Italian version of the Vaccination Fear Scale (VFS-6): internal and external validation
Abstract
Background: COVID-19 is one of the biggest threats in our current society in terms of mental and public health. Vaccination represents the most cost-efficient way to avoid disease, mental health negative outcomes, and an overload of the healthcare system, however, many people expressed fears and concerns related to COVID-19 vaccines. This paper presents the Italian validation of the Vaccination Fear Scale (VFS-6) originally developed in Spanish to complement clinical efforts in the prevention of vaccine hesitancy.
Methods: The sample was composed of 1111 Italian participants (14.2% not vaccinated) recruited by means of on-line anonymous voluntary census. The items of the VFS-6 were firstly adapted to the Italian language by means of a translation and back-translation standard procedure, and subsequently administered together with convergent and divergent concurrent measures to ascertain their reliability and validity (i.e., internal and external) properties. Finally, confirmatory factor analysis has been carried out to validate the internal structure of the test and investigate its psychometric properties.
Results: Confirmatory factor analysis supported a bifactorial model (cognitive and physical factors) also for the Italian version of the test, with very robust goodness of fit indicators, reliability, and internal consistency. Our data indicated that fear of vaccination is greater for females and highly correlated with vaccine anxiety and hesitancy. In particular, vaccine fear appeared strongly related to vaccination.
Conclusion: The Italian version of the VFS-6 appears valid and reliable to assess the fear of vaccination among the Italian population, as well as to support the research for the design of public campaigns devoted to decreasing vaccine hesitancy.
Keywords
Full Text:
PDFReferences
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Baumeister RF, Bratslavsky E, Finkenauer C, Vohs KD. Bad is stronger than good. Rev Gen Psychol. 2001;5(4):323–70. https://doi.org/10.1037/1089-2680.5.4.323
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25, 3186–3191. https://doi.org/10.1097/00007632-200012150-00014
Bendau, A., Plag, J., Petzold, M. B., & Ströhle, A. (2021). COVID-19 vaccine hesitancy and related fears and anxiety. International immunopharmacology, 97, 107724. https://doi.org/10.1016/j.intimp.2021.107724
Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological bulletin, 107(2), 238. https://doi.org/10.1037/0033-2909.107.2.238
Bentler, P. M. (1995). EQS structural equations program manual (Vol. 6). Encino, CA: Multivariate software.
Betsch, C., Schmid, P., Heinemeier, D., Korn, L., Holtmann, C., & Böhm, R. (2018). Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PloS one, 13(12), e0208601. https://doi.org/10.1371/journal.pone.0208601
Bodner, E., Bergman, Y. S., Ben‐David, B., & Palgi, Y. (2021). Vaccination anxiety when vaccinations are available: The role of existential concerns. Stress and Health. https://doi.org/10.1002/smi.3079
Caffieri, A., & Margherita, G. (2021). The psychological impact of COVID-19 on women’s wellbeing during pregnancy and postpartum one year after pandemic outbreak in Italy. A Systematic review. Mediterranean Journal of Clinical Psychology, 9(2). https://doi.org/10.13129/2282-1619/mjcp-3026
Cerda, A. A., & García, L. Y. (2021). Hesitation and refusal factors in individuals' decision-making processes regarding a coronavirus disease 2019 vaccination. Frontiers in public health, 9. https://doi.org/10.3389/fpubh.2021.626852
Ciccarelli, M., Nigro, G., D'Olimpio, F., Griffiths, M. D., Sacco, M., Pizzini, B., & Cosenza, M. (2022). The associations between loneliness, anxiety, and problematic gaming behavior during the COVID-19 pandemic: The mediating role of mentalization. Mediterranean Journal of Clinical Psychology, 10(1). https://doi.org/10.13129/2282-1619/mjcp-3257
Cheung, G. W., & Rensvold, R. B. (1999). Testing factorial invariance across groups: A reconceptualization and proposed new method. Journal of management, 25(1), 1-27. https://doi.org/10.1177/2F014920639902500101
Cohen, J. (1998). Statistical Power Analysis for the Behavioural Sciences (2nd edition). https://doi.org/10.4324/9780203771587
Comrey, A. L. (1988). Factor-analytic methods of scale development in personality and clinical psychology. Journal of consulting and clinical psychology, 56(5), 754. https://doi.org/10.1037/0022-006X.56.5.754
Cudeck, R. (1993). of Assessing Model Fit. Testing structural equation models, 154, 136.
DeVellis, R. F. (1991). Guidelines in scale development. Scale development: Theory and applications, 51-91.
Di Giacomo, D. (2020). Public Health emergencies and quarantine: virtual patient engagement as challenge and opportunity for Mental Health strategy. Mediterranean Journal of Clinical Psychology, 8(2). https://doi.org/10.6092/2282-1619/mjcp-2533
Di Trani, M., Pippo, A. C., & Renzi, A. (2022). Burnout in Italian hospital physicians during the COVID-19 pandemic: the roles of alexithymia and defense mechanisms. Mediterranean Journal of Clinical Psychology, 10(1). https://doi.org/10.13129/2282-1619/mjcp-3250
Dubé, E., Laberge, C., Guay, M., Bramadat, P., Roy, R., & Bettinger, J. A. (2013). Vaccine hesitancy: an overview. Human vaccines & immunotherapeutics, 9(8), 1763-1773. https://doi.org/10.4161/hv.24657
Dunn, T. J., Baguley, T., & Brunsden, V. (2014). From alpha to omega: A practical solution to the pervasive problem of internal consistency estimation. British journal of psychology, 105(3), 399-412. https://doi.org/10.1111/bjop.12046
Elbur, A., Alharthi, A., Aljuaid, A., & Hasan, N. (2016). Knowledge of Middle East respiratory syndrome coronavirus (MERS-CoV) and its management: a survey among Saudi people in Taif; Kingdom of Saudi Arabia. IOSR J Pharm, 6(8), 33-39. https://doi.org/10.9790/3013-068023339
Elgendy, M. O., & Abdelrahim, M. E. (2021). Public awareness about coronavirus vaccine, vaccine acceptance, and hesitancy. Journal of Medical Virology, 93(12), 6535-6543. https://doi.org/10.1002/jmv.27199
Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behaviour research methods, 41(4), 1149-1160. https://doi.org/10.3758/BRM.41.4.1149
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioural, and biomedical sciences. Behaviour research methods, 39(2), 175-191. https://doi.org/10.3758/BF03193146
Filindassi, V., Pedrini, C., Sabadini, C., Duradoni, M., & Guazzini, A. (2022). Impact of COVID-19 First Wave on Psychological and Psychosocial Dimensions: A Systematic Review. COVID, 2(3), 273-340. https://doi.org/10.3390/covid2030022
Freeman D, Loe BS, Chadwick A, Vaccari C, Waite F, Rosebrock L, Jenner L, Petit A, Lewandowsky S, Vanderslott S, et al. COVID-19 vaccine hesitancy in the UK: the Oxford Coronavirus explanations, attitudes, and narratives survey (OCEANS) II. Psychol Med. 2020;11:1–34. https://doi.org/10.1017/S0033291720005188
Goerman, P. L., & Caspar, R. A. (2010). A preferred approach for the cognitive testing of translated materials: Testing the source version as a basis for comparison. International Journal of Social Research Methodology, 13, 303–316. https://doi.org/10.1080/13645570903251516
Gori, A., Topino, E., Craparo, G., Grotto, R. L., & Caretti, V. (2021). An empirical model for understanding the threat responses at the time of COVID-19. Mediterranean Journal of Clinical Psychology, 9(1). https://doi.org/10.6092/2282-1619/mjcp-2916
Guazzini, A., Pesce, A., Gino, F., & Duradoni, M. (2022a). How the COVID-19 Pandemic Changed Adolescents’ Use of Technologies, Sense of Community, and Loneliness: A Retrospective Perception Analysis. Behavioral Sciences, 12(7), 228. https://doi.org/10.3390/bs12070228
Guazzini, A., Pesce, A., Marotta, L., & Duradoni, M. (2022b). Through the Second Wave: Analysis of the Psychological and Perceptive Changes in the Italian Population during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 19(3), 1635. https://doi.org/10.3390/ijerph19031635
Hammour, K. A., Farha, R. A., Manaseer, Q., & Al-Manaseer, B. (2022). Factors affecting the public’s knowledge about COVID-19 vaccines and the influence of knowledge on their decision to get vaccinated. Journal of the American Pharmacists Association, 62(1), 309-316. https://doi.org/10.1016/j.japh.2021.06.021
Hayes, A. F., & Coutts, J. J. (2020). Use omega rather than Cronbach’s alpha for estimating reliability. But…. Communication Methods and Measures, 14(1), 1-24. http://dx.doi.org/10.1080/19312458.2020.1718629
Hoffman, Y., Palgi, Y., Goodwin, R., Ben-Ezra, M., & Greenblatt-Kimron, L. (2021). A storm in a teacup: older adults’ low prevalence of COVID-19 vaccine side-effects and their link with vaccination anxiety. International Psychogeriatrics, 1-3. https://doi.org/10.1017/s1041610221001071
Hortal, M., & Di-Fabio, J.L. (2019). Rechazo y gestión en vacunaciones: sus claroscuros. Revista Panamericana de Salud Pública, 43. https://dx.doi.org/10.26633%2FRPSP.2019.54
Hsiao, Y. Y., & Lai, M. H. (2018). The impact of partial measurement invariance on testing moderation for single and multi-level data. Frontiers in Psychology, 9, 740. https://doi.org/10.3389/fpsyg.2018.00740
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural equation modeling: a multidisciplinary journal, 6(1), 1-55. https://doi.org/10.1080/10705519909540118
Il Sole 24 ore. (2022, January 10). I dati dei vaccinati al 10 gennaio 2022. Il Sole 24 Ore.
https://stream24.ilsole24ore.com/video/italia/i-dati-vaccinati-10-gennaio-2022/AEw1u76?refresh_ce=1
Italian Government. (2022, January 10). Conferenza stampa del Presidente Draghi. Governo.It.
https://www.governo.it/it/articolo/conferenza-stampa-del-presidente-draghi/18950
Jiménez-Corona, M. E., & Ponce-de-León-Rosales, S. (2011). Influenza vaccine and healthcare workers. Archives of Medical Research, 42(8), 652-657. https://doi.org/10.1016/j.arcmed.2011.12.006
Jöreskog, K. G. (1969). A general approach to confirmatory maximum likelihood factor analysis. Psychometrika, 34(2), 183-202. https://doi.org/10.1007/BF02289343
Karafillakis E, Simas C, Jarrett C, Verger P, Peretti-Watel P, Dib F, De Angelis S, Takacs J, Ali KA, Pastore Celentano L, et al. HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe. Hum Vaccines Immunother. 2019;15(7–8):1615–27. https://doi.org/10.1080/21645515.2018.1564436
Karlsson LC, Soveri A, Lewandowsky S, Karlsson L, Karlsson H, Nolvi S, Karukivi M, Lindfelt M, Antfolk J. Fearing the disease or the vaccine: the case of COVID-19. Pers Individ Dif. 2021;172 (1):110590. https://www.sciencedirect.com/science/article/pii/S0191886920307819
Killgore, W. D., Cloonan, S. A., Taylor, E. C., & Dailey, N. S. (2021). The COVID-19 Vaccine Is Here—Now Who Is Willing to Get It?. Vaccines, 9(4), 339. https://doi.org/10.3390/vaccines9040339
Kotta, I., Kalcza-Janosi, K., Szabo, K., & Marschalko, E. E. (2021). Development and Validation of the Multidimensional COVID-19 Vaccine Hesitancy Scale. Human vaccines & immunotherapeutics, 1-10. https://doi.org/10.1080/21645515.2021.2007708
Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, Schuster M, MacDonald NE, Wilson R. Measuring vaccine hesitancy: the development of a survey tool. Vaccine. 2015;33 (34):4165–75. https://doi.org/10.1016/j.vaccine.2015.04.037
MacDonald, N. E. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161-4164. https://doi.org/10.1016/j.vaccine.2015.04.036
Malas, O., & Tolsá, M. D. (2021). Vaccination Fear Scale (VFS-6): Development and Initial Validation. Mediterranean Journal of Clinical Psychology, 9(2). https://doi.org/10.13129/2282-1619/mjcp-2971
Maniaci, G., La Cascia, C., Giammanco, A., Maria, C., Ferraro, L., Tripoli, G., ... & La Barbera, D. (2022). Latent burnout profiles in a sample of frontline healthcare professionals after the peak of the Italian COVID-19 pandemic. Mediterranean Journal of Clinical Psychology, 10(1). https://doi.org/10.13129/2282-1619/mjcp-3292
McDonald, R. (1999). Test Theory: A Unified Treatment (1st Edition). https://doi.org/10.4324/9781410601087
Meade, A. W., Johnson, E. C., & Braddy, P. W. (2008). Power and sensitivity of alternative fit indices in tests of measurement invariance. Journal of applied psychology, 93(3), 568. https://doi.org/10.1037/0021-9010.93.3.568
Mellers, B.A., & McGraw, A.P. (2001). Anticipated emotions as guides to choice. Current directions in psychological science, 10(6), 210-214. https://psycnet.apa.org/doi/10.1111/1467-8721.00151
Moroianu, L. A., Moroianu, M., Toma, A., Barbu, R. E., Ardeleanu, V., & Nitoi, L. C. (2021). Psychopathology in patients diagnosed with SARS COV 2: A brief report. Mediterranean Journal of Clinical Psychology, 9(1). https://doi.org/10.6092/2282-1619/mjcp-2982
Nunnally, J. C., & Bernstein, I. H. (1994). Validity. Psychometric theory, 3(1), 99-132.
Ornell, F., Schuch, J. B., Sordi, A. O., & Kessler, F. H. P. (2020). “Pandemic fear” and COVID-19: Mental health burden and strategies. Brazilian Journal of Psychiatry, 42(3), 232–235. https://doi.org/10.1590/1516-4446-2020-0008
OWID (2022, February). Shared of people vaccinated against Covid 19. Recovered the 9th of February 2022 from https://ourworldindata.org/covid-vaccinations?country=OWID_WRL
OWID. (2022, February). Número acumulado de casos de coronavirus en el mundo desde el 22 de enero de 2020 hasta el 6 de febrero de 2022. In Statista. Recovered the 09th of February 2022 from https://es-statista-com.recursos.uloyola.es/estadisticas/1104227/numero-acumulado-de-casos-de-coronavirus-covid-19-en-el-mundo-enero-marzo/
Pakpour, A.H., & Griffiths, M.D. (2020). The fear of COVID-19 and its role in preventive behaviors. Journal of Concurrent Disorders, 2(1), 58-63. http://irep.ntu.ac.uk/id/eprint/39561/
Rahnea-Nita, G., Badiu, D. C., Popescu, C. G., Grigorean, V. T., Serban, D., Smarandache, C. G., ... & Stoian, A. R. (2021). The impact of Coronavirus disease 2019 pandemic on the treatment of cancer patients: the first steps in this fight. Mediterranean Journal of Clinical Psychology, 9(2). https://doi.org/10.13129/2282-1619/mjcp-3011
Ranieri, J., Guerra, F., Cilli, E., Caiazza, I., Gentili, N., Ripani, B., ... & Di Giacomo, D. (2021). Buffering effect of e-learning on Generation Z undergraduate students: A cross-sectional study during the second COVID-19 lockdown in Italy. Mediterranean Journal of Clinical Psychology, 9(2). https://doi.org/10.13129/2282-1619/mjcp-3051
Rief W. Fear of adverse effects and COVID-19 vaccine hesitancy: recommendations of the treatment expectation expert group. JAMA Health Forum. 2021;2(4):e210804.
https://doi.org/10.1001/jamahealthforum.2021.0804
Rollè, L., Trombetta, T., Calabrese, C., Vismara, L., & Sechi, C. (2022). Adult Attachment, Loneliness, Covid-19 Risk Perception and Perceived Stress During Covid-19 Pandemic. Mediterranean Journal of Clinical Psychology, 10(1). https://doi.org/10.13129/2282-1619/mjcp-3286
Robison, S., & Skiles, M. P. (2008, March). Development of a Measure of Vaccine Hesitancy. In The 42nd National Immunization Conference.
Robotham, D., Satkunanathan, S., Doughty, L., & Wykes, T. (2016). Do we still have a digital divide in mental health? A five-year survey follow-up. Journal of medical Internet research, 18(11), e6511. https://doi.org/10.2196/jmir.6511
Rodriguez VJ, Alcaide ML, Salazar AS, Montgomerie EK, Maddalon MJ, and Jones DL. Psychometric properties of a vaccine hesitancy scale adapted for COVID-19 vaccination among people with HIV. AIDS Behav. 2021; 1–6. https://doi.org/10.1007/s10461-021-03350-5
Saied, S. M., Saied, E. M., Kabbash, I. A., & Abdo, S. A. E. F. (2021). Vaccine hesitancy: Beliefs and barriers associated with COVID‐19 vaccination among Egyptian medical students. Journal of medical virology, 93(7), 4280-4291. https://doi.org/10.1002/jmv.26910
Settineri, S., & Merlo, E. M. (2020). Fear of contamination. Mediterranean Journal of Clinical Psychology, 8(1). https://doi.org/10.6092/2282-1619/mjcp-2424
Sha, M., & Immerwahr, S. (2018). Survey translation: Why and how should researchers and managers be engaged? Survey Practice, 11, 1–10. https://doi.org/10.29115/SP-2018-0016
Sotiriadis, A., Dagklis, T., Siamanta, V., Chatzigeorgiou, K., & Agorastos, T. (2012). Increasing fear of adverse effects drops intention to vaccinate after the introduction of prophylactic HPV vaccine. Archives of Gynecology and Obstetrics, 285(6), 1719-1724. https://doi.org/10.1007/s00404-011-2208-z
Statista Research Department. (2021, September). Internet usage in Italy - statistics & facts. Recovered the 09th of March 2022 from https://www.statista.com/topics/4217/internet-usage-in-italy/#dossierKeyfigures
Tahir, A. I., Ramadhan, D. S., Taha, A. A., Abdullah, R. Y., Karim, S. K., Ahmed, A. K., & Ahmed, S. F. (2021). Public fear of COVID-19 vaccines in Iraqi Kurdistan region: a cross-sectional study. Middle East Current Psychiatry, 28(1), 1-8. https://doi.org/10.1186/s43045-021-00126-4
Tucker, L. R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38(1), 1-10. https://doi.org/10.1007/BF02291170
Vandenberg, R. J., & Lance, C. E. (2000). A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational research methods, 3(1), 4-70. https://doi.org/10.1177/2F109442810031002
Vlaeyen, J. W., Crombez, G., & Linton, S. J. (2016). The fear-avoidance model of pain. Pain, 157(8), 1588-1589. https://doi.org/10.1097/j.pain.0000000000000574
Watkins, M. W. (2017). The reliability of multidimensional neuropsychological measures: From alpha to omega. The Clinical Neuropsychologist, 31(6-7), 1113-1126. https://doi.org/10.1080/13854046.2017.1317364
WHO (2019). Ten threats to global health in 2019. Geneva, Switz: World Health Organization; Available from: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 [Accessed 2022 Feb]
DOI: https://doi.org/10.13129/2282-1619/mjcp-3404
Refbacks
- There are currently no refbacks.