Peer-reviewed article
Instruments for measuring parents' vaccine hesitancy towards their children based on the COSMIN guidelines: A systematic review.
Ting Cao, Bin Chen, Shi Chen, Huanle Liu, Yuhang Li et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review evaluated 31 different instruments used to measure parental vaccine hesitancy towards their children, assessing their measurement quality against established international standards. The researchers found that three instruments—the Malay version of the modified vaccine hesitancy scale, the Vietnamese parent attitudes about childhood vaccines survey, and the parental attitude scale towards vaccination—were most reliable for assessing vaccine hesitancy. The review aims to help researchers and health programmes choose the best tools for measuring and understanding parental concerns about vaccination. This work is important because parental vaccine hesitancy reduces immunization coverage and contributes to preventable disease outbreaks and child deaths.
Key points
- Forty studies evaluating 31 vaccine hesitancy assessment instruments were systematically reviewed using COSMIN guidelines
- Three instruments received the highest recommendation (Category A): the Malay version of the modified vaccine hesitancy scale, the Vietnamese version of the parent attitudes about childhood vaccines survey, and the parental attitude scale towards vaccination
- Parental vaccine hesitancy undermines immunization gains and leads to resurgent disease outbreaks and increased child mortality
- Future research should comprehensively assess measurement properties of instruments, especially exploring measurement error and responsiveness
- The review provides an evidence-based basis for selecting appropriate instruments for measuring vaccine hesitancy in both research and clinical settings
Limitations
This is a systematic review of measurement instruments rather than a study of vaccine hesitancy in a specific population; it does not evaluate the effectiveness of interventions to reduce vaccine hesitancy or provide data on actual vaccine coverage rates in any particular country or region.
Abstract
BACKGROUND: Parental vaccine hesitancy undermines immunization gains, leading to resurgent outbreaks and increased child mortality. Reliable assessment instruments are urgently needed to guide effective interventions and improve coverage. Despite multiple vaccine hesitancy assessment instruments, no systematic reviews have evaluated the measurement properties of these instruments against established methodological standards, limiting evidence-based selection. OBJECTIVE: To systematically evaluate the methodological quality and measurement properties of vaccine hesitancy assessment instruments for parents of 0-18 children, providing an evidence-based basis for selecting appropriate instruments. DESIGN: Measurement properties are systematically reviewed according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. METHODS: Six electronic databases were systematically searched from inception until July 15, 2025. Methodological quality was assessed using the COSMIN Risk of Bias Checklist and measurement properties were synthesized according to the COSMIN criteria. A modified Grading, Recommendations, Assessment, Development, and Evaluation system was used to assess the certainty of evidence. RESULTS: Forty studies evaluating 31 vaccine hesitancy assessment instruments were included. Based on COSMIN evidence grading, the Malay version of the modified vaccine hesitancy scale (MVHS-M), the Vietnamese version of the parent attitudes about childhood vaccines survey (PACV-Viet), and the parental attitude scale towards vaccination (PASV) received Category A recommendation. The general vaccine hesitancy scale (GVHS), vaccination attitudes examination (VAX), vaccine acceptance instrument (VAI), and vaccine barriers assessment tool (VBAT) received Category C recommendation, while others were Category B recommendation. CONCLUSIONS: This systematic review identified MVHS-M, PACV-Viet, and PASV as effective tools for assessing vaccine hesitancy in parents, suitable for both research and clinical use. Future research should comprehensively assess their measurement properties, especially exploring measurement error and responsiveness. REGISTRATION: A protocol was registered on the PROSPERO (CRD420251070194).