Measuring vaccine hesitancy: The development of a survey tool

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

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Measuring vaccine hesitancy: The development of a survey tool 2015 Vaccine 10.1016/j.vaccine.2015.04.037 larson2015-measuring-vaccine-hesitancy-the-de larson2015-measuring-vaccine-hesitancy-the-de.txt, the project's staged copy d7e486bf7f5a99358ac6e2fbcb540dcd5de56f62 cc-by social-sciences

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0 spans located by searching the stored text for the quote's exact words, allowing any whitespace between them HOW TO MEASURE 'vaccine hesitancy' - a construct defined by the same working group, in the adjacent article of the same journal supplement, three months earlier Quotation withheld because this record is not cleared for redistribution. what 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 Quotation withheld because this record is not cleared for redistribution. a 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 Quotation withheld because this record is not cleared for redistribution. method Quotation withheld because this record is not cleared for redistribution. hesitancy as a SUB-GROUP property rather than a population-wide one, so that the measurement has to answer WHO, WHAT and WHERE separately Quotation withheld because this record is not cleared for redistribution. survey survey Quotation withheld because this record is not cleared for redistribution. the 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 because this record is not cleared for redistribution. and 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 Quotation withheld because this record is not cleared for redistribution. THE 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 Quotation withheld because this record is not cleared for redistribution. and 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 Quotation withheld because this record is not cleared for redistribution. THE 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 Quotation withheld because this record is not cleared for redistribution. the 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 Quotation withheld because this record is not cleared for redistribution. THE 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 because this record is not cleared for redistribution. and 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 Quotation withheld because this record is not cleared for redistribution. the 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 Quotation withheld because this record is not cleared for redistribution. and 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` Quotation withheld because this record is not cleared for redistribution. the 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 Quotation withheld because this record is not cleared for redistribution. whether the instrument counts refusal, or access failure, as hesitancy 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 Quotation withheld because this record is not cleared for redistribution. whether the questions have been validated 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 Quotation withheld because this record is not cleared for redistribution. whether the item pool covers the construct it is mapped onto 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 Quotation withheld because this record is not cleared for redistribution. the two JRF indicators were pilot-tested across the Americas, Europe and East, South and Central Africa, in four languages, before being proposed 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 Quotation withheld because this record is not cleared for redistribution. vaccine hesitancy vaccine hesitancy Quotation withheld because this record is not cleared for redistribution. delay in acceptance or refusal of vaccines delay in acceptance or refusal of vaccines Quotation withheld because this record is not cleared for redistribution. refusal refusal Quotation withheld because this record is not cleared for redistribution. access issues access issues Quotation withheld because this record is not cleared for redistribution. vaccine confidence vaccine confidence Quotation withheld because this record is not cleared for redistribution. Vaccine Hesitancy Matrix Vaccine Hesitancy Matrix Quotation withheld because this record is not cleared for redistribution. JRF JRF Quotation withheld because this record is not cleared for redistribution. vaccine 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 because this record is not cleared for redistribution. vaccine 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 because this record is not cleared for redistribution. hesitancy 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 because this record is not cleared for redistribution. `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 because this record is not cleared for redistribution. `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 Quotation withheld because this record is not cleared for redistribution. extends → 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 Quotation withheld because this record is not cleared for redistribution. supports → the Global Vaccine Action Plan's Strategic Objective 2 indicators - which the 2012 pilot was shaped to match before the construct was Quotation withheld because this record is not cleared for redistribution. extends → SAGE's own final report, whose validation warning the paper quotes against its own compendium Quotation withheld because this record is not cleared for redistribution. vaccine hesitancy —operationalised-as→ delay in acceptance or refusal of vaccines vaccine hesitancy delay in acceptance or refusal of vaccines Quotation withheld because this record is not cleared for redistribution. vaccine hesitancy —distinct-from→ refusal vaccine hesitancy refusal Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but endpoint by anaphora: 'hesitancy' = vaccine hesitancy (previous sentence). Quotation withheld because this record is not cleared for redistribution. vaccine hesitancy —distinct-from→ access issues vaccine hesitancy access issues Quotation withheld because this record is not cleared for redistribution. vaccine confidence —distinct-from→ vaccine hesitancy vaccine confidence vaccine hesitancy 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. Quotation withheld because this record is not cleared for redistribution. one stated form of the definition speaks of vaccines and vaccine services rather than vaccination and vaccination services one stated form of the definition speaks of vaccines and vaccine services rather than vaccination and vaccination services Quotation withheld because this record is not cleared for redistribution. the 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 the 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 because this record is not cleared for redistribution. REFUSAL IS NOT HESITANCY, stated as a rule for question selection: `counting only vaccine refusers will not capture hesitancy` REFUSAL IS NOT HESITANCY, stated as a rule for question selection: `counting only vaccine refusers will not capture hesitancy` Quotation withheld because this record is not cleared for redistribution. hesitancy must be assessed as distinct from access issues hesitancy must be assessed as distinct from access issues Quotation withheld because this record is not cleared for redistribution. the 2012 JRF pilot focused on vaccine confidence rather than broader hesitancy, to match the Global Vaccine Action Plan indicators the 2012 JRF pilot focused on vaccine confidence rather than broader hesitancy, to match the Global Vaccine Action Plan indicators Quotation withheld because this record is not cleared for redistribution. the 2012 JRF pilot response rate was 14% - 13 of 94 countries - and the paper calls it sub-optimal the 2012 JRF pilot response rate was 14% - 13 of 94 countries - and the paper calls it sub-optimal Quotation withheld because this record is not cleared for redistribution. the item pool came from two keyword searches over 2,933 re-screened articles the item pool came from two keyword searches over 2,933 re-screened articles Quotation withheld because this record is not cleared for redistribution. the compendium mixes items from previously validated questionnaires (high-income countries only), items from experts, and newly proposed ones the compendium mixes items from previously validated questionnaires (high-income countries only), items from experts, and newly proposed ones Quotation withheld because this record is not cleared for redistribution. the questions `do not address all the determinants in the Vaccine Hesitancy Matrix` and `few have been validated` the questions `do not address all the determinants in the Vaccine Hesitancy Matrix` and `few have been validated` Quotation withheld because this record is not cleared for redistribution. SAGE'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` SAGE'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 because this record is not cleared for redistribution. the construct is declared unstable in time: `a survey which reveals little hesitancy this year may have a different result next year` the construct is declared unstable in time: `a survey which reveals little hesitancy this year may have a different result next year` Quotation withheld because this record is not cleared for redistribution. and SAGE calls for sociologists, psychologists, anthropologists, social marketers and communication experts - a MULTI-DISCIPLINARY approach to a single construct and SAGE calls for sociologists, psychologists, anthropologists, social marketers and communication experts - a MULTI-DISCIPLINARY approach to a single construct Quotation withheld because this record is not cleared for redistribution. a delay in acceptance or refusal of vaccination despite availability of vaccination services; complex and context specific, varying across time, place, and vaccines vaccine hesitancy Quotation withheld because this record is not cleared for redistribution. delay in acceptance or refusal of VACCINES despite availability of VACCINE SERVICES - the narrower form, in the same paper Vaccine hesitancy Quotation withheld because this record is not cleared for redistribution. articles re-screened to harvest candidate survey items 2933 Quotation withheld because this record is not cleared for redistribution. percent response to the first JRF pilot - 13 of 94 countries 14 Quotation withheld because this record is not cleared for redistribution. vaccine confidence vaccine confidence Quotation withheld because this record is not cleared for redistribution.

The full text of this article is not redistributable, so it is not included here. The evidence sentences are withheld with it; the tag layer and its grounding status remain. The article itself is at https://doi.org/10.1016/j.vaccine.2015.04.037.