ArticleVaccines2025
Discriminative Cut-Offs, Concurrent Criterion Validity, and Test-Retest Reliability of the Oxford Vaccine Hesitancy Scale.
Article in Vaccines, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundValidated instruments can be used to quantify vaccine hesitancy, but few provide transportable operational cut-offs or temporal stability metrics. We evaluated the Oxford Vaccine Hesitancy Scale (OVHS) to quantify discrimination for the self-reported historical COVID-19 vaccine refusal, derive and validate a single operational cut-off across populations, and assess the test-retest reliability.
methodsFive datasets (including one from a repeat administration) comprising 2451 assessments from 1989 demographically representative UK and US respondents were analyzed without pooling. Receiver operating characteristic (ROC) curves with 10,000 bootstrap replications (bias-corrected and accelerated and percentile Cis) were used to quantify discrimination. A Youden's J near-optimal plateau algorithm constrained by a cross-dataset specificity floor (≥0.75) was used to select a transportable cut-off. A prevalence-agnostic aggregate Index of Union (Iuagg) provided secondary confirmation of this cut-off. Cut-off behaviour was visualized with a multi-sample two-graph ROC plot. The six-week test-retest reliability on a UK sample used a two-way mixed-effects, absolute-agreement ICC(A,1).
resultsAUCs ranged 0.760-0.971 across datasets (derivation AUC: 0.960). The Youden plateau spanned scores 34-38; applying the specificity floor yielded an operational cut-off OVHS ≥ 35, which was confirmed by the Iuagg. At ≥35, sensitivity/specificity were 0.73-0.95/0.63-0.87 across samples; negative predictive value exceeded 0.90 in all cohorts. The test-retest reliability was good to excellent, with the OVHS total ICC(A,1) = 0.884 (95% CI 0.863-0.903); subscales ranged from 0.649 to 0.901 and the average-measure ICC(A,2) = 0.939.
conclusionsThe OVHS demonstrates good-to-excellent discrimination for historical COVID-19 vaccine refusal and strong temporal stability. We found a single, transparent, and transportable operational cut-off (≥35). Our cut-off derivation framework is scale- and endpoint-agnostic and may generalize to other hesitancy instruments and decision cut-offs more broadly.
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