Reliability and validity of a survey to identify vaccine hesitancy among parents in Changxing county, Zhejiang province

Figures & data

Table 1. Characteristics of the participants (N = 285).

Characteristic	n	%	Characteristic	n	%
Relationship to child			Immigration status
Mother	239	83.9	Migrant	103	36.1
Father	46	16.1	Resident	182	63.9
Parent Age (years)			Household income per month (RMB)
< 30	197	69.1	< 5000	68	23.9
≥ 30	88	30.9	5000–10000	135	47.4
Education level			≥ 10000	82	28.8
≤ Junior school	39	13.7	Number of children in household
Senior school	96	33.7	1	189	66.3
College	150	52.6	2	79	27.7
			≥ 3	17	6.0

Table 2. Descriptive statistics, item association with immunization status, and factor analysis (N = 285).

Item	Response	n	%	Mean% of days under-immunized	p*	Factor loadings (>0.3)
						Behavior	Safety and efficacy	Attitude
Have you ever delayed your child’s vaccination for reasons other than illness or allergy?	Hesitate	63	22.1	13.1	<0.05	0.531
	Not sure	38	13.3	9.5
	Non-hesitate	184	64.6	1.5
How sure that following the recommended schedule is good for your child?	Hesitate	77	27.0	17.5	<0.01			0.611
	Not sure	42	14.7	8.2
	Non-hesitate	166	58.2	2.1
It is my role as a parent to question vaccinations.	Hesitate	94	33.0	10.4	>0.05		0.382
	Not sure	85	29.8	9.5
	Non-hesitate	106	37.2	9.7
If you had another infant today, would you intend to get all the recommended vaccinations?	Hesitate	71	24.9	14.7	<0.05	0.322		0.425
	Not sure	37	13.0	9.2
	Non-hesitate	177	62.1	1.7
Overall, how hesitant about childhood vaccinations would you consider yourself to be?	Hesitate	106	37.2	10.6	>0.05			0.325
	Not sure	60	21.1	9.7
	Non-hesitate	119	41.8	8.9
Children receiving more vaccinations are good for them.	Hesitate	93	32.6	10.5	>0.05			0.357
	Not sure	83	29.1	9.4
	Non-hesitate	109	38.2	8.8
I believe that many of the illnesses prevented by vaccines are severe.	Hesitate	62	21.8	12.4	<0.05			0.466
	Not sure	34	11.9	6.5
	Non-hesitate	189	66.3	1.1
It is better for my child to develop immunity by getting sick than vaccination.	Hesitate	98	34.4	19.6	<0.01			0.507
	Not sure	36	12.6	7.9
	Non-hesitate	151	53.0	2.4
It is better for children to get fewer vaccines at the same time.	Hesitate	102	35.8	20.7	<0.01	0.552	0.592
	Not sure	33	11.6	7.1
	Non-hesitate	150	52.6	2.5
How concerned about the potential serious side effect following vaccination?	Hesitate	99	34.7	19.6	<0.01		0.582
	Not sure	38	13.3	8.2
	Non-hesitate	148	51.9	2.2
How concerned about the vaccine efficacy?	Hesitate	96	33.7	18.8	<0.01		0.612
	Not sure	32	11.2	7.2
	Non-hesitate	157	55.1	2.0
The only reason for get childhood vaccinations is they can enter daycare or school.	Hesitate	94	33.0	10.5	>0.05	0.333
	Not sure	81	28.4	9.6
	Non-hesitate	110	38.6	8.7
I trust the information received about vaccine.	Hesitate	97	34.0	19.7	<0.01			0.632
	Not sure	37	13.0	8.2
	Non-hesitate	151	53.0	2.4
I can discuss my concern on vaccines with my doctors openly.	Hesitate	93	32.6	10.9	>0.05			0.316
	Not sure	83	29.1	9.5
	Non-hesitate	109	38.2	8.9
Overall, how much do you trust your child’s vaccination doctor?	Hesitate	77	27.0	15.2	<0.01			0.517
	Not sure	34	11.9	6.4
	Non-hesitate	174	61.1	1.3

^a Linear regression of mean% days of under-immunization and item responses (non-hesitant response as referent group).

Table 3. Determinants associated with the mean% of days of under-immunization from birth to 19 months old.

Variable	β	t	p
Education level	1.112	3.065	<0.01
Score of vaccination hesitancy	1.023	2.992	<0.01
Constant	6.553	2.886	<0.01

Table 4. The content of the survey questionnaire.

Content domain	Item	Response format and category
		Hesitant	Not sure	Non-hesitant
Behavior	1. Have you ever delayed your child’s vaccination for reasons other than illness or allergy?	Yes	Not sure	No
	2. How sure that following the recommended schedule is good for your child?	0–5 points	6–7 points	8–10 points
	3. It is my role as a parent to question vaccinations.	Strongly Agree/Agree	Not sure	Disagree/Strongly Disagree
	4. If you had another infant today, would you intend to get all the recommended vaccinations?	No	Not sure	Yes
	5. Overall, how hesitant about childhood vaccinations would you consider yourself to be?	Somewhat hesitant/Very hesitant	Not sure	Not at all hesitant/Not too hesitant
Beliefs	6. Children receiving more vaccinations are good for them.	Disagree/Strongly Disagree	Not sure	‘Strongly Agree/Agree
	7. I believe that many of the illnesses prevented by vaccines are severe.	Disagree/Strongly Disagree	Not sure	‘Strongly Agree/Agree
	8. It is better for my child to develop immunity by getting sick than vaccination.	‘Strongly Agree/Agree	Not sure	Disagree/Strongly Disagree
	9. It is better for children to get fewer vaccines at the same time.	‘Strongly Agree/Agree	Not sure	Disagree/Strongly Disagree
	10. How concerned about the potential serious side effect following vaccination?	Somewhat concerned/Very concerned	Not sure	Not at all concerned/Not too concerned
	11. How concerned about the vaccine efficacy?	Somewhat concerned/Very concerned	Not sure	Not at all concerned/Not too concerned
Attitudes	12. The only reason for get childhood vaccinations is they can enter daycare or school.	Yes	Not sure	No
Trust	13. I trust the information received about vaccine.	Disagree/Strongly Disagree	Not sure	‘Strongly Agree/Agree
	14. I can discuss my concern on vaccines with my doctors openly.	Disagree/Strongly Disagree	Not sure	‘Strongly Agree/Agree
	15. Overall, how much do you trust your child’s vaccination doctor?	0–5 points	6–7 points	8–10 points

Table 5. Immunization schedule in Chinese expanded program on immunization and minimum ages and intervals for specific vaccinations.

Vaccine	Dose	Recommended age (months)	Minimum acceptable age (days)	Minimum interval (days)	Age when under-immunized count initiated (days)	Maximum number of days under-immunized at 19 months (days)
BCG	-	Birth	0	-	32	581–32 = 549
HepB	1	Birth	0	-	32	581–32 = 549
	2	1	28	28	93
	3	6	168	56	215
PV	1	2	56	-	93	581–93 = 488
	2	3	84	28	123
	3	4	112	28	154
DTP	1	3	84	-	123	581–123 = 458
	2	4	112	28	154
	3	5	140	28	184
MPV-A	1	6	168	-	215	581–215 = 366
	2	9	252	84	306
MR	-	8	224	-	276	581–276 = 305
JEV	-	8	224	-	276	581–276 = 305
Total	14					3020

Note: BCG: Bacillus-Calmette-Guerin vaccine; HepB: hepatitis B vaccine; PV: polio vaccine; DTP: diphtheria-tetanus-pertussis vaccine; MPV-A: meningococcal polysaccharide vaccine-type A; MR: measles-rubella vaccine; JEV: Japanese encephalitis vaccine; MMR: measles-mumps-rubella vaccine; HepA: hepatitis A Vaccine; MPV-AC: meningococcal polysaccharide vaccine-type A and C; DT: diphtheria-tetanus vaccine.