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

Background:

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.

Method:

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.

Results:

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).

Conclusions:

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

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