Validation and Cultural Adaptation of the Parent Attitudes about Childhood Vaccines (PACV) Questionnaire in Arabic Language Widely Spoken in a Region with a High Prevalence of COVID-19 Vaccine Hesitancy

Abstract

The parents’ attitude toward vaccinating children and adolescents against coronavirus disease 2019 (COVID-19) remains inconsistent and needs further elucidation. The high rates of COVID-19 vaccine hesitancy in the Middle East and North Africa (MENA) region require intensive research to understand the determinants of this phenomenon. This study aimed to validate a version of the Parent Attitudes about Childhood Vaccines (PACV) tool in Arabic, the most widely spoken language in the MENA. The study objectives included the investigation of Arab-speaking parents’ views regarding COVID-19 vaccination of their children. Parents living in Egypt with at least one child aged 5–18 years were eligible to participate in the study that was conducted through an online survey with 15 PACV items. The PACV tool was translated into Arabic using forward and backward translation. To assess the psychometric properties of the Arabic version of PACV, Pearson’s correlation coefficient and exploratory and confirmatory factor analysis (EFA and CFA) were performed. A total of 223 parents participated in the study: 59.82% aged 30–39 years, 69.20% were females, 46.19% were university-educated, and 40.63% had one child. The overall Cronbach’s alpha for the Arabic version of PACV was 0.799. The EFA of the 15 items showed that three domains were most conceptually equivalent. All items had a positive significant correlation with the mean score of each subscale except for item 4 (r = 0.016, p = 0.811). Regression analyses results indicated that education, previous COVID-19 infection, vaccine status of parents, and PACV score were significantly associated with the intention of the parents to vaccinate their children against COVID-19. The CFA results showed that most of the factor loadings were statistically significant (p < 0.010) except for items 4 and 7. However, the root mean square error of approximation (RMSEA = 0.080) and the standardized root mean squared residual (SRMR = 0.080) indicated that the model had a reasonable fit, and the three factors were good in reproducing each correlation. Our study results indicated the validity and reliability of the PACV instrument in Arabic language. Consequently, the PACV can be used to assess COVID-19 vaccine hesitancy in a majority of MENA countries for better delineation of this highly prevalent phenomenon in the region.

Determinants of parental seasonal influenza vaccine hesitancy in the Eastern Mediterranean region: A cross-sectional study

“…The English and Arabic validated versions of the PACV were used to identify parents who were hesitant toward childhood influenza vaccine (22,23). The PACV has 15 elements with three domains: behavior toward the vaccine, beliefs about the safety and efficacy of (23).…”

Acceptance of COVID-19 Vaccine Booster Doses Using the Health Belief Model: A Cross-Sectional Study in Low-Middle- and High-Income Countries of the East Mediterranean Region

“…Hence, COVID-19 booster doses are expected to face rejection or hesitancy, which necessitates a thorough exploration of the underlying causes for such attitudes [21]. One of the ten threats to global health is vaccine hesitancy, which was widely prevalent in the context of COVID-19 vaccination [22][23][24][25]. Vaccine hesitancy is defined as the unwillingness or refusal to vaccinate despite the availability of vaccines [26].…”

External validation of the parental attitude about childhood vaccination scale

“…To validate the PACV tool externally in six countries, we collected data from 2095 respondents, with 399 cases in Libya, 301 cases in Lebanon, 386 cases in the Syrian Arab Republic, 389 cases in Iraq, 389 cases in Palestine, and 231 cases in Sudan. We chose to develop the predicted model using data from Egypt because we had previously internally validated the Arabic version of the PACV tool using Egypt’s data in a previous publication, which indicated the validity and reliability of the PACV instrument in Arabic language ( 15 ).…”

“…The Parent Attitudes about Childhood Vaccines (PACV) survey is a reliable technique that has been successfully used in several countries to identify parental VH ( 13 , 14 ). The PACV has been internally validated in English and Arabic versions ( 10 , 13 , 15 ). Unlike internal validation, external validation aims to assess the performance of a risk-prediction model for new individuals (new dataset).…”