Reliability and validity study of the “5Cs” hesitancy scale for maternal influenza vaccination among pregnant and postpartum women

TL;DR

This study created a reliable and valid scale to measure maternal hesitancy toward influenza vaccination in pregnant and postpartum women in China.

Contribution

The study introduces a new scale based on the 5C model to assess maternal influenza vaccine hesitancy.

Findings

The five-factor structure of the scale showed good model fit (RMSEA = 0.098, CFI = 0.921).

Cronbach's alpha coefficients ranged from 0.802 to 0.958, indicating strong internal consistency.

Collective responsibility had the highest score, while complacency and constraints had the lowest.

Abstract

Maternal influenza vaccine hesitancy plays a vital role in the low rates of vaccination. However, instruments to appropriately assess perinatal influenza vaccine hesitancy are unavailable. This study aimed to develop the Maternal Influenza Vaccine Hesitancy Scale based on the 5C vaccination hesitancy scale, containing the subscales of confidence, complacency, constraints, calculative, and collective responsibility, and to provide a preliminary overview of the current hesitancy on maternal influenza vaccination in China.

A cross-sectional survey, from January to March 2024, was carried out among 2035 pregnant and postpartum women from nine provincial-level administrative divisions representing eastern, central, western, and northeastern areas of China. Reliability was evaluated by internal consistency reliability and split-half reliability, and a Cronbach’s alpha coefficient > 0.7 was considered acceptable. Construct validity was assessed using confirmatory factor analysis (CFA), with good model fit defined as root mean square error of approximation (RMSEA) < 0.100, normed fit index (NFI) > 0.9, comparative fit index (CFI) > 0.9, and Tucker-Lewis index (TLI) > 0.9.

Confirmatory factor analysis results supported the five-factor structure of the scale (RMESA = 0.098, CFI = 0.921, TLI = 0.903, NFI = 0.918). The Cronbach's alpha coefficients for the scale as well as the subscales ranged from 0.802 to 0.958. Among five subscales, collective responsibility (2.73 ± 0.63) scored highest, while complacency (2.16 ± 0.69) and constraints (2.17 ± 0.69) were the lowest.

The Maternal Influenza Vaccine Hesitancy Scale developed in this study is a reliable and valid instrument to measure the influenza vaccine hesitancy of pregnant and postpartum women. It is recommended that interventions including health education and improving the access to the vaccination service be carried out to reduce the maternal influenza vaccination hesitancy.

The online version contains supplementary material available at 10.1186/s40249-025-01295-8.

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