AlShurman Bara' Abdallah, Majowicz Shannon E, Grindrod Kelly, Goh Joslin, Butt Zahid Ahmad
School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada.
School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada; School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, Ontario N2G 1C5, Canada.
Vaccine. 2025 Aug 13;61:127368. doi: 10.1016/j.vaccine.2025.127368. Epub 2025 Jun 7.
Vaccine hesitancy (VH) continues to impede COVID-19 vaccine coverage. Booster dose uptake lags behind primary dose uptake, especially among younger adults. Unlike most studies that focus on initial stages of VH, the aim of this study was to validate the COVID-19 Vaccine Hesitancy Scale (CVHS) for both primary and booster doses among University of Waterloo (UW) students.
An online survey was conducted among UW students in Ontario, Canada, between March and May 2024. The CVHS items were adapted for primary and booster doses. Exploratory (EFA) and confirmatory factor analyses (CFA) assessed the factor structure and model fit. Reliability was evaluated using Cronbach's alpha and composite reliability (CR). Convergent and discriminant validity were assessed through average variance extracted (AVE). Significant differences between primary and booster dose hesitancy were determined via 95 % Confidence Interval.
A total of 4453 students participated. Respondents were predominantly female (57.2 %), aged 18-22 years (84.0 %), and undergraduates (94.8 %). EFA and CFA confirmed a three-factor structure for both primary and booster dose scales. Both scales had high reliability (Cronbach's alpha >0.60, CR >0.7). CFA results indicated a good model fit (Comparative Fit Index = 0.94; Root Mean Square Error of Approximation = 0.07), and demonstrated adequate convergent, discriminant, and criterion validity. Known-group validity was supported by significant differences in VH scores across gender and academic level, with men and undergraduate students reporting higher hesitancy than women and graduate students (p < 0.001). VH was higher for booster doses (33.4 %) than primary doses (19.3 %) with more students delaying (32.1 %) or refusing boosters (29.3 %) than delaying (11.5 %) or refusing (6.2 %) primary doses.
Our adapted scales performed well psychometrically to measure VH across different COVID-19 vaccine phases. These scales can help in identifying key barriers of VH to understand shifting trajectories over time, thereby informing targeted interventions to promote vaccination uptake among younger adults.
疫苗犹豫情绪持续阻碍新冠疫苗接种覆盖率。加强针接种率落后于首剂接种率，在年轻成年人中尤为明显。与大多数关注疫苗犹豫情绪初始阶段的研究不同，本研究旨在验证滑铁卢大学（UW）学生中针对首剂和加强针的新冠疫苗犹豫量表（CVHS）。
2024年3月至5月期间，对加拿大安大略省的UW学生进行了一项在线调查。CVHS项目针对首剂和加强针进行了调整。探索性因素分析（EFA）和验证性因素分析（CFA）评估了因素结构和模型拟合度。使用克朗巴哈系数和组合信度（CR）评估信度。通过提取平均方差（AVE）评估聚合效度和区分效度。通过95%置信区间确定首剂和加强针犹豫情绪之间的显著差异。
共有4453名学生参与。受访者主要为女性（57.2%），年龄在18 - 22岁之间（84.0%），且为本科生（94.8%）。EFA和CFA证实了首剂和加强针量表的三因素结构。两个量表都具有较高的信度（克朗巴哈系数>0.60，CR>0.7）。CFA结果表明模型拟合良好（比较拟合指数=0.94；近似均方根误差=0.07），并显示出足够的聚合效度、区分效度和效标效度。不同性别和学术水平的疫苗犹豫得分存在显著差异，支持了已知群体效度，男性和本科生报告的犹豫情绪高于女性和研究生（p<0.001）。加强针的疫苗犹豫情绪（33.4%）高于首剂（19.3%），延迟（32.1%）或拒绝加强针（29.3%）的学生多于延迟（11.5%）或拒绝（6.2%）首剂的学生。
我们调整后的量表在心理测量方面表现良好，可用于测量不同新冠疫苗接种阶段的疫苗犹豫情绪。这些量表有助于识别疫苗犹豫的关键障碍，以了解随时间变化的轨迹，从而为有针对性的干预措施提供依据，以促进年轻成年人的疫苗接种。
