl J Med 2011;364:97-9.
5. 5. Leask J. Should we do battle with antivaccination activists? Public Health Res Pract 2015;25:e2521515.
6. 6. Callender D. Vaccine hesitancy: more than a movement. Hum Vaccin Immunother 2016;12:2464-8.
7. 7. Dubé E, Gagnon D, Nickels E, Jeram S, Schuster M. Mapping vaccine hesitancy-Country-specific characteristics of a global phenomenon. Vaccine 2014;32:6649-54.
8. 8. Dube E, Gagnon D, Ouakki M, Bettinger JA, Guay M, Halperin S, et al. Understanding vaccine hesitancy in Canada: results of a consultation study by the Canadian immunization research network. PLoS One 2016;11:e0156118.

9. 9. Roberts JR, Thompson D, Rogacki B, Hale JJ, Jacobson RM, Opel DJ, et al. Vaccine hesitancy among parents of adolescents and its association with vaccine uptake.Vaccine 2015;33:1748-55.
10. 10. MacDonald N E. the SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants. Vaccine 2015;33:4161-4.
11. 11. Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007–2012. Vaccine 2014;32:2150-9.
12. 12. Shapiro GK, Perez S, Naz A, Tatar O, Guichon J, Amsel R, et al. Investigating Canadian parents’ HPV vaccine knowledge, attitudes, and behaviour: a study protocol for a longitudinal national online survey. BMJ Open 2017;7:e017814
13. 13. WHO, The SAGE Vaccine Hesitancy Working Group. What Influences Vaccine Acceptance: A Model of Determinants of Vaccine Hesitancy. Access date: 08.09.2020. https://www.who.int/immunization/sage/meetings/2014/october/1_Report_WORKING_GROUP_vaccine_hesitancy_final.pdf
14. 14. Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, et al. Measuring vaccine hesitancy: the development of a survey tool. Vaccine 2015;33:4165-75.
15. 15. Domek GJ, O'Leary ST, Bull S, Bronsert M, Contreras-Roldan IL, Bolaños Ventura GA, et al. Measuring vaccine hesitancy: field testing the WHO SAGE Working Group on Vaccine Hesitancy survey tool in Guatemala. Vaccine 2018;36:5273-81.
16. 16. Shapiro GK, Tatar O, Dube E, Amsel R, Knauper B, Naz A, et al. The vaccine hesitancy scale: psychometric properties and validation. Vaccine 2018;36:660-7.
17. 17. Luyten J, Bruyneel L, van Hoek AJ. Assessing vaccine hesitancy in the UK population using a generalized vaccine hesitancy survey instrument. Vaccine 2019;37:2494-2501.
18. 18. Sabahelzain MM, Dubé E, Moukhyer M, Larson HJ, van den Borne B, Bosma H. Psychometric properties of the adapted measles vaccine hesitancy scale in Sudan. PLoS One 2020;15:e0237171.
19. 19. Bertin P, Nera K, Delouvée S. Conspiracy beliefs, rejection of vaccination, and support for hydroxychloroquine: a conceptual replication-extension in the COVID-19 pandemic context. Front Psychol 2020;11:565128.
20. 20. Fadda M, Albanese E, Suggs LS. When a COVID-19 vaccine is ready, will we all be ready for it? Int J Public Health 2020;65:711-2.
21. 21. Le TT, Andreadakis Z, Kumar A. The COVID-19 vaccine development landscape. Nat Rev Drug Discov 2020;19:305-6.
22. 22. Magadmi RM, Fatemah OK. Beliefs and barriers associated with COVID-19 vaccination among the general population in Saudi Arabia. Reserach Square 2020;1-17.
23. 23. Palamenghi L, Barello S, Boccia S, Graffigna G. Mistrust in biomedical research and vaccine hesitancy: the forefront challenge in the battle against COVID-19 in Italy. Eur J Epidemiol 2020;35: 785-8.
24. 24. Gilkey MB, Reiter PL, Magnus BE, McRee AL, Dempsey AF, Brewer NT. Validation of the vaccination confidence scale: a brief measure to identify parents at risk for refusing adolescent vaccines. Acad Pediatr 2016;16:42-9.
25. 25. Opel DJ, Taylor JA, Mangione-Smith R, Solomon C, Zhao C, Catz S, et al. Validity and reliability of a survey to identify vaccine-hesitant parents. Vaccine 2011;29:6598-605.
26. 26. Shapiro GK, Holding A, Perez S, Amsel R, Rosberger Z. Validation of the vaccine conspiracy belief scale. Papillomavirus Res 2016;2:167-72.
27. 27. Martin LR, Petrie KJ. Understanding the dimensions of anti-vaccination attitudes: the Vaccination Attitudes Examination (VAX) scale. Ann Behav Med 2017;51:652-60.
28. 28. Horne Z, Powell D, Hummel JE, Holyoak KJ. Countering antivaccination attitudes. Proc Natl Acad Sci U S A 2015;112:10321-4.
29. 29. Esin MN. Veri toplama yöntem ve araçları & veri toplama araçlarının güvenirlik ve geçerliği. Erdoğan S, Nahcivan N, Esin MN (eds.), Hemşirelikte Araştırma: Süreç, Uygulama ve Kritik, İstanbul: Nobel Tıp Kitabevleri, 2014.
30. 30. Karakoç FY, Dönmez L. [Basic principles of scale development]. Tıp Eğitimi Dünyası 2014;40:39-49. [Article in Turkish]
31. 31. Lawshe CH. A quantitative approach to content validity 1. Personnel Psychology 1975;28:563-75.
32. 32. Ayre C, Scally AJ. Critical values for Lawshe’s content validity ratio: revisiting the original methods of calculation. Meas Eval Couns Dev 2014;47:79-86.
33. 33. Raubenheimer J. An item selection procedure to maximise scale reliability andvalidity. SA J Industrial Psychology 2004;30;168-74.
34. 34. Şencan H. Sosyal ve davranışsal ölçümlerde güvenilirlik ve geçerlik. Seçkin yayıncılık, Ankara, 2005.
35. 35. Taşkın Ç, Akat Ö. Araştırma yöntemlerinde yapısal eşitlik modelleme. Ekin Yayınevi, Bursa. 2010.
36. 36. Yıldız D, Uzunsakal E. [A comparison of reliability tests in field researches and an applıcatıon on agrıcultural data]. Uygulamalı Sosyal Bilimler Dergisi 2018;1:16-21. [Article in Turkish]
37. 37. Luyten J, Bruyneel L, van Hoek AJ. Assessing vaccine hesitancy in the UK population using a generalized vaccine hesitancy survey instrument. Vaccine 2019;37:2494-2501.
38. 38. Eisinga R, te Grotenhuis M, Pelzer B. The reliability of a two-item scale: Pearson, Cronbach, or Spearman-Brown? Int J Public Health 2013;58:637-42.
39. 39. Peretti-Watel P, Larson HJ, Ward JK, Schulz WS, Verger P. Vaccine hesitancy: clarifying a theoretical framework for an ambiguous notion. PLoS Curr 2015;7:ecurrents.outbreaks.6844c80ff9f5b273f34c91f71b7fc289.
40. 40. Somon DA, Dudley MZ, Glanzc JM, Omer SB. Vaccine hesitancy: causes, consequences, and a call to action. Vaccine 2015;9(6 Suppl 4):391-8.