Public Attitude Towards COVID-19 Vaccination: Validation of COVID-Vaccination Attitude Scale (C-VAS).

Introduction: The fear of emergence of newer strains of SARS-CoV-2 as well as concerns of waning of protection after doses of COVID-19 vaccine has created a degree of global uncertainty surrounding the pandemic. Some of the emerging strains of SARS-CoV-2 have shown potential for causing serious disease and death, a threat that has been ameliorated by ensuring the vaccine coverage in populations. Still, the vaccine coverage remains unsatisfactory in certain populations. Hence, understanding and working on the factors which affect acceptance of the vaccine amongst the public can be considered a priority for public health as much as ensuring availability of the vaccines. Objective: This research work aims to build and validate a scale to assess the public attitude towards COVID vaccination. The proposed scale has been named as COVID Vaccination Attitude Scale (C-VAS). Materials and Methods: A three-stage process was used to develop the C-VAS which includes (1) item generation (deductive and inductive approach); (2) item-refinement (pre-testing and pilot testing, exploratory factor analysis (EFA); and (3) scale validation (confirmatory factor analysis, CFA). The sample size used for this research was 840. In order to overcome the issue of common method bias, the data was collected in two phases. The sample n1 (411) was used for EFA and the sample n2 (429) was employed for undertaking CFA. Common method bias was assessed to check if variations in responses are caused by the instrument instead of the actual dispositions of the respondents. Items of the scale were taken by reviewing the extant literature about vaccination, from the relevant established theories such as health belief model and by interviewing with domain experts. The content validity of the scale was determined. Results: EFA extracted five factors, labelled as "Perceived Benefits", "Perceived Barriers", "Perceived Severity", "Health Motivation" and "Perceived Risk". To further validate the factor-item structure CFA was performed. Conclusion: The measurement model was assessed by applying CFA to examine the reliability, accuracy and validity of the scale. Development of this scale can help in understanding factors that affect vaccine acceptability behavior. This can be used in promoting COVID vaccine coverage in countries and societies which still have low vaccination rates especially due to lack of acceptance of the vaccine. This scale also has the potential to understand public behavior in relation to similar future outbreaks and the acceptance of the mitigatory vaccines.