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. 2023 Dec 15;19(3):2271765.
doi: 10.1080/21645515.2023.2271765. Epub 2023 Oct 31.

Assessing vaccine hesitancy and health literacy using a new Italian vaccine confidence index and a modified Italian medical term recognition test: A cross-sectional survey on Italian parents

Guglielmo Arzilli  1 , Lorenzo Stacchini  2 , Virginia Casigliani  1 , Sara Mazzilli  3 , Francesco Aquino  4 , Aurea Oradini-Alacreu  1 , Beatrice Bruni  4 , Filippo Quattrone  5 , Francesca Papini  1 , Daniele Sironi  1 , Andrea Davide Porretta  1   6 , Gaetano Pierpaolo Privitera  1 , Caterina Rizzo  1   6 , Lara Tavoschi  1 , Pier Luigi Lopalco  7
Affiliations

Assessing vaccine hesitancy and health literacy using a new Italian vaccine confidence index and a modified Italian medical term recognition test: A cross-sectional survey on Italian parents

Guglielmo Arzilli et al. Hum Vaccin Immunother. .

Abstract

The decline in children's vaccination coverage and the resurgence of preventable infectious diseases draw attention to parents' vaccine hesitancy. Our study introduces two validated tools to independently assess vaccine hesitancy and health literacy among parents with school-age children. We developed a Vaccine Confidence Index (VCI) from 10 Likert items, exploring their relationships through exploratory and confirmatory factor analyses. We modified the IMETER (Italian medical term recognition test) to measure health literacy. We assessed the internal consistency of the modified IMETER and the 10 Likert items using Cronbach's alpha test (α) and McDonald's omega total coefficient (ω) with good results (ω = 0.92, α = 0.90; ω = 0.87, α = 0.82 respectively). We used these tools within a questionnaire conducted on 743 parents recruited from pediatric clinic waiting rooms in Italy, collecting demographic data, information sources on vaccines and vaccine-preventable diseases knowledge. The VCI resulting from factor analyses consisted of six items on a ten-point Likert scale, reflecting the ratio of positive to negative items. The survey revealed significant variations in the VCI according to individual features such as education, use of social networks, or Health institutions as sources of information. Multivariate logistic regression identified an association between vaccine intention and the VCI. Health literacy was functional for 91.2% of participants, but knowledge about vaccine-preventable diseases was generally low. The VCI showed no significant association with health literacy and vaccine-preventable diseases knowledge. The VCI and the modified IMETER effectively assess vaccination attitude and health literacy, offering valuable public health tools for tailoring vaccination campaigns to hesitant population subgroups.

Keywords: Italy; Vaccine hesitancy; confidence; health literacy; parents; vaccine index; vaccine-preventable diseases.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Time-flow diagram of the two phases of the study.
Figure 2.
Figure 2.
Parallel analysis. The values reported on the x-axis represent the factor number to be included in the analysis while on the y-axis the values of eigenvalue.
Figure 3.
Figure 3.
Confirmatory analysis with 3-factors solution and item allocation by factor.
See this image and copyright information in PMC

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