Measuring vaccine hesitancy: The development of a survey tool

Heidi J. Larson, Caitlin Jarrett, W Schulz, Mohuya Chaudhuri, Yuqing Zhou, Ève Dubé, Melanie Schuster, Noni E. MacDonald, Rose Wilson · Vaccine · 2015 · social-sciences · 10.1016/j.vaccine.2015.04.037 · record larson2015-measuring-vaccine-hesitancy-the-de
tag layer · index · concepts · authors · עברית
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How to read this page. The article itself is not reproduced here — this paper is not cleared for redistribution, so what follows is the tag layer alone. The evidence sentences are withheld with the article. The table at the foot lists every tag the record carries; each row names the facet it belongs to, and the whose words column says whether the tag records the paper's own wording or the tagger's sentence about the paper. Every tag links to each other paper in the corpus carrying it. The machine-readable edition of the same thing is the TEI file beside this one, where the tags live in standOff, and the article is at its publisher via the link below. When we have changed our mind. Some entries in the table begin with a word in capitals and the reason for it. EVIDENCE CORRECTED — the finding still stands, but we had quoted the wrong sentence from the paper, and the quotation has been replaced with the right one. RETRACTED — the entry itself was wrong; it stays on the page, marked, with the reason, rather than being deleted. WITHDRAWN AND REPLACED — the entry was wrong, and a corrected version of it appears in the entries below. Each mark carries its own reason, in brackets, because the reasons differ from one entry to the next. An entry we have WITHDRAWN is removed from this page and kept in the record, with its reason. A line reading Audit and a date is a later re-reading of the entry against its whole sentence: DOUBTFUL means it was kept, and the reason says what is loose about it. Quotation marks inside the tagger's sentence. Where a tag is the tagger's own sentence, a phrase in quotation marks inside it is borrowed from the paper — the tagger's wording around it is not. The paper's own sentence is the evidence quote for that row; on this page it is withheld with the article, and the article is at its publisher. Nothing inside quotation marks anywhere on this page is ours: if it is quoted, it is the paper's. Whose words a concept carries. A concept entry records a term the paper itself uses, so the term, the sense given for it, and its evidence are the paper's own words, quoted where the paper fixes them. This is the opposite of a sense entry in the tag table, which is the tagger's sentence about how the paper uses a term. Where a concept entry could not be grounded in the paper's words, the entry says so on its own row.
Other fields define these differently the same word, defined another way in another discipline
vaccine hesitancy 2 fields

Tags on this paper

Every tag the record carries, each linking to every other paper in the corpus that carries it. A tag appears here whether or not its words occur in the article — the spans below are only the ones a sentence in this paper licenses. Of the 7 concept tags on this paper, all 7 are grounded in a quoted sentence. All carry the tagger's gloss of what the term means in this paper, which is not something the article can license.
vaccine hesitancy delay in acceptance or refusal of vaccines refusal access issues vaccine confidence Vaccine Hesitancy Matrix JRF survey
Method, as described: items harvested from a systematic review by two keyword searches, re-screening 2,933 articles, then supplemented by expert contribution and newly written questions; two indicators pilot-tested through national Joint Reporting Forms

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relation to other workclaim_relationshow this paper stands to another: agrees, contradicts, extends, qualifies
claim typeclaim_typethe shape of the claim: existence, mechanism, method, critique, prediction, null
concept edgeconcept_edgesan asserted relation between two concepts, with the sentence asserting it
conceptconceptsan idea the paper works with, quoted where the paper uses it
content tagcontent_tagsa finding, definition, quantity, statistic or variable named in the paper
contributioncontributionwhat the paper claims to add
controlcontrolsan experiment run to eliminate a rival explanation
limitationlimitationswhat the paper says its evidence cannot support
mechanismmechanismshow the reported effect is said to come about
methodmethodhow the paper produced its evidence
object of studyobject_of_studywhat the paper is about — the thing it investigates
phenomenonphenomenonthe effect or regularity under study
research questionresearch_questionthe question the paper sets itself
sensesensesa distinct use of a term, quoted where the paper fixes it

The paper

The full text is not reproduced here. This article is not cleared for redistribution, so the page carries the tag layer only. Its evidence sentences are withheld; the grounding status remains with each tag, and the article itself is at https://doi.org/10.1016/j.vaccine.2015.04.037. The reading view exists for the papers whose licence permits it.

Every tag on this page

claim_relations 3 · claim_type 1 · concept_edges 4 · concepts 7 · content_tags 17 · contribution 1 · controls 4 · limitations 9 · mechanisms 2 · method 1 · object_of_study 1 · phenomenon 1 · research_question 1 · senses 5

Relations on this page carry a quotation for the claim. Where a relation was separately evidenced — and so tested against the vocabulary for its type — the row says so; none of 4 relations here carry that mark. The rest are the tagger’s reading of the sentence quoted beside them.

facettagfieldconf.whose words
object_of_studyHOW TO MEASURE 'vaccine hesitancy' - a construct defined by the same working group, in the adjacent article of the same journal supplement, three months earlier
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object_of_studythe paper's words
research_questionwhat to ask, of whom, so that the scale and nature of hesitancy can be compared across countries - and how to keep the answer from counting refusal, or access failure, as hesitancy
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research_questionthe paper's words
contributiona compendium of survey questions in three forms - closed, Likert and open-ended - mapped onto the Determinants Matrix, plus two indicators piloted in the WHO-UNICEF Joint Reporting Form
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contributionthe paper's words
claim_typemethod
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claim_typethe paper's words
phenomenonhesitancy as a SUB-GROUP property rather than a population-wide one, so that the measurement has to answer WHO, WHAT and WHERE separately
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phenomenonthe paper's words
methodsurvey
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also in: survey
methodthe paper's words
mechanismsthe survey is built to separate three things a raw uptake figure cannot: REFUSAL, ACCESS FAILURE, and HESITANCY. `Counting only vaccine refusers will not capture hesitancy`, and the reasons for being unvaccinated must be assessed to tackle hesitancy `as distinct from access issues`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[0]0.95the tagger's words
mechanismsand it is built to be VACCINE-SPECIFIC, because the construct is: hesitancy `may be specific to one or some, but not all, vaccines`, so a survey answer must not be generalised across vaccines unless the question said so
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mechanisms[1]0.95the tagger's words
limitationsTHE DEFINITION IS RESTATED IN A NARROWER FORM THAN ITS OWN SOURCE PAPER USES. macdonald2015 writes `delay in acceptance or refusal of vaccination despite availability of vaccination services`; this paper's Discussion writes `delay in acceptance or refusal of vaccines despite availability of vaccine services`. macdonald2015 spent a paragraph choosing the narrower NAME while keeping the broader SENSE, and the breadth lived in exactly those two words
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limitations[0]0.95the tagger's words
limitationsand the Introduction's block quotation differs from the source too, in two places: `A delay` for `delay`, and `time, place, and vaccines` for `time, place and vaccines`. Small, and they establish that THE DEFINITION IS BEING RE-TYPED RATHER THAN COPIED - which is how the third version becomes possible
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limitations[1]0.95the tagger's words
limitationsTHE FIRST INSTRUMENT MEASURED SOMETHING ELSE ON PURPOSE: the 2012 pilot focused on vaccine confidence `rather than on the broader issues driving vaccine hesitancy`, `in order to be in harmony with the Global Vaccine Action Plan indicators`. The instrument was aligned to a programme's reporting framework before it was aligned to the construct
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limitations[2]0.95the tagger's words
limitationsthe pilot it reports on had a 14% response rate - 13 of 94 countries - and the paper calls it `SUB-OPTIMAL` in its own first results sentence
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limitations[3]0.95the tagger's words
limitationsTHE QUESTIONS ARE LARGELY UNVALIDATED AND THE PAPER SAYS SO THREE TIMES: `few have been validated`; `Most are predominately designed for high-income settings`; and the questions `do not address all the determinants in the Vaccine Hesitancy Matrix`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
limitations[4]0.95the tagger's words
limitationsand SAGE's own final report is quoted saying the compendium has been `assessed and validated only in some high-income countries or not at all` - a validation warning carried inside the paper that ships the instrument
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limitations[5]0.95the tagger's words
limitationsthe items are of MIXED PROVENANCE and it is declared: some `derived from previously validated questionnaires, albeit in high-income countries only`, some from experts, and `others are newly proposed`. Three evidential grades in one compendium, distinguishable nowhere in the instrument itself
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limitations[6]0.95the tagger's words
limitationsand the construct is declared UNSTABLE IN TIME, which limits any single measurement: `A survey which reveals little hesitancy this year may have a different result next year`
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limitations[7]0.95the tagger's words
limitationsthe funding disclosure is IDENTICAL to its companion paper's, and lands on the same word: the group monitoring `public confidence in Immunization Programs` took Novartis research funding and GSK meeting funding, and the first author consulted for GSK ON VACCINE CONFIDENCE
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limitations[8]0.95the tagger's words
controlswhether the instrument counts refusal, or access failure, as hesitancy
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
eliminates: both confounds AT THE LEVEL OF INSTRUCTION - the paper states that refusal is not hesitancy and that hesitancy must be assessed as distinct from access - but no item, scoring rule or threshold is given that would separate them in a returned survey · outcome: partial
controls[0]0.95the tagger's words
controlswhether the questions have been validated
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eliminates: nothing, declared three times over: 'few have been validated', 'most are predominately designed for high-income settings', and SAGE's own report says they are validated 'only in some high-income countries or not at all' · outcome: failed
controls[1]0.95the tagger's words
controlswhether the item pool covers the construct it is mapped onto
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
eliminates: nothing - the questions 'do not address all the determinants in the Vaccine Hesitancy Matrix', and the remedy offered is that more 'will need to be developed and validated' · outcome: failed
controls[2]0.95the tagger's words
controlsthe two JRF indicators were pilot-tested across the Americas, Europe and East, South and Central Africa, in four languages, before being proposed
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
eliminates: single-region wording effects as an explanation of the responses - the paper says the spread 'allowed for input from a broad range of high, middle and low-income countries' · outcome: partial
controls[3]0.85the tagger's words
conceptsvaccine hesitancy
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[0]0.95the paper's words
conceptsdelay in acceptance or refusal of vaccines
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concepts[1]0.95the paper's words
conceptsrefusal
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: refusal
concepts[2]0.95the paper's words
conceptsaccess issues
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: access issues
concepts[3]0.95the paper's words
conceptsvaccine confidence
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[4]0.95the paper's words
conceptsVaccine Hesitancy Matrix
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concepts[5]0.95the paper's words
conceptsJRF
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: JRF
concepts[6]0.95the paper's words
sensesvaccine hesitancy, AS QUOTED HERE - `refers to a delay in acceptance or refusal of vaccination despite availability of vaccination services ... time, place, and vaccines`. Two words apart from macdonald2015's own text, which says `delay` and `place and`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[0]0.95the tagger's words
sensesvaccine hesitancy, AS RESTATED IN THE DISCUSSION - `delay in acceptance or refusal of vaccines despite availability of vaccine services`. THIS IS THE NARROW READING macdonald2015 EXPLICITLY DECLINED, appearing in the paper that builds the instrument. Three versions of one definition, two of them in this record
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[1]0.95the tagger's words
senseshesitancy vs REFUSAL vs ACCESS - the three the instrument exists to separate. `Refusal is not the same as hesitancy, i.e. counting only vaccine refusers will not capture hesitancy`, and hesitancy must be assessed `as distinct from access issues`. A raw uptake number confounds all three
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[2]0.95the tagger's words
senses`vaccine confidence` - WHAT THE 2012 INSTRUMENT ACTUALLY MEASURED, chosen `rather than the broader issues driving vaccine hesitancy` and `in order to be in harmony with the Global Vaccine Action Plan indicators`. The 2013 revision widened it back to complacency and convenience
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[3]0.95the tagger's words
senses`a survey question about vaccine hesitancy` - OPERATIONALLY, whatever two keyword searches returned from 2,933 re-screened articles: `Survey` with any of accept/barrier/refus/trust/missed/delay/confidence/partial/unsure/timeliness/hesitan, or Scale/Index/measurement/instrument/Questionnaire with any of Trust/Confidence/Hesitan
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senses[4]0.95the tagger's words
claim_relationsextends → macdonald2015's definition of vaccine hesitancy and its Determinants Matrix - this paper is the instrument for that definition, by the same working group, in the adjacent article of the same supplement
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claim_relations[0]0.95the tagger's words
claim_relationssupports → the Global Vaccine Action Plan's Strategic Objective 2 indicators - which the 2012 pilot was shaped to match before the construct was
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claim_relations[1]0.95the tagger's words
claim_relationsextends → SAGE's own final report, whose validation warning the paper quotes against its own compendium
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
claim_relations[2]0.95the tagger's words
concept_edgesvaccine hesitancy —operationalised-as→ delay in acceptance or refusal of vaccines
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concept_edges[0]0.95the tagger's words
concept_edgesvaccine hesitancy —distinct-from→ refusal
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but endpoint by anaphora: 'hesitancy' = vaccine hesitancy (previous sentence).
concept_edges[1]0.95the tagger's words
concept_edgesvaccine hesitancy —distinct-from→ access issues
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
concept_edges[2]0.95the tagger's words
concept_edgesvaccine confidence —distinct-from→ vaccine hesitancy
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but the span says the pilot focused on vaccine confidence rather than the broader issues driving hesitancy; distinct-from is loose.
concept_edges[3]0.95the tagger's words
content_tagsone stated form of the definition speaks of vaccines and vaccine services rather than vaccination and vaccination services
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[0]0.95the tagger's words
content_tagsthe quoted definition calls vaccine hesitancy a delay in acceptance or refusal of vaccination despite available services, complex, context specific, and influenced by complacency, convenience and confidence
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[1]0.95the tagger's words
content_tagsREFUSAL IS NOT HESITANCY, stated as a rule for question selection: `counting only vaccine refusers will not capture hesitancy`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[2]0.95the tagger's words
content_tagshesitancy must be assessed as distinct from access issues
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[3]0.95the tagger's words
content_tagsthe 2012 JRF pilot focused on vaccine confidence rather than broader hesitancy, to match the Global Vaccine Action Plan indicators
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[4]0.95the tagger's words
content_tagsthe 2012 JRF pilot response rate was 14% - 13 of 94 countries - and the paper calls it sub-optimal
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[5]0.95the tagger's words
content_tagsthe item pool came from two keyword searches over 2,933 re-screened articles
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[6]0.95the tagger's words
content_tagsthe compendium mixes items from previously validated questionnaires (high-income countries only), items from experts, and newly proposed ones
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[7]0.95the tagger's words
content_tagsthe questions `do not address all the determinants in the Vaccine Hesitancy Matrix` and `few have been validated`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[8]0.95the tagger's words
content_tagsSAGE's own final report is quoted warning that the compendium has been `assessed and validated only in some high-income countries or not at all`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[9]0.95the tagger's words
content_tagsthe construct is declared unstable in time: `a survey which reveals little hesitancy this year may have a different result next year`
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[10]0.95the tagger's words
content_tagsand SAGE calls for sociologists, psychologists, anthropologists, social marketers and communication experts - a MULTI-DISCIPLINARY approach to a single construct
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content_tags.findings[11]0.95the tagger's words
content_tagsa delay in acceptance or refusal of vaccination despite availability of vaccination services; complex and context specific, varying across time, place, and vaccines
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content_tags.definitions[0]0.95the tagger's words
content_tagsdelay in acceptance or refusal of VACCINES despite availability of VACCINE SERVICES - the narrower form, in the same paper
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content_tags.definitions[1]0.95the tagger's words
content_tagsarticles re-screened to harvest candidate survey items
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content_tags.quantities[0]0.95the tagger's words
content_tagspercent response to the first JRF pilot - 13 of 94 countries
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.quantities[1]0.95the tagger's words
content_tagsvaccine confidence
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content_tags.variables[0]0.95the tagger's words

Interpretive choices

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What was deliberately not tagged, and why, is recorded per paper by the tagger. Where a paper has no such record, this page says so rather than implying that nothing was declined.

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