Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States.
Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA, United States.
Vaccine. 2021 Mar 26;39(13):1831-1839. doi: 10.1016/j.vaccine.2021.02.039. Epub 2021 Mar 4.
Vaccine hesitancy contributes to outbreaks of preventable disease worldwide. The Vaccine Hesitancy Scale (VHS), developed by the international WHO SAGE Working Group, has been validated previously for measuring hesitancy towards childhood vaccines; some psychometric properties were suboptimal.
We collected data using large, nationally-representative samples of parents in the U.S. We adapted the VHS items, and additional hesitancy items, to assess hesitancy towards influenza and HPV vaccines in addition to routine childhood vaccines. We then used exploratory and confirmatory factor analysis to identify latent constructs and create modified scales for childhood (VHS-child), influenza (VHS-flu) and HPV (VHS-HPV) vaccines with improved psychometric properties. Finally, we compared hesitancy scores on the VHS-child, VHS-flu, and VHS-HPV, to self-reported receipt of each vaccine category, and compared subscale scores to assess whether drivers of hesitancy differed by vaccine category.
2052 parents of children <18 years old completed the VHS-child and VHS-flu while 2020 parents of adolescents completed the VHS-HPV. A two-factor structure of 'risks' and a 'lack of confidence' was found for each vaccine category. Slight modifications to the VHS improved psychometric properties. Hesitancy was strongly associated with vaccine receipt: e.g., 76% of parents not hesitant towards influenza vaccine had vaccinated their child the past season, versus 9% of hesitant parents (p < 0.0001). Subscale scores also differed significantly between vaccines: lack of confidence was greater towards influenza (Median (IQR): 2.0 (1.2, 3.3)) and HPV (2.0 (1.3, 3.0)) vaccines than childhood (1.2 (1.0, 1.8), p < 0.0001 for both) vaccines; perceived risks of HPV vaccines (2.7 (1.7, 3.7)) were greater than for childhood vaccines (2.0 (1.3, 3.0), p < 0.0001).
Our modified VHS scales perform well psychometrically and allow for consistent measurement of the extent and reasons for hesitancy between vaccine categories. We suggest that future work use these scales to examine hesitancy towards other vaccines and to monitor hesitancy over time.
疫苗犹豫是导致全球可预防疾病爆发的原因之一。由国际世卫组织 SAGE 工作组开发的疫苗犹豫量表（VHS）此前已被验证可用于衡量儿童疫苗的犹豫程度；但其部分心理测量特性并不理想。
我们收集了美国大规模、具有全国代表性的父母样本数据。我们改编了 VHS 项目以及其他一些犹豫项目，以评估除常规儿童疫苗外，对流感疫苗和 HPV 疫苗的犹豫程度。然后，我们使用探索性和验证性因子分析来确定潜在的结构，并为儿童疫苗（VHS-child）、流感疫苗（VHS-flu）和 HPV 疫苗（VHS-HPV）创建经过修改的量表，这些量表具有改进的心理测量特性。最后，我们将 VHS-child、VHS-flu 和 VHS-HPV 上的犹豫评分与每种疫苗类别的自我报告接种情况进行比较，并比较子量表评分，以评估不同疫苗类别对犹豫的驱动因素是否存在差异。
2052 名 18 岁以下儿童的父母完成了 VHS-child 和 VHS-flu，2020 名青少年的父母完成了 VHS-HPV。每个疫苗类别都发现了“风险”和“缺乏信心”的两因素结构。对 VHS 的轻微修改提高了心理测量特性。犹豫与疫苗接种有很强的相关性：例如，过去季节有 76%不犹豫接种流感疫苗的父母为孩子接种了疫苗，而有 9%犹豫的父母（p<0.0001）。疫苗之间的子量表评分也存在显著差异：对流感（中位数（IQR）：2.0（1.2，3.3））和 HPV（2.0（1.3，3.0））疫苗的信心不足程度大于儿童（1.2（1.0，1.8））疫苗（两者均 p<0.0001）；HPV 疫苗的感知风险（2.7（1.7，3.7））大于儿童疫苗（2.0（1.3，3.0），p<0.0001）。
我们修改后的 VHS 量表在心理测量学上表现良好，可用于在疫苗类别之间一致测量犹豫的程度和原因。我们建议未来的工作使用这些量表来检查对其他疫苗的犹豫，并监测随时间推移的犹豫情况。
