Development and validation of a tool assessing knowledge and attitudes regarding adult vaccination: The Attitude Towards Adult VACcination (ATAVAC) questionnaire.

Philippe-Richard Domeyer, Dimitrios Gougourelas, Konstantinos Kolokas, Anastasia Papaioannou, Vasileios Gkizlis, Emmanuil Chatzimanolis, Sofia Birka, Ioanna Tsiligianni, Athina Tatsioni, Zoi Tsimtsiou

Keywords: development; validation; tool; questionnaire; knowledge; attitudes; vaccination; adults


Despite the unequivocal value of vaccination in reducing the global burden of infectious disease, anti-vaccination movement thrives. To our knowledge, no fully validated tool exploring knowledge and attitudes of primary care patients regarding adult vaccination exists.

Research questions:

The aim of our study was to develop and validate a questionnaire assessing knownledge and attitudes regarding adult immunization.


This national cross-sectional study included 2,070 adult patients who presented for routine care in 23 Greek public Primary Healthcare Units. The development of the questionnaire was a result of literature review, semi-structured interviews and pilot-testing of its preliminary versions to researchers and patients. The initial version of the questionnaire contained 15 items measuring the respondents’ knowledge and attitude towards adult immunization 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 multi-item scales; confirmatory factor analysis was used in the second sample to assess goodness of fit.


The final sample consisted of 1571 individuals. Overall Cronbach’s alpha was 0.844. 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 (root mean square error of approximation, RMSEA=0.050; comparative fit index, CFI=0.955, Tucker Lewis index, TLI=0.937; standardised root mean square residual, SRMR=0.053).


The ATAVAC instrument proved to be a reliable and valid tool, suitable for assessing knowledge and attitudes regarding adult vaccination.

Points for discussion:

Vaccination is considered the second most successful public health intervention; there is a need for using validated instruments to assess vaccination knowledge and attitudes in primary care populations

Need for translation to other languages and further validation in other settings