A mixed method approach to evaluate a vaccine hesitancy assessment among parents in Dutch language

Abstract

Abstract Vaccine hesitancy (VH), as a driver for falling vaccine uptake rates, is a significant public health challenge. It is important to monitor this phenomenon and compare results in a unambiguous manner. However, in Dutch and possibly other languages, there is no unequivocal translation for VH. Therefore, we aimed to develop and cross culturally validate a method to assess VH in a simple and self-reported manner, using five differently worded alternatives reflecting ‘doubt’, ‘reluctance’, ‘uncertainty’, ‘concerned’ and ‘indecision’. We designed a mixed method study with a quantitative and qualitative evaluation. In the quantitative evaluation, parents were asked to rate experienced vaccine hesitancy in their decision about vaccinations on a 10-item Likert scale, using the five differently worded alternatives. We analyzed internal consistency with Cronbach’s alpha and correlation with the short parental attitudes about childhood vaccination (PACV-5) scale. A total of 532 parents participated in the survey. We found that the five worded alternatives measured the same construct, indicated by a Cronbach’s alpha of 0.95. The wording resembling ‘doubt’ had the highest correlation with the PACV score (coefficient -0.525, p < 0.001). We subsequently conducted cognitive interviews with 12 parents with lower education levels to evaluate their interpretation of the five wording alternatives and the comprehensibility of the question itself. The wordings resembling ‘doubt’ and ‘uncertainty’ were viewed as most clear and reflecting VH, although some participants had a negative association with ‘uncertainty’. Overall, the question was well understood and minor suggestions were provided to improve comprehensibility. Based on the integrated results of both studies, we conclude that using the word resembling ‘doubt’ in Dutch language is the best instrument to assess VH. We encourage uniform translation of vaccine hesitancy in other languages to enable comparison of results across countries. Key messages • Uniform translation of the term vaccine hesitancy in other language is important to enable comparison of results across countries. • In Dutch language, the word resembling ‘doubt’ is the best instrument to assess vaccine hesitancy.