Development of Valid and Reliable Scale of Vaccine Hesitancy in Turkish Language

Abstract

Objective Anti-vaccine movement has been increasing in recent years, leading to poor health outcomes. There are some scales to measure the vaccine hesitancy but most of them have limitation and may not be proper for Turkey. The aim of this study is to develop a Turkish scale of vaccine hesitancy.

Method: Two cross sectional studies were conducted. Purposive sampling method was used to reach participants in hospital and its surroundings. Study1: Explanatory factor analysis involved 315 participants, whose 61.3% were female mean age was 33.3 years. The draft scale with 36 items were applied face to face. Study 2: Confirmatory factor analysis involved 214 participants for the long form and 200 for short form. Of the participants, 62.0% was female and the mean age was 33.9 for short form. Of the participants, 65.4% was female and the mean age was 34.5 for the long form. Goodness of fit indexes of both forms were compared with literature.

Results: The long form with 21 items in 4 factors and the short form with 12 items in 3 factors were selected as they best explained the data. Explained variance by long form and short form were 57.4%and 65.3% respectively. Cronbach Alpha values for long form and short form were 0.905 and 0.855 respectively.

Conclusion: It is important to understand vaccine hesitancy at local levels because differences in sociocultural structure have major effect. In this study, two forms of reliable vaccine hesitancy scale were presented in Turkish as first in literature.

Keywords

• Vaccine refusal
• antivaccination movement
• reliability and validity
• scale
• Turkey

Geçerli ve Güvenilir Türkçe Aşı Karşıtlığı Ölçeği Geliştirilmesi

Abstract

Amaç Aşı karşıtlığı son yıllarda artarak kötü sağlık sonuçlarına neden olmaktadır. Literatürde aşı karşıtlığı ölçekleri bulunsa da bunlar Türkiye için uygun olmamakla birlikte kısıtlılıkları bulunmaktadır. Bu çalışmanın amacı, Türkçe aşı karşıtlığı ölçeğini geliştirmektir.

Yöntem: İki farklı kesitsel çalışma yürütüldü. Hastane ve çevresindeki katılımcılara ulaşmak için amaçlı örnekleme yöntemi kullanıldı. Çalışma 1: Açıklayıcı faktör analizi, %61,3'ü kadın ve ortalama yaşı 33,3 yıl olan 315 katılımcıyı içermektedir. Otuz altı maddeli taslak ölçek yüz yüze uygulanmıştır. Çalışma 2: Doğrulayıcı faktör analizi, uzun form için 214 katılımcı ve kısa form için 200 katılımcıdan oluşmaktadır. Kısa form katılımcılarının %62,0'ı kadındı ve ortalama yaş 33,9 idi. Uzun form katılımcılarının %65,4'ü kadındı ve ortalama yaş 34,5 idi. Her iki formun uyum iyiliği indeksleri literatürle karşılaştırıldı.

Bulgular: Yüksek açıklayıcılıkları nedeniyle 4 faktörde 21 maddeden oluşan uzun form ve 3 faktörde 12 maddeden oluşan kısa form seçilmiştir. Uzun formun ve kısa formun açıkladığı varyans sırasıyla %57,4 ve %65,3 idi. Uzun form ve kısa form için Cronbach Alpha değerleri sırasıyla 0,905 ve 0,855 idi.

Sonuç: Sosyokültürel yapıdaki farklılıkların büyük etkisi olduğu için aşı karşıtlığını yerel düzeylerde anlamak önemlidir. Bu çalışmada literatürde ilk kez, geçerli ve güvenilir olarak iki farklı Türkçe aşı karşıtlığı ölçeği geliştirilmiştir.

Keywords

• aşı reddi
• aşı karşıtlığı hareketi
• güvenilirlilik ve geçerlilik
• ölçek
• Türkiye

References

1. [1] Koppaka R. Ten great public health achievements - worldwide, 2001-2010. Morb Mortal Wkly Rep 2011;60:814–8.
2. [2] Dubé E, Vivion M, MacDonald NE. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: Influence, impact and implications. Expert Rev Vaccines 2014;14:99–117.
3. [3] Jacobson RM, St. Sauver JL, Finney Rutten LJ. Vaccine hesitancy. Mayo Clin Proc 2015;90:1562–8.
4. [4] Lo NC, Hotez PJ. Public health and economic consequences of vaccine hesitancy for measles in the United States. JAMA Pediatr 2017;171:887–92.
5. [5] Strategic Advisory Group of Experts on Immunization. Report of the SAGE working group on vaccine hesitancy. 2014.
6. [6] 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.
7. [7] Yaqub O, Castle-Clarke S, Sevdalis N, Chataway J. Attitudes to vaccination: A critical review. Soc Sci Med 2014;112:1–11.
8. [8] MacDonald NE, Eskola J, Liang X, Chaudhuri M, Dube E, Gellin B, et al. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015;33:4161–4.

9. [9] Gust D, Brown C, Sheedy K, Hibbs B, Weaver D, Nowak G. Immunization attitudes and beliefs among parents: Beyond a dichotomous perspective. Am J Health Behav 2005;29:81–92.
10. [10] Leask J. Target the fence-sitters. Nature 2011;473:443–5.
11. [11] Nyhan B, Reifler J, Richey S, Freed GL. Effective messages in vaccine promotion: A randomized trial. Pediatrics 2014;133.
12. [12] Gilkey MB, Magnus BE, Reiter PL, McRee AL, Dempsey AF, Brewer NT. The Vaccination Confidence Scale: A brief measure of parents’ vaccination beliefs. Vaccine 2014;32:6259–65.
13. [13] 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.
14. [14] 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.
15. [15] Opel DJ, Mangione-Smith R, Taylor JA, Korfiatis C, Wiese C, Catz S, et al. Development of a survey to identify vaccine-hesitant parents. Hum Vaccin 2011;7:419–25.
16. [16] Shapiro GK, Holding A, Perez S, Amsel R, Rosberger Z. Validation of the vaccine conspiracy beliefs scale. Papillomavirus Res 2016;2:167–72.
17. [17] 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.
18. [18] Szczerbińska K, Brzyski P, Prokop-Dorner A, Ocetkiewicz T, Barańska I. Development and validation of Attitudes Towards Vaccinations Scale (ATVS) – part 1. Eur Geriatr Med 2017;8:320–4.
19. [19] Brown KF, Shanley R, Cowley NAL, van Wijgerden J, Toff P, Falconer M, et al. Attitudinal and demographic predictors of measles, mumps and rubella (MMR) vaccine acceptance: Development and validation of an evidence-based measurement instrument. Vaccine 2011;29:1700–9.
20. [20] McRee AL, Brewer NT, Reiter PL, Gottlieb SL, Smith JS. The Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS): Scale development and associations with intentions to vaccinate. Sex Transm Dis 2010;37:234–9.
21. [21] Perez S, Shapiro GK, Tatar O, Joyal-Desmarais K, Rosberger Z. Development and validation of the human papillomavirus attitudes and beliefs scale in a National Canadian Sample. Sex Transm Dis 2016;43:626–32.
22. [22] Lee SJ, Newman PA, Duan N, Cunningham WE. Development of an HIV vaccine attitudes scale to predict HIV vaccine acceptability among vulnerable populations: L.A. VOICES. Vaccine 2014;32:5013–8.
23. [23] Zingg A, Siegrist M. Measuring people’s knowledge about vaccination: Developing a one-dimensional scale. Vaccine 2012;30:3771–7.
24. [24] Martin LR, Petrie KJ. Understanding the dimensions of anti-vaccination attitudes: the Vaccination Attitudes Examination (VAX) Scale. Ann Behav Med 2017;51:652–60.
25. [25] Horne Z, Powell D, Hummel JE, Holyoak KJ. Countering antivaccination attitudes. Proc Natl Acad Sci U S A 2015;112:10321–4.
26. [26] Betsch C, Korn L, Holtmann C. Don’t try to convert the antivaccinators, instead target the fence-sitters. Proc Natl Acad Sci U S A 2015;112:E6725–6.
27. [27] 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.
28. [28] Cohen RJ, Swerdik M. Psychological Testing and Assessment: An Introduction to Tests and Measurement. 7th ed. McGraw Hill Higher Education; 2009.
29. [29] Everitt BS. Multivariate analysis: the need for data, and other problems. Br J Psychiatry 1975;126:237–40. doi:10.1192/bjp.126.3.237.
30. [30] Tabachnick BG, Fidell LS. Using Multivariate Statistics. 6th ed. New Jersey: Pearson Education; 2013.
31. [31] Warner RM. Applied Statistics: From Bivariate Through Multivariate Techniques: From Bivariate Through Multivariate Techniques. 2th ed. California: SAGE Publications; 2013.
32. [32] Field AP. Discovering statistics using IBM SPSS statistics. 5th ed. London: SAGE Publications; 2017.
33. [33] Özdamar K. Paket Programlar ile İstatistiksel Veri Analizi Cilt 1. 10th ed. Ankara: Nisan Kitabevi; 2015.
34. [34] WHO. Improving vaccination demand and addressing hesitancy n.d. https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/ (accessed November 27, 2019).
35. [35] Gorsuch RL. Factor Analysis: Classic Edition. Taylor & Francis; 2014.
36. [36] Eskola J, Duclos P, Schuster M, MacDonald NE, Liang X, Chaudhuri M, et al. How to deal with vaccine hesitancy? Vaccine 2015;33:4215–7.
37. [37] Lázaro C, Caseras X, Whizar-Lugo VM, Wenk R, Baldioceda F, Bernal R, et al. Psychometric properties of a Spanish version of the McGill Pain Questionnaire in several Spanish-speaking countries. Clin J Pain 2001;17.
38. [38] Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model 1999;6:1–55.
39. [39] Hooper D, Coughlan J, Mullen MR. Structural equation modelling: Guidelines for determining model fit. Electron J Bus Res Methods 2008;6:53–60.
40. [40] Kline TJB. Psychological Testing: A Practical Approach to Design and Evaluation. Thousand Oaks, CA: SAGE; 2005.