Understanding what people think and feel about adult vaccinations and the associated barriers in Greece: Development and validation of the attitude towards adult vaccination (ATAVAC) scale

Abstract

Despite the unequivocal value of vaccination in reducing the global burden of infectious diseases, the anti-vaccination movement thrives. The vast majority of the existing validated tools explore attitudes regarding vaccination in children. The aim of our study was to develop and validate a scale assessing attitudes towards adult immunisation. This national cross-sectional study included adult healthcare users who visited 23 Greek Primary Healthcare Units. The development of the scale was the result of literature review, semi-structured interviews and pilot testing of its preliminary versions. The initial version contained 15 items measuring respondents' attitudes on a 6-point Likert scale. The sample was randomly split into two halves. Exploratory factor analysis, performed in the first sample, was used for the creation of multiitem scales; confirmatory factor analysis was used in the second sample to assess goodness of fit. Moreover, concurrent validity, internal consistency reliability, testretest reliability and ceiling and floor effects were explored. The total sample consisted of 1,571 individuals. Overall 'Cronbach's alpha' (0.821) indicated good internal consistency. The initial exploratory factor analysis resulted in a three-factor model.The subsequent confirmatory factor analysis indicated that an 11-item version of the scale provided the best fit of the model to the data (RMSEA = 0.050, SRMR = 0.053, TLI = 0.937, CFI = 0.955, AIC = 24,999.949). All subscales ('value of adult vaccination', 'safety concerns' and 'perceived barriers') demonstrated strong concurrent associations with participants' attitudes and behaviour regarding vaccination (p < .001). No ceiling or floor effects were noted for any of the subscales (0.13%, 2.61% and 0.51%; 0.13%, 0.57% and 0.45% respectively). The 11-item ATAVAC scale proved to be a reliable and valid tool, suitable for assessing attitudes towards adult vaccination.

Exploring Perceptions and Practices Regarding Adult Vaccination against Seasonal Influenza, Tetanus, Pneumococcal Disease, Herpes Zoster and COVID-19: A Mixed-Methods Study in Greece

“…They were particularly asked to identify themselves across the five categories of the vaccine hesitancy continuum: (a) accept all adult vaccines; (b) accept adult vaccines, but unsure; (c) accept some adult vaccines, but delay or refuse some; (d) refuse adult vaccines, but unsure; and (e) refuse all adult vaccines [ 5 ]. Participants then completed the valid and reliable Attitude Towards Adults Vaccination (ATAVAC) scale [ 18 ]. The ATAVAC scale consists of 11 items, in which participants respond with their degree of agreement using a 6-point Likert scale (ranging from 1 = strongly disagree to 6 = strongly agree), and three subscales: (a) “Value of adult vaccination” (7 items); (b) “Safety concerns” (2 items); and (c) “Perceived barriers” (2 items).…”

Research needs for optimising wastewater-based epidemiology monitoring for public health protection

“…Currently, clinical surveillance for pathogenic viruses is limited to those who seek treatment, which excludes those who are asymptomatic, mildly symptomatic, or who do not present for treatment for other reasons (e.g., lack of access to healthcare or mistrust in healthcare systems; Tsimtsiou et al 2021). There have been attempts to use data collection methods that would include information on populations not seeking clinical treatment, as well as people who do.…”