The psychometric properties and the factorial structure of COVID-19 Vaccines Acceptance scale (VAC-COVID-19) within the Arabic language in a Palestinian contex
The coronavirus disease of 2019 (COVID-19) remains a current threat to public health [26]. Across the world, several countries implemented large-scale measures to reduce the rapid spread of COVID-19, such as strict social distancing guidelines and limitations on movement, otherwise known as ‘lockdowns’ [19]. However, despite these measures, the pandemic is still ongoing. While government mandates of personal protective gear, such as masks, are vital to managing the spread of this infectious disease, vaccination may provide more extraordinary safety measures against hospitalizations related to the COVID-19 virus [18].
By April 22, 2022, about 11.2 billion COVID-19 vaccines had been administered in more than 197 countries. The percentage of individuals fully vaccinated worldwide is 60% of the total world population. The rate of receiving the COVID-19 vaccine varied in different countries; for example, in China, 58%, USA 66%, New Zealand 83%, Saudi Arabic 72%, Jordan 44%, Egypt 33%, and Lebanon 32%. In Palestine, the percentage of fully vaccinated people is 38% [26].
The WHO Strategic Advisory Group of Experts (SAGE) defines vaccine hesitancy as a delay in acceptance or refusal of vaccination despite the availability of vaccination services [5]. Complacency, convenience, and confidence are considered factors that affect one’s attitude towards vaccination acceptance [27]. Complacency signifies a low perception associated with the risk of getting the disease and, therefore, deems the need for vaccination unnecessary. Convenience looks at vaccines’ affordability, availability, and delivery in a reliable context. Confidence refers to the trust in vaccination safety and effectiveness, as it relates to the competence of the healthcare systems [25].
Earlier studies have shown vaccine hesitancy to be a global phenomenon, with variability in the cited reasons owing to the refusal of vaccine acceptance. The prevailing reasons include anticipated benefits vs. risks, a lack of knowledge and/or awareness, and particular religious beliefs [14, 27, 26). A global survey to determine possible rates and factors related to accepting a COVID-19 vaccine was administered to 13,426 people in 19 countries. Of those surveyed, 71.5% stated that they would be ‘very’ or ‘somewhat likely to take a COVID-19 vaccine. Participants who responded with high levels of trust in government sources and information were ‘more likely to listen to their employer’s advice and take the vaccine [17].
One study had participants from Jordan complete a survey to investigate the acceptability, predictors, and perceived beliefs toward the COVID-19 vaccines. A total of 3,100 participants were involved in the study, and vaccination acceptance among participants was reasonably low (37.4%); the findings also showed that those who take the seasonal influenza vaccine (2.03%) were more inclined to take the COVID-19 vaccines, as well as those who were willing to pay for vaccines (19.22%), and who believed that vaccines are generally safe (9.25%), [11].
Few studies have centred on the demand for vaccines in middle and lower-income countries (LMICs). This may be due to varying factors involving the population compared to higher-income countries. LMICs may have fewer means when introducing new vaccines and may need to contend with citizenry who show hesitancy due to their beliefs [13].
Studies from different cultures have identified many factors influencing the acceptance of the COVID-19 vaccine. [8] investigated the knowledge, attitudes, and vaccine acceptance/hesitancy towards COVID- vaccinations in Italy. Factors significantly associated with willingness to receive the COVID-19 vaccination were confidence in vaccines, fear of contracting COVID-19 infection, considering vaccination to be the best strategy to counteract the COVID-19 virus, and adherence to influenza vaccination during the 2020/2021 season[21] evaluated psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Results showed that vaccine-hesitant/resistant respondents in Ireland and the U.K. were similar across various psychological constructs. In both populations, those resistant to a COVID-19 vaccine were less likely to obtain information about the pandemic from traditional and authoritative sources and had similar levels of mistrust in these sources compared to vaccine-accepting respondents. [25] study aimed to evaluate COVID-19 vaccine acceptance in Jordan. This study showed the high prevalence of COVID-19 vaccine hesitancy and its association with conspiracy beliefs among university students in Jordan. Moreover, dependence on social media platforms was significantly associated with lower intention to get COVID-19 vaccines compared to dependence on medical doctors, scientists, and scientific journals.
Therefore, information concerning individuals’ attitudes and considerations for vaccinating should be investigated to encourage individuals to take the vaccine and allow communities to uptake their vaccination rates [10].
The COVID-19 vaccine acceptance scale (VAC-COVID-19) is a new international instrument developed by [22] to explore individuals’ attitudes and considerations in vaccinating against COVID-19 in Peru. According to CFA and EFA results, two subscales with 11 items were found to explain 58.17% of the total variance; the two subscales can be used separately in assessing reasons for not receiving the vaccination and reasons for receiving a vaccination, or they can be used together after reversing the scoring for one of these subscales. Each item had five possible Likert-type responses (strongly disagree = 1 score, disagree = 2 scores, neither disagree nor agree = 3 scores, agree = 4 scores, and strongly agree = 5 scores). The fit indices show that the proposed model is adequate. Finally, Cronbach’s α was very satisfactory for the generated scale.
Several studies have been implemented to validate vaccination hesitancy scales in different contexts. [24] tested the psychometric properties of a modified version of the Vaccine Hesitancy Scale (VHS) among people with HIV in the United States. Results illustrate that the modified VHS for COVID-19 vaccination has adequate psychometric properties to assess vaccination hesitancy. [28] examined whether DrVac-COVID19S is measurement invariant across different subgroups (Taiwanese vs. mainland Chinese university students; males vs. females; and health-related program majors vs. non-health-related program majors. The findings indicated that the DrVac-COVID19S is a stable method across the subgroups. [1] assessed the psychometric properties of the 5 C scale for assessing the COVID-19 vaccine’s psychological antecedents in the Arabic language. Results revealed that the Arabic version of the 5 C scale is a valid and reliable tool to assess the psychological antecedents of the COVID-19 vaccine among the Arab population. [7] examined the validation indicators of an Italian version of the Vaccination Attitudes Examination (VAX) scale; the results showed that the VAX-I scale appears to be a valid instrument to assess vaccine hesitancy in the Italian context. Finally, [16] tested the validation of the Multidimensional Covid-19 Vaccine Hesitancy Scale (CoVaH) in the Hungarian context, the CoVaH displayed excellent fit indices and internal consistencies and was found to have good validity in identifying Covid-19 vaccine hesitancy in the general population.
Despite the validation of different vaccination hesitancy scales in various contexts, there is a need to explore the VAC-COVID-19 scale’s validity and reliability indicators in a specific cultural context, such as within the Palestinian context [19, 20].
Hence, this is the first study to explore the validity and reliability indicators of VAC-COVID-19 within the Palestinian population. Therefore, our study would test the VAC-COVID-19’s two-factor structure in assessing vaccination acceptance among Palestinians, (b) the VAC-COVID-19 would be a reliable measure in assessing reasons for not receiving and receiving vaccination in Palestine, (c) the VAC-COVID-19 would be a valid measure in assessing reasons for not receiving and receiving vaccination in Palestine.
