Assessing vaccine literacy and exploring its association with vaccine hesitancy: A validation of the vaccine literacy scale in China

[Health literacy and health behaviour-insights into a developing field of research and action for public health]

The research and action field of health literacy and health behaviour is increasingly differentiating. General health literacy is established and focuses on population-based studies. Specific health literacy for health behaviour offers topic-related starting points for interventions and public health strategies.There are various concepts, definitions and measurement instruments for general health literacy and specific health literacy in the areas of nutrition and physical activity. These differ in terms of the levels of action and areas of application of health literacy.Most studies show a positive association between health literacy and various health behaviours. Higher health literacy is more often associated with improved health-promoting behaviour. This applies to both general as well as specific health literacy regarding nutrition and exercise (physical activity). Some studies found no correlation for certain behaviours, while others only found correlations for certain groups, which may be due to the different measuring instruments and research contexts. This points to the importance of always considering the interaction between behaviour and circumstances in order to improve the fit between the individual and the everyday demands of dealing with health information.The behavioural and cultural insights (BCI) approach can provide insights into how to promote health literacy with regard to various health behaviours, individual barriers and facilitators that arise from life circumstances and conditions, and that take social practice into account. BCI and health literacy complement each other and have the potential to make strategies for improving health behaviour more effective and targeted.

Association between adults' vaccine literacy and their intention to recommend older family members for influenza vaccine

OBJECTIVE

Seasonal influenza vaccine is effective to reduce the risk of hospitalization and death in vulnerable older persons, but the coverage of influenza vaccine remains low in these population in China. This study thus aimed to investigate how adults' vaccine literacy affects their intention to recommend influenza vaccination to older family members in China.

METHODS

A cross-sectional survey was performed in China during October 7 to 16, 2023 through a web-based questionnaire. The participants' influenza vaccine literacy (IVL) was quantitatively assessed using an adapted scale, and bivariate analyses were undertaken to evaluate variable associations among the participants. Multivariable logistic regression and mediation effect model were used to analyze the target factors.

RESULTS

3027 valid respondents were included in our survey, 89.6 % of them were willing to recommend their older family members for influenza vaccine. Participants with higher IVL scores were more likely to recommend influenza vaccination (OR = 1.553, P < 0.01). In addition, participants who were living with their older family members, received annual influenza vaccinations, or whose older family members had infected influenza within the past six months, were also more likely to do so. Of note, despite of a higher level of vaccine literacy, healthcare works were more reluctant to recommend vaccination for older family members (OR = 0.496, P < 0.05).

CONCLUSION

High level of vaccine literacy is positively correlated to adults' intention to recommend influenza vaccination for older family members. We should take educational interventions of vaccine literacy among adults, and thus promoting influenza vaccination coverage among the older population.

Validation of an Arabic tool for assessing vaccination literacy: A factor and Rasch analysis

Vaccine literacy is a significant part of health literacy. Although several tools have been developed to assess vaccine literacy, such tools are lacking in Arabic. Validating an Arabic version of a tool that evaluates vaccine literacy is critically important, as it would aid in understanding the decision-making process regarding vaccinations among individuals in Arabic-speaking countries. Therefore, the current study aimed to validate an Arabic tool for assessing vaccine literacy in adult vaccination. An online questionnaire was distributed to people throughout Jordan by sharing the questionnaire link via various social media platforms. The reliability and validity of the Arabic version of the vaccination literacy assessment tool (HLVa-Ar) were evaluated using factor analysis and Rasch analyses. The two-factor model generated fit indices were in the acceptable range (χ2/df = 2.48, RMSEA = 0.06, SRMR = 0.05, GFI = 0.94, CFI = 0.97, and TLI = 0.96). Cronbach's alpha for functional Vaccination literacy (VL) and interactive/critical VL were 0.91 and 0.88 respectively. The Rasch analysis indicated acceptable infit/outfit values and high item and person separation reliabilities for the two factors (0.852, 0.868, and 0.771, 0.818 respectively). Overall, the 420 participants displayed a good understanding of the general benefits and importance of vaccination. The HLVa-Ar was shown to be a valid and reliable tool that portrayed a wide range of vaccination literacy levels in the studied sample and provided valuable insights into participants' vaccination knowledge. The findings emphasize the need for developing targeted strategies to improve vaccination literacy and increase vaccination rates.

Bibliometric and visual analyses of vaccine literacy research from 1982 to 2023

Vaccine literacy (VL) is an important part of health literacy (HL), which is of great significance in reducing vaccine hesitancy and improving vaccine coverage rate. We aimed to perform a bibliometric analysis of VL research conducted from 1982 to 2023 to evaluate its current status and prospects. All relevant publications were retrieved from the Web of Science Core Collection database and the Scopus database. The Bibliometrix R-package and VOSviewer software were used to analyze the publication outputs, countries, organizations, authors, journals, cited publications, and keywords. In total, 1,612 publications were included. The number of articles published on VL generally showed an increasing trend. The United States was in a leading position among all countries and had the closest connections with other countries and organizations. Its in-depth study of vaccine hesitancy provided a good foundation for VL research. Harvard University was the most productive organization. Bonaccorsi G was the most productive and cited author. VACCINES was the most productive journal. Research topics primarily revolved around vaccination, HL, vaccine hesitancy, and COVID-19 vaccine. In conclusion, the current research on the conceptual connotation and influencing factors of VL is insufficiently deep and should be further improved in the future to distinguish it from HL in a deeper manner. More tools for measuring VL need to be developed, such as those applicable to different populations and vaccines. The more complex relationship between VL, vaccine hesitancy and vaccination needs to be further explored. Gender differences deserve further investigation.

Chronic impacts of natural infrastructure on the physical and psychological health of university students during and after COVID-19: a case study of Chengdu, China

Introduction

The COVID-19 pandemic has underscored the health benefits of green spaces, yet research on how specific elements of natural infrastructure affect well-being during the pandemic has been limited.

Methods

This study, conducted at Sichuan Agricultural University with 300 students in 2022, investigated how urban natural infrastructure impacts physical and psychological well-being during the pandemic. Different aspects of natural infrastructure, such as thermal comfort, air quality (negative ion concentration), and noise and light levels, varied in their positive effects on students' health.

Results

The findings revealed that 65.6% of university students felt reduced stress when engaging with outdoor spaces, and 72.8% of them renewed recognized the therapeutic value of nature.

Discussion

The study emphasizes the importance of incorporating natural elements into urban planning to enhance outdoor activity and well-being, especially in post-pandemic settings. Recommendations are provided for future urban design to address the therapeutic needs of specific populations.

Evaluating a WeChat-Based Intervention to Enhance Influenza Vaccination Knowledge, Attitude, and Behavior Among Chinese University Students Residing in the United Kingdom: Controlled, Quasi-Experimental, Mixed Methods Study

BACKGROUND

University students, who often live in close quarters and engage in frequent social interaction, face a heightened risk of influenza morbidity. Still, vaccination rates among this group, particularly Chinese students, remain consistently low due to limited awareness and insufficient access to vaccinations.

OBJECTIVE

This study examines the effectiveness of a cocreated WeChat-based intervention that targets mainland Chinese university students in the United Kingdom, aiming to improve their knowledge, attitude, and behavior (KAB) toward seasonal influenza vaccination.

METHODS

A quasi-experimental mixed methods design was used, incorporating an intervention and comparison group, with baseline and follow-up self-reported surveys. The study was conducted from December 19, 2022, to January 16, 2023. The primary outcome is the KAB score, which was measured before and after the intervention phases. System-recorded data and user feedback were included in the analysis as secondary outcomes. A series of hypothesis testing methods were applied to test the primary outcomes, and path analysis was used to explore the relationships.

RESULTS

Our study included 596 students, of which 303 (50.8%) were in the intervention group and 293 (49.2%) were in the control group. The intervention group showed significant improvements in knowledge, attitude, and intended behavior scores over time, whereas the control group had only a slight increase in intended behavior scores. When comparing changes between the 2 groups, the intervention group displayed significant differences in knowledge and attitude scores compared to the control group, while intended behavior scores did not significantly differ. After the intervention, the actual vaccination rate was slightly higher in the intervention group (63/303, 20.8%) compared to the control group (54/293, 18.4%). Path analysis found that the intervention had a significant direct impact on knowledge but not on attitudes; knowledge strongly influenced attitudes, and both knowledge and attitudes significantly influenced intended behavior; and there was a strong correlation between intended and actual behavior. In the intervention group, participants expressed a high level of satisfaction and positive review of the content and its use.

CONCLUSIONS

This study demonstrates how a WeChat intervention effectively improves KAB related to seasonal influenza vaccination among Chinese students, highlighting the potential of social media interventions to drive vaccination behavior change. It contributes to the broader research on digital health intervention effectiveness and lays the groundwork for tailoring similar interventions to different health contexts and populations.

Vaccine literacy, vaccination intention, and their correlation among adults in Mainland China: a cross-sectional study

BACKGROUND

Vaccination is one of the most economic and effective strategies for preventing infectious diseases. However, public intention to be vaccinated is, to a certain degree, influenced by issues related to vaccine hesitancy, anti-vaccine movement, and public concerns about safety and adverse effects. Vaccine literacy is considered as a positive factor in improving vaccination intention, however, the correlation between vaccine literacy and vaccination intention has not been thoroughly investigated in mainland China. This study aims to (1) explore the correlation between vaccine literacy and vaccination intention among adults in mainland China; (2) investigate whether participants could seek out vaccine information on their own initiative and whether they knew basic information of common vaccines.

METHODS

An online cross-sectional survey was conducted on 614 adult participants from 27 May to 8 June 2023 by a convenience sampling. Data were collected by using the questionnaire of demographic characteristics, vaccine literacy, vaccination intention, initiative of seeking out vaccine information, and basic vaccine quiz about common vaccines. Data were analyzed by using IBM SPSS version 24.0 at a significance level of 0.05.

RESULTS

The mean scores of functional, and interactive-critical vaccine literacy were 2.97 ± 0.70 and 2.73 ± 0.66; the vaccination intentions of influenza, hepatitis B, COVID-19 and HPV were 58.5%, 80.0%, 71.3% and 62.9% respectively; interactive-critical vaccine literacy was significantly and positively associated with vaccination intention. The results also showed: 71.4% of the participants could seek out vaccine information on their own initiative, however, a certain proportion of the participants merely knew vaccine names and did not know basic information of common vaccines, especially influenza vaccine and hepatitis B vaccine.

CONCLUSIONS

There is still room for improvement in vaccine literacy, vaccination intention of influenza and HPV vaccines, and basic vaccine information. Based on the significantly positive correlation between interactive-critical vaccine literacy and vaccination intention, it is advisable to harness vaccine literacy to boost vaccination intention by communicating and learning basic information of common vaccines.

The relationship between influenza vaccine hesitancy and vaccine literacy among youth and adults in China

Objectives

The present study aimed to assess influenza vaccine hesitancy and vaccine literacy levels among youth and adults in China, as well as the association between them.

Methods

An online cross-sectional survey was conducted in Mainland China. Participants' total vaccine literacy and three sub-dimension vaccine literacy (knowledge literacy, competence literacy, and decision-making literacy) were assessed by a validated vaccine literacy scale. Having received influenza vaccination in the past three years or intending to accept it in next influenza season indicates less influenza vaccine hesitancy.

Results

Among 997 participants, a sub-optimal vaccine literacy was observed, with a mean score of 66.83 ± 10.27. Regression models 1-4 revealed that participants with middle (aOR: 1.431, P=0.039, 95% CI: 1.018~2.010) or high (aOR: 1.651, P=0.006, 95% CI: 1.157~2.354) total vaccine literacy, as well as those with high competence literacy (aOR: 1.533, P=0.017, 95% CI: 1.079~2.180), or high decision-making literacy (aOR: 1.822, P=0.001, 95% CI: 1.261~2.632) were more likely to have been vaccinated against influenza at least once in past three years. However, those with a high knowledge literacy were associated with a lower influenza vaccine rate (aOR: 0.676, P=0.046, 95% CI: 0.460~0.994). Regression models 5-8 revealed that participants with middle (aOR: 1.661, P=0.008, 95% CI: 1.142~2.414) or high total vaccine literacy (aOR: 2.645, P=0.000, 95% CI: 1.774~3.942), as well as those with middle (aOR: 1.703, P=0.005, 95% CI: 1.177~2.464) or high competence literacy (aOR: 2.346, P=0.000, 95% CI: 1.159~3.461), or high decision-making literacy (aOR: 2.294, P=0.000, 95% CI: 1.531~3.436) were more likely to express the willingness to receive the influenza vaccine in the next influenza season.

Conclusion

The participants' influenza vaccine hesitancy was negatively associated with their total vaccine literacy levels and two of the three sub-dimensions: competence literacy and decision-making literacy. Knowledge literacy suggested a positive or no relationship with influenza vaccine hesitancy.

Perspectives in the Development of Tools to Assess Vaccine Literacy

Vaccine literacy (VL) is the ability to find, understand, and evaluate vaccination-related information to make appropriate decisions about immunization. The tools developed so far for its evaluation have produced consistent results. However, some dimensions may be underestimated due to the complexity of factors influencing VL. Moreover, the heterogeneity of methods used in studies employing these tools hinders a comprehensive understanding of its role even more. To overcome these limitations, a path has been sought to propose new instruments. This has necessitated updating earlier literature reviews on VL and related tools, exploring its relationship with vaccine hesitancy (VH), and examining associated variables like beliefs, attitudes, and behaviors towards immunization. Based on the current literature, and supported by the re-analysis of a dataset from an earlier study, we propose a theoretical framework to serve as the foundation for creating future assessment tools. These instruments should not only evaluate the psychological factors underlying the motivational aspect of VL, but also encompass knowledge and competencies. The positioning of VL in the framework at the intersection between sociodemographic antecedents and attitudes, leading to behaviors and outcomes, explains why and how VL can directly or indirectly influence vaccination decisions by countering VH and operating at personal, as well as at organizational and community levels.

Comparing factors influencing seasonal influenza vaccine acceptance and intentions among Chinese university students residing in China and UK: A cross-sectional study

University students, who face an elevated risk of influenza due to close living quarters and frequent social interactions, often exhibit low vaccine uptake rates. This issue is particularly pronounced among Chinese students, who encounter unique barriers related to awareness and access, emphasizing the need for heightened attention to this problem within this demographic. This cross-sectional study conducted in May-June 2022 involved 1,006 participants (404 in the UK, 602 in Mainland China) and aimed to explore and compare the factors influencing influenza vaccine acceptance and intentions between Chinese university students residing in the UK (C-UK) and Mainland China (C-M). The study employed a self-administered questionnaire based on the Theoretical Domains Framework and Capability Opportunity Motivation-Behavior model. Results revealed that approximately 46.8% of C-UK students received the influenza vaccine in the past year, compared to 32.9% of C-M students. More than half in both groups (C-UK: 54.5%, C-M: 58.1%) had no plans for vaccination in the upcoming year. Knowledge, belief about consequences, and reinforcement significantly influenced previous vaccine acceptance and intention in both student groups. Barriers to vaccination behavior included insufficient knowledge about the influenza vaccine and its accessibility and the distance to the vaccine center. Enablers included the vaccination behavior of individuals within their social circles, motivation to protect others, and concerns regarding difficulties in accessing medical resources during the COVID-19 pandemic. The findings of this study offer valuable insights for evidence-based intervention design, providing evidence for healthcare professionals, policymakers, and educators working to enhance vaccination rates within this specific demographic.