Publication: Development and validation of knowledge and attitude on covid-19 infection and vaccination toward pregnancy questionnaire and validation of adult vaccine hesitancy scale (AVHS) among pregnant women.
Date
2024-04
Authors
Mood, Nur Azreen Che
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Pregnancy is one of the risks for severe COVID-19 infection and COVID-19 vaccination hesitancy among pregnant women is still an issue. This study aims to develop and validate the knowledge and attitude (pKAC19) to examine COVID-19 infection and vaccination among pregnant women. It also validates the Pregnancy Vaccine Hesitancy Scale (pVHS) to assess vaccine hesitancy among pregnant women in Malaysia. First phase involved the development of new Knowledge and Attitude (pKAC19) and the adaptation of the aVHS, second phase includes a cross-sectional study for internal validation of the new Knowledge and Attitude (pKAC19) to assess the knowledge and attitude on COVID-19 infection and vaccination toward pregnancy and vaccine hesitancy among pregnant women using EFA. Meanwhile, CFA data collection; a cross-sectional study was conducted to confirm Knowledge and Attitude (pKAC19) validation. During phase 1, face and content validity were performed; meanwhile, during phase 2, EFA and CFA were performed in two locations with larger sample sizes. Six expert panels were involved in content validity after the items for knowledge and attitude and COVID-19 vaccine hesitancy were evaluated. About ten pregnant women were involved in the face validity followed by reliability testing: Exploratory Factor Analysis (EFA) involving 200 pregnant women attending Obstetrics and Gynaecology Clinic, Hospital Universiti Sains Malaysia, Kelantan. Confirmatory Factor Analysis (CFA) involved 300 pregnant women from Obstetrics and Gynaecology clinic, Hospital Raja Perempuan Zainab II (HRPZ), Kelantan. During Phase 1: Content Validity, the item-level content validity index (I-CVI) is 0.96 for knowledge and 0.99 for attitude while 1.00 for COVID-19 vaccine hesitancy, demonstrating good relevance of the 20 items to assess knowledge and the 22 items used to assess attitude while 10 items used to assess vaccine hesitancy. Phase 1: Face Validity index (I-FVI) obtained is 0.99 for knowledge, 0.98 for attitude and 0.99 for COVID-19 vaccine hesitancy questionnaires, indicating that the items were clear and comprehensible. Phase 2: EFA was conducted, and all items had good factor loadings; two items from COVID-19 vaccine hesitancy domain were removed due to low factor loadings where the cut-off point for factor loadings should be more than 0.3 (Samuels, 2017). Phase 2: CFA was performed afterwards with the remaining items in the questionnaire. The proposed model fit in all five model indices with (χ2 = 1079.584 (499) p <0.001; RMSEA = 0.062; CFI = 0.917; TLI =0.857) with factor loading ranged from 0.22 to 0.92. The final remaining items produced a newly combined questionnaire with 3 domains which are knowledge (16 items), attitude (10 items) and COVID-19 vaccine hesitancy (8 items). The Cronbach alpha scores were 0.66, 0.81 and 0.94 for knowledge, attitude, and COVID-19 vaccine hesitancy, respectively. The newly combined Malay version questionnaire which included the newly developed Knowledge and Attitude (pKAC19) and adapted version of Adult Vaccine Hesitancy Scale (aVHS) which turned into Pregnancy Vaccine Hesitancy Scale (pVHS) is found valid and reliable to test the knowledge and attitude towards COVID-19 infection and vaccination and COVID-19 vaccine hesitancy among pregnant women in Malaysia.
Description
Keywords
pregnancy