Parental Vaccine Hesitancy, Trust in Physicians, and Future Vaccination Intentions: A PACV Cross-Sectional Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

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Comments for author File: Comments.pdf

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This Is an interesting manuscript showing important results of a study on vaccine acceptance/hesitance. However I have a couple of questione and comments. Firstly, i would like to know whether there Is any information on the number of individuals who refused to participate at the study and on their main characteristics. Second, the difference in the scope and use of variables in the uni/multivariate analysis and the uni/bivariate analysis should be better explained in both methods and results sections.

Comments on the Quality of English Language

English editing Is ok

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The authors, who recently published a qualitative study on the reasons that induce parents to vaccinate or not to vaccinate their children, have carried out a quantitative study on this topic.

1. Generally, acronyms are not allowed in the title.
2. Abstract: The description of the statistical methods used (“Analyses included descriptive statistics, univariate and multivariable logistic regression, and non-parametric tests/correlations to explore bivariate associations between trust and vaccine beliefs”) is unnecessary and can be omitted.
3. Some keywords are already present in the title. Since keywords are used to classify the article, repeating a word that's already in the title is pointless.
4. The authors state already in the first sentence of the abstract that "trust in healthcare professionals strongly influences [Parents' vaccine hesitancy]”. In support of this statement they report in reference 7 a systematic literature review concluded in August 2016. If this fact was already known ten years ago, what is the interest of the current study?
5. The reasons and objectives of this study are not clearly stated. In the final part of the Introduction the authors state that “the present study systematically examined socio-demographic predictors of parents' pro- and anti-vaccination behaviors and the associations between these factors and their intentions regarding future childhood vaccinations.” The authors should emphasize, however, that a cross-sectional study cannot infer causality. Consequently, the term "predictors" is misused. A cross-sectional study can at best collect anamnestic data on previous experiences. Even future behavior is entirely hypothetical and untested.
6. The PACV (Parent Attitudes About Childhood Vaccines) questionnaire is a 15-item research instrument designed to assess parents' attitudes toward childhood vaccines. Responses are scored on a scale ranging from 0 to 100, with scores above 50 indicating parental vaccine hesitation, while scores below 50 indicate non-hesitant parents. The questionnaire focuses on three domains: "Behavior," "Safety and Effectiveness," and "General Attitudes." The authors used a shortened version of this questionnaire. It would appear, however, that they did not work on the internationally known 15-question version, but on a 28-question version. They did not indicate the criteria used to reduce the number of questions. Furthermore, they did not demonstrate that, despite the reduction, the questionnaire retained acceptable psychometric characteristics. They will need to provide reliability data for this study and perform a principal components analysis to verify that the scores obtained belong to a unidimensional or tridimensional instrument. Furthermore, they must demonstrate that the 50-point cut-off, which refers to the original 15-question version, is also valid in the transformed questionnaire.
7. In describing the sample, the authors reported some characteristics such as age, number of family members and education, but they did not collect or process variables that could influence behavior, such as being married or income. The fact that the sample is made up almost exclusively of women raises the question of the existence of a paternal figure
8. In the results analysis, approximately on line 200, the authors analyze the scores of individual questions using a 0-10 scale. This is the first time readers have been informed of the existence of a 0-10 scale. This procedure is incorrect. The "Methods" section is intended to inform readers of the tools used, how the measurements are made, and how the scores will be used. Subsequently, the authors perform other transformations of the question scores, for example, Q14 is transformed into a dichotomous score. This too must be explained first, in the methods.
9. The data analysis methods are not linear. To report the results of a single questionnaire, the authors require six tables and three figures. They tend to fragment the data, adapting them to their hypotheses, rather than designing an experiment and observing the results. This procedure is not scientifically sound and should not be encouraged.

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have provided the requested clarifications