| ObjectiveTo introduce the Parent Attitudes about Childhood Vaccines(PACV)scale,test its reliability and validity to explore its practical application value,and to provide an assessment tool for the identification of vaccine hesitant parents,so as to provide convenience for domestic researchers.For understanding the distribution of parental hesitation in Guangzhou,exploring the risk factors of vaccine hesitancy,a prevalence survey was conducted in Guangzhou city by using Children’s Vaccination Status and Behavior Questionnaire based on the Chinese version of the PACV scale.It will promote follow-up in-depth study,and provide support for follow-up intervention and improvement.Methods1.After obtaining the authorization of the author of the original scale,the scale was translated according to the double translation-back translation,and the scale was modified and debugged through expert consultation and small sample pre-tests to form the Chinese version of PACV.2.In May-September 2019,convenience sampling was used to survey the parents of children under 13 in Guangzhou through the Chinese version of the PACV scale.A total of 421 valid questionnaires were collected finally.Using Epidata 3.1 software for double entry,SPSS 23.0 for statistical analysis such as Independent-Samples T-test,exploratory factor,content validity and reliability test.AMOS 21.0 was used for confirmatory factor analysis of the scale.3.The cross-sectional study with PAPV in 5 community health service centers of Guangzhou city was carried out through stratified sampling.Epidata 3.1 was used for double entry.Using SPSS 23.0 to perform descriptive analysis of the 755 valid questionnaires,Wilcoxon rank sum test(normal approximation method),and Spearman rank correlation analysis between multiple sets of data,c~2 test was used for comparison of qualitative independent samples.α=0.05(two-sided).Results1.The Chinese version of the PACV scale contained three dimensions,immunization planning behavior(2 items),vaccine safety and effectiveness beliefs(4items),and overall attitudes to immunization planning(9 items).Exploratory factor analysis showed that the factor load of 15 items were all greater than 0.4,and the cumulative contribution rate of variance was 59.796%.Confirmatory factor analysis showed that the model fitting evaluations met the judgment criteria;The Item-Content Validity Index of the scale is 0.67～1.00,and the Scale Content Validity Index is0.955.The Cronbach’αcoefficient for the overall scale was 0.705,and ranging from0.534 to 0.668 for each domain.Split-half reliability was 0.621 for the overall scale,and 0.563～0.696 for each domain.2.The results of the Chinese version of PACV showed that 153(20.5%)parents had delayed their children’s vaccination in the national immunization program but not because of their illness and allergies.20(2.6%)of their parents had refused to vaccinate according to the immunization programs.More than half(66.2%)of parents said they were worried about serious side effects after vaccination,or that each vaccination might not be safe(54.7%).Nearly half(48.1%)of parents worry that vaccination can’t effectively prevent their corresponding diseases.In general,13.6%of parents are somewhat hesitant about vaccination for children,but to a large extent(88.8%)agree to let their children vaccinate according to the national immunization program.3.The Guangzhou parents’PACV scale score among 0～83,the median and four quantile spacing were 30(20,37).705(93.4%),the parents’PACV score was below50 points,48(6.4%)parents’scores were between 50～69,only 2(0.3%)parents’PACV score was larger than 69 points,and the two parents had postponed and refused to vaccinated their children in the national immunization program.4.The score of vaccine knowledge among parents in Guangzhou was 0～18.The median and four quantile spacing were 11(9,13),and the overall median level was higher.The main ways for parents to get knowledge of vaccination were social media push(441,66.3%),medical workers’Introduction(433,64.5%),and"community publicity"(364,54.7%).At present,59.6%(416)of Guangzhou’s parents believe in most domestic vaccines,but they are not satisfied with certain vaccines.20.8%(145)parents do not trust domestic vaccines,preferentially choose imported vaccines;18.1%(126)parents trust domestic vaccines and believe that it is not necessary to choose imported vaccines.Only 11 parents(1.6%)were very distrust and did not vaccinated their children with domestic vaccines.The parents believed that the main measures to improve the confidence of vaccination were:strengthening supervision,increasing punishment,improving relevant legislation,and improving the quality standards and strictly implementing production.5.Univariate analysis showed that parental hesitant attitude was not related to demographic characteristics(P>0.05),and parents with different children’s vaccine attitudes had different distributions in different vaccine trusts(P=0.006).Spearman rank correlation analysis showed that the correlation coefficient between vaccine hesitation and vaccine cognition score was 0.183(P<0.001),and the correlation coefficient between the vaccine and the degree of vaccine trust was-0.179(P<0.001),all of which were significantly negatively correlated.6.Qualitative interview results showed that 35 parents responded vaccination delay to inadequate vaccination at vaccination sites,and 27 parents said they"were too busy",or"had no time",or"forgot"to take their children to vaccinate,or 25 leave their communities for reasons,such as touring,being on business trips,going back to hometown and so on.Reasons above failed vaccination on time.1 of the 4 parents who refused to vaccinate one type of vaccine for their children were out of the"abnormal reaction".Another 3 parents refused to regenerate their children after the failure of BCG vaccination,in which one child had an abnormal response at the first vaccination.13 parents used to take their children to Hongkong,Macao or overseas for vaccination.Conclusion1.The revised Chinese children vaccination attitude scale has good reliability and validity in the context of Chinese situation,and can be used as an assessment tool for the vaccine hesitation of children’s parents.The scale has 3 dimensions.They are named immunization program behavior,vaccine safety and validity beliefs,and the overall attitude of immunization program.The number of entries is moderate and easy to understand,and it takes 4～5 minutes to complete the test.2.On the whole,about 90%of Guangzhou’s parents approved the overall procedure of the national immunization plan,but a certain percentage(6.6%)of Guangzhou’s parents indicated that there was a medium to high degree of vaccine hesitation.Guangzhou parents’vaccine hesitation is not related to demographic characteristics,and is related to vaccine cognition and trust.Improving parents’vaccine cognition and vaccine trust level can reduce vaccine hesitation.The former can be achieved through network push and medical workers’science popularization,and the latter requires the state to strengthen supervision,improve laws and regulations and regulate vaccine production.3.The Chinese version of the PACV scale can objectively reflect the situation of vaccine hesitation.It is suitable for the measurement and evaluation of vaccine hesitation of Chinese parents,which helps to find out or intervene in parents with children’s vaccine hesitation in a timely manner.The introduction and application of this scale has public health implications. |
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