Cent Eur J Public Health 2022, 30(2):99-106 | DOI: 10.21101/cejph.a7074

Determinants of COVID-19 vaccine hesitancy: questionnaire development and validation

Smiljana Cvjetković1, 2, Vida Jeremić Stojković1, 2, Pavle Piperac1, 2, Ognjen Djurdjević1, Vesna Bjegović-Mikanović2, 3
1 Department of Humanities, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
2 School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
3 Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Objectives: Vaccine hesitancy presents one of the critical constraints in combating COVID-19 pandemic. The aim of this study was to develop and validate an instrument for measuring factors that contribute to COVID-19 vaccine hesitancy.

Methods: The key constructs in the study instrument were factors that constitute the "3C" model of vaccine hesitancy: Confidence, Complacency and Convenience. Using a cross-sectional, online survey design, the 8-item COVID-19 Vaccine Hesitancy Questionnaire was administered to a sample of 667 adult citizens of Serbia in December 2020. We used confirmatory factor analysis to investigate the model that assumes three latent variables. To ensure that the instrument measures the same constructs in different groups, the measurement invariance examination was conducted. To examine criterion validity, Spearman's correlation was applied to determine the association between the instrument total score and the single-item measuring the likelihood of getting vaccinated against SARS-CoV-2.

Results: Confirmatory factor analysis established the three-factor structure, with subscales fitting within the "3C" model of vaccine hesitancy comprising confidence, convenience and complacency. The full scalar invariance was found across gender, and the partial scalar invariance was achieved for the age, region and education level. A higher level of the COVID-19 vaccine hesitancy was associated with the lower likelihood to get vaccinated against the SARS-CoV-2 virus.

Conclusion: Our scale is brief and consistent, maintaining a good fit across key socio-demographic subgroups. This result implies that the scale could be useful for quick assessment of COVID-19 vaccine hesitancy in various target populations.

Keywords: vaccination, vaccine hesitancy, COVID-19 vaccines, surveys and questionnaires, factor analysis, psychological/behavioural medicine

Received: August 24, 2021; Revised: June 13, 2022; Accepted: June 13, 2022; Published: June 30, 2022  Show citation

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Cvjetković S, Jeremić Stojković V, Piperac P, Djurdjević O, Bjegović-Mikanović V. Determinants of COVID-19 vaccine hesitancy: questionnaire development and validation. Cent Eur J Public Health. 2022;30(2):99-106. doi: 10.21101/cejph.a7074. PubMed PMID: 35876598.
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    References

    1. World Health Organization. Draft landscape and tracker of COVID-19 candidate vaccines [Internet]. Geneva: WHO [cited 2021 Feb 4]. Available from: https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines.
    2. Lazarus JV, Ratzan SC, Palayew A, Gostin LO, Larson HJ, Rabin K, et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med. 2021;27(2):225-8. Go to original source... Go to PubMed...
    3. Dubé E, Gagnon D, Nickels E, Jeram S, Schuster M. Mapping vaccine hesitancy - country-specific characteristics of a global phenomenon. Vaccine. 2014;32(49):6649-54. Go to original source... Go to PubMed...
    4. MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161-4. Go to original source... Go to PubMed...
    5. Lin C, Tu P, Beitsch LM. Confidence and receptivity for COVID-19 vaccines: a rapid systematic review. Vaccines (Bassel). 2021;9(1):16. doi: 10.3390/vaccines9010016. Go to original source... Go to PubMed...
    6. Sallam M, Dababseh D, Eid H, Al-Mahzoum K, Al-Haidar A, Taim D, et al. High rates of COVID-19 vaccine hesitancy and its association with conspiracy beliefs: a study in Jordan and Kuwait among other Arab countries. Vaccines (Basel). 2021;9(1):42. doi: 10.3390/vaccines9010042. Go to original source... Go to PubMed...
    7. Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, et al. Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 2020;35(8):775-9. Go to original source... Go to PubMed...
    8. Rhodes A, Hoq M, Measey MA, Danchin M. Intention to vaccinate against COVID-19 in Australia. Lancet Infect Dis. 2021;21(5):e110. doi: 10.1016/S1473-3099(20)30724-6. Go to original source... Go to PubMed...
    9. Salali GD, Uysal MS. COVID-19 vaccine hesitancy is associated with beliefs on the origin of the novel coronavirus in the UK and Turkey. Psychol Med. 2020;1-3. Go to original source... Go to PubMed...
    10. de Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. Lancet. 2020;396(10255):898-908. Go to original source... Go to PubMed...
    11. Our World in Data. Coronavirus (COVID-19) vaccinations [Internet]. [cited 2021 Feb 4]. Available from: https://ourworldindata.org/covid-vaccinations.
    12. Our World in data. COVID-19 data Explorer [Internet]. [cited 2022 May 18]. Available from: https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&facet=noneπckerSort=ascπckerMetric=location&hideControls=true&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=~SRB&Metric=People+vaccinated.
    13. Butler R, MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Diagnosing the determinants of vaccine hesitancy in specific subgroups: the Guide to Tailoring Immunization Programmes (TIP). Vaccine. 2015;33(34):4176-9. Go to original source... Go to PubMed...
    14. SAGE Working Group. Report of the SAGE Working Group on Vaccine Hesitancy [Internet]. 2014 [cited 2022 Jun 5]. Available from: https://www.asset-scienceinsociety.eu/sites/default/files/sage_working_group_revised_report_vaccine_hesitancy.pdf.
    15. Statistical yearbook of the Republic of Serbia 2019 [Internet]. Belgrade: Statistical Office of the Republic of Serbia; 2019 [cited 2020 Nov 20]. Available from: https://publikacije.stat.gov.rs/G2019/Pdf/G20192052.pdf.
    16. Marsh HW, Hau KT, Wen Z. In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler's (1999) findings. Struct Equ Modeling. 2004;11(3):320-41. Go to original source...
    17. Vandenberg RJ, Lance CE. A review and synthesis of the measurement invariance literature: suggestions, practices, and recommendations for organizational research. Organ Res Methods. 2000;3(1):4-70. Go to original source...
    18. Putnick DL, Bornstein MH. Measurement invariance conventions and reporting: the state of the art and future directions for psychological research. Dev Rev. 2016;41:71-90. Go to original source... Go to PubMed...
    19. Chen FF. Sensitivity of goodness of fit indexes to lack of measurement invariance. Struct Equ Modeling. 2007;14(3):464-504. Go to original source...
    20. Van de Schoot R, Lugtig P, Hox J. A checklist for testing measurement invariance. Eur J Dev Psychol. 2012;9(4):486-92. Go to original source...
    21. Byrne BM, Shavelson RJ, Muthén B. Testing for the equivalence of factor covariance and mean structures: the issue of partial measurement invariance. Psychol Bull. 1989;105(3):456-66. Go to original source...
    22. Larson HJ, Schulz WS, Tucker JD, Smith DM. Measuring vaccine confidence: introducing a global vaccine confidence index. PLoS Curr. 2015 Feb 25;7:ecurrents.outbreaks.ce0f6177bc97332602a8e3fe7d7f7cc4. doi: 10.1371/currents.outbreaks.ce0f6177bc97332602a8e3fe7d7f7cc4. Go to original source... Go to PubMed...
    23. Smith LE, Amlôt R, Weinman J, Yiend J, Rubin GJ. A systematic review of factors affecting vaccine uptake in young children. Vaccine. 2017;35(45):6059-69. Go to original source... Go to PubMed...
    24. Bieber F, Prelec T, Jović, D, Nechev Z. The suspicious virus: conspiracies and COVID 19 in the Balkans [Internet]. Europen Fund for the Balkans; 2020 [cited 2021 Jan 15]. Available from: https://www.google.com/search?client=firefox-b-d&q=The+suspicious+virus%3A+conspiracies+and+COVID+19+in+the+Balkans.
    25. Sherman SM, Smith LE, Sim J, Amlôt R, Cutts M, Dasch H, et al. COVID-19 vaccination intention in the UK: results from the COVID-19 vaccination acceptability study (CoVAccS), a nationally representative cross-sectional survey. Hum Vaccin Immunother. 2021 Jun 3;17(6):1612-21. Go to original source... Go to PubMed...
    26. Lin Y, Hu Z, Zhao Q, Alias H, Danaee M, Wong LP. Understanding COVID-19 vaccine demand and hesitancy: a nationwide online survey in China. PLoS Negl Trop Dis. 2020;14(12):e0008961. doi: 10.1371/journal.pntd.0008961. Go to original source... Go to PubMed...
    27. Neumann-Böhme S, Varghese NE, Sabat I, Pita Barros P, Brouwer W, van Exel J, et al. Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19. Eur J Health Econ. 2020 Sep;21(7):977-82. Go to original source... Go to PubMed...
    28. Paul E, Steptoe A, Fancourt D. Attitudes towards vaccines and intention to vaccinate against COVID-19: Implications for public health communications. Lancet Reg Health Eur. 2021 Feb;1:100012. doi: 10.1016/j.lanepe.2020.100012. Go to original source... Go to PubMed...
    29. Ruiz JB, Bell RA. Predictors of intention to vaccinate against COVID-19: results of a nationwide survey. Vaccine. 2021;39(7):1080-6. Go to original source... Go to PubMed...
    30. Detoc M, Bruel S, Frappe P, Tardy B, Botelho-Nevers E, Gagneux-Brunon A. Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic. Vaccine. 2020;38(45):7002-6. Go to original source... Go to PubMed...
    31. Khubchandani J, Sharma S, Price JH, Wiblishauser MJ, Sharma M, Webb FJ. COVID-19 vaccination hesitancy in the United States: a rapid national assessment. J Community Health. 2021 Apr;46(2):270-7. Go to original source... Go to PubMed...

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