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Article

Validation of the Modified Japanese 7C Readiness Scale for Parental Intentions of Child COVID-19 Vaccination

by
Mikiko Tokiya
1,*,
Akiko Matsumoto
1,
Yutaro Furukawa
2,
Takaomi Kobayashi
2,
Takashi Nakano
3,
Yoshio Hirota
4 and
Megumi Hara
2
1
Department of Social and Environmental Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
2
Department of Preventive Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
3
Department of Pediatrics, Kawasaki Medical School, 577 Matsushima, Kurashiki 701-0192, Japan
4
Clinical Epidemiology Research Center, SOUSEIKAI Medical Group (Medical Co. LTA), 3-5-1 Kashiiteriha, Fukuoka 813-0017, Japan
*
Author to whom correspondence should be addressed.
Hygiene 2024, 4(4), 515-526; https://doi.org/10.3390/hygiene4040039
Submission received: 5 October 2024 / Revised: 22 November 2024 / Accepted: 29 November 2024 / Published: 2 December 2024
(This article belongs to the Section Health Promotion, Social and Behavioral Determinants)
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Abstract

Parental willingness is a prerequisite for childhood immunization. This study evaluated whether parental vaccination readiness and willingness, measured using the modified Japanese 7C Vaccination Readiness Scale, predicted vaccination behavior. In December 2021, 2 months before the approval of COVID-19 vaccines for children aged 5–11 years in Japan, 1190 parents of children in this age group were surveyed regarding their intention to vaccinate their children against COVID-19. The survey utilized an online version of the modified 7C Vaccination Readiness Scale, comprising seven components: Confidence, Complacency, Constraints, Calculation, Collective Responsibility, Compliance, and Conspiracy. The modified 7C components were analyzed for model fit and their association with parental intention using structural equation modeling. The scale demonstrated good model fit (goodness-of-fit index: 0.98), with high standardized factor loadings for parental readiness (factor loadings: 0.84). In January 2024, the same parents were surveyed about their children’s COVID-19 vaccination status (valid responses: 536). The relationship between the components of the modified 7C scale and actual vaccination behavior was examined. Parents with low readiness to vaccinate their children against COVID-19 exhibited a significantly higher non-vaccination rate. These findings suggest that the modified 7C scale could support the development of targeted interventions to improve childhood vaccination uptake.

1. Introduction

Childhood immunization is essential for protecting children from vaccine-preventable diseases [1,2,3]. As parents play a key role in the decision-making process, childhood immunization rates are influenced by parental intention, access to resources, and health-related behavior [4,5]. A psychometrically valid measurement scale can improve the understanding of parental vaccination readiness, thereby facilitating targeted interventions to enhance vaccination rates among children [6].
For adults, vaccination intention has been assessed using the 3C [7] and 5C [8] scales, which are psychological measures of vaccination readiness [9,10,11,12,13,14,15,16,17]. The 3C scale includes Confidence (trust in the safety and efficacy of vaccines, health services, and government), Complacency (tendency to ignore vaccines because of low perceived risk of infectious disease), and Constraints (structural or psychological barriers to vaccination in daily life). The 5C scale extends the 3C framework by adding Calculation (engagement in extensive information searching that indicates a deliberate comparison of the risks of infection and vaccination from which to make an informed decision) and Collective Responsibility (the tendency to consider the protection of others in the decision to vaccinate). During the COVID-19 pandemic, a new 7C Vaccination Readiness Scale (7C) was developed [6] by adding two components: Compliance (support for societal monitoring and sanctioning of people who are not vaccinated) and Conspiracy (conspiracy thinking and belief in fake news related to vaccination) to the 5C scale. The 7C Vaccination Readiness Scale has two characteristics: (1) it measures an individual’s readiness and willingness to be vaccinated rather than focusing on vaccine hesitancy and (2) it assesses seven psychological components relevant to vaccination readiness [6]. The 7C Vaccination Readiness Scale has been shown to reflect the vaccination intentions of adults [18,19,20]. However, vaccination readiness, willingness, and coverage vary depending on time, type of vaccine, and location [21,22,23,24,25,26,27,28], necessitating region-specific studies. Machida et al. [29] developed a Japanese version of the 7C for adults. However, until the end of 2021, it was unknown whether this scale could be adapted to assess parental readiness to vaccinate their children.
The Parent Attitudes about Childhood Vaccines (PACV) is another widely used and standardized questionnaire for evaluating parents’ attitudes and beliefs about childhood vaccination [30]. Initially developed in the United States [31,32,33], the PACV has been shown to be highly reliable, with high scores predictive of childhood vaccination status [33]. It has been validated in multiple languages, including Vietnamese [34], Malay [35], Spanish [36], and German [37]. However, as of 2021, no Japanese version of the PACV existed.
To address this gap, we partially modified the Japanese version of the 7C Vaccination Readiness Scale [29] in 2021 to create a parental version, which was administered to parents. In 2024, we re-interviewed the same parents to evaluate actual vaccination rates and validate the modified 7C scale. The purpose of this study was to determine whether parental vaccination readiness and willingness, as measured by the modified Japanese 7C Vaccination Readiness Scale, could predict vaccination behavior.

2. Materials and Methods

2.1. Survey Respondents and Data Collection

For the baseline survey, an online survey was conducted from December 20 to 22, 2021, through a web-survey company (Macromill, Inc., Tokyo, Japan), which maintains a research panel of approximately 1.2 million individuals [38]. Participation in the panel was voluntary, and respondents who completed the survey were rewarded with points that could be redeemed for cash-equivalent transactions at participating stores within the network. The sample size was calculated to include 1064 respondents, based on the following assumptions: 20% of the target population expressed interest in vaccinating their children and 30% of those interested ultimately vaccinated their children, an odds ratio of 1.8, α = 0.05 ÷ 50 items (0.001), and β = 0.20. Recruitment continued until the target number of participants was reached, with invitations sent via email and an app.
At the time of the survey, COVID-19 vaccines had not been approved for children aged 5–11 years in Japan. Vaccines were authorized only for individuals aged 12 years or older, and booster vaccinations for adults had not yet been introduced [39]. The follow-up survey was conducted from January 26 to 29, 2024, two years after the introduction of COVID-19 vaccines for children aged 5–11 years. Each participant had assigned a unique identification number, enabling the linkage of baseline and follow-up survey responses.

2.2. Measurement Methods (Baseline Survey)

Sociodemographic factors assessed in the baseline survey included sex, age, occupation, residential region, marital status (married or unmarried), presence of children aged under 11 years in the household, household income category (< JPY 4 million, ≥ JPY 4 million), educational attainment (high school, vocational school, or university), and concern about adverse events. Participants were also asked how many doses of the COVID-19 vaccine they had received and whether they had experienced any adverse events, such as fever, fatigue, headache, chills, vomiting, diarrhea, muscular pain, arthralgia, or anaphylactic shock.
Parental intention to vaccinate their children against COVID-19 was measured using the statement: “When a pediatric vaccine for COVID-19 becomes available, I will have my children vaccinated.” Responses were collected on a 5-point Likert scale with the options: strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree.
The Japanese version of the 7C Vaccination Readiness Scale was adapted for [6,29,40] parents by adding the terms “child” or “school” to four items—Complacency, Constraints, Calculation, and Collective Responsibility—as described by Geiger et al. [6] and Machida et al. [29] (Table 1). Items assessing Confidence, Compliance, and Conspiracy remained unchanged from the original Japanese version of Machida et al. [29]. The Japanese version of the 7C Scale was developed using the Translation and Cultural Adaptation Process for Patient Reported Outcomes Measures Guideline from the Professional Society for Health Economics and Outcomes Research (ISPOR) Task Force to ensure content validity and cultural adaptation [29]. The Japanese version of Machida et al. was completed through the following process: translation by a Japanese researcher fluent in English, back-translation by a native English speaker fluent in Japanese, multiple rounds of back-translation reviews, and cognitive debriefing with Japanese participants [29]. While the original 7C scale used a 7-point Likert scale, this study employed a 5-point Likert scale due to space limitations in the web-based survey. The scores were assigned as follows: strongly disagree = 1, disagree = 2, neither agree nor disagree = 3, agree = 4, and strongly agree = 5. Scores for Confidence, Complacency, Constraints, Collective Responsibility, and Compliance were assigned in ascending order, while scores for Calculation and Conspiracy were assigned in descending order, in line with the original scoring method [6]. Higher scores indicated greater vaccination readiness [6].

2.3. Follow-Up Survey

In the follow-up survey, parents were asked how many doses of the COVID-19 vaccine their children aged 5–11 years had received. The responses were recorded.

2.4. Statistical Analysis

Statistical analysis included 1190 parents of children aged 5–11 years. Parental characteristics at baseline were analyzed based on their intention to vaccinate their children against COVID-19. Chi-square, Kruskal–Wallis, and Fisher’s exact tests were used to identify characteristics associated with parental intention.
To evaluate the structural validity of the modified scale, confirmatory factor analysis was performed following the method described by Geiger et al. [6]. Model fit was deemed acceptable if the goodness-of-fit index (GFI) was ≥0.90, Bentler–Bonett Normed Fit Index (NFI) ≥ 0.90, root mean square error of approximation (RMSEA) < 0.08, and standardized root mean square residual (SRMR) < 0.11 [6,26,29,41].
The modified scale’s model fit and association with parental intention to vaccinate were assessed using structural equation modeling. Spearman correlation coefficients (ρ) were calculated to examine the relationship between parental intention and components of the modified scale. Criterion validity was assessed by calculating the percentage of children vaccinated, based on each component of the 7C scale. All analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA).

2.5. Ethical Considerations

This study was approved by the Ethics Committee of Saga University (approval number: R2–24; date of approval: 30 November 2020) and the Ethics Committee of Saga University (approval number: R5–28; date of approval: 27 December 2023). Respondents were informed that participation was voluntary and that their responses would remain confidential. Survey results would be published only after anonymized processing. Participants provided informed consent before answering the survey and were required to respond to all questions to prevent missing data. Responses were stored in a secure, password-protected database.

3. Results

3.1. Parental Attributes and Intention Regarding Vaccinating Their Children Against COVID-19

The most common response to the statement about parental intention to vaccinate their children before the approval of the COVID-19 vaccine was “neither agree nor disagree” (36.5%), indicating indecision among respondents, followed by “agree” (34.3%). Parents intending to vaccinate their children were typically older, less likely to report concerns about adverse events, and more likely to have received more than two doses of the COVID-19 vaccine themselves (Table 2).

3.2. Measurement Model and Criterion Validity for Parental Readiness to Vaccinate Their Children Against COVID-19

The modified scale g-factor model fit the data well for parental intention to vaccinate their children against COVID-19 (χ2[14]: 83.9, p < 0.001; GFI: 0.980; Bentler–Bonett NFI: 0.948; RMSEA: 0.067; SRMR: 0.040). In the confirmatory factor analysis, the factor saturation (ω) was 0.970, the Akaike information criterion (AIC) was 112 (Figure 1), and Cronbach’s alpha was 0.63.

3.3. Predictors of Parental Intention to Vaccinate Their Children Against COVID-19

The model fit of the modified scale to predict parental vaccination intentions was good (χ2[14]: 89.5, p < 0.001; GFI: 0.981; Bentler–Bonett NFI: 0.966; RMSEA: 0.057; SRMR: 0.035; ω: 0.969; and square of the multiple correlation coefficient: 0.70) (Figure 2).

3.4. Relationship Between Components of the Modified Scale and Parental Intention to Vaccinate Their Children Against COVID-19

The bivariate correlation between the components of the modified scale and parental intention is shown in Table 3. Calculation, Compliance, and Conspiracy were found to be less related to the intention to vaccinate than the other four components. In addition, the correlation coefficient for Calculation showed a negative value. Complacency and Constraints were highly correlated with parental intention to vaccinate their children (Table 3).

3.5. Predicted and Observed Vaccination Behavior

In January 2024, approximately 2 years after the initial survey had been conducted, a follow-up survey was conducted of the same parents who participated in the baseline survey, asking about their children’s COVID-19 vaccination status (valid responses: 536, follow-up rate = 47.7%). The proportion of children who had not been vaccinated was high (over 80%) among parents who were negative about vaccination (strongly disagreed or disagreed for the five ascending-score components, or strongly agreed or agreed for the two reverse-scored components) (Table 4). In contrast, the children’s vaccination rate among parents who were positive about vaccination was 30–58.6% (Table 4).

4. Discussion

Understanding individual differences in parental readiness to vaccinate their children can aid in predicting pediatric vaccination rates. This study partially modified the Japanese version of the 7C Vaccination Readiness Scale (originally developed for adults by Machida et al. [29]) to create an abbreviated parental version designed to measure parental readiness to vaccinate their children. Initially, the modified 7C scale was evaluated by assessing parental intention to vaccinate their children against COVID-19. Structural equation modeling revealed a good model fit between the 7C components and parental vaccination intentions. Subsequently, a follow-up survey compared the components of the modified 7C scale with actual vaccination behavior, showing that parents with low readiness to vaccinate their children had a high rate of non-vaccination. The modified 7C scale demonstrated high specificity in this context.
Concurrent with this study, Rees et al. [26] developed a parent version of the 7C scale based on the original framework by Geiger et al. [6]. Rees et al. [26] found that the Parental Vaccination Readiness Scale had demonstrated good psychometric properties and high criterion validity in German and Danish populations, highlighting its utility in reflecting parental vaccination intentions regarding their children. Similar to a previous study by Rees et al. [26], our study demonstrated the effectiveness of assessing parental preparedness for vaccination in Japanese parents, focusing on parents of children aged under 12 years, and identified Constraints, Collective Responsibility, and Confidence as the strongest correlates of parental vaccination intention. Consistent with their findings, this study confirmed that Complacency, Constraints, and Collective responsibility were related to vaccination behavior. However, the percentage of children who received the COVID-19 vaccine was 58.6% (strongly agree) for the “Constraints” attitude, 38.5% (strongly agree) for the “Confidence” attitude, and 32.4% (strongly agree) for the “Collective responsibility” attitude, indicating that the sensitivity of the 7C scale is limited (Table 4). However, considering that the overall vaccination rate for Japanese children aged 5–11 years during the same period was 24.5% [42], the modified 7C scale was able to predict vaccination behavior. Although the Calculation component showed negative factor loadings and a negative correlation coefficient with parents’ intention to vaccinate their children, in contrast to the findings of Rees et al. [26]. The actual percentage of children who received the COVID-19 vaccine was less than 30% even when parents indicated readiness to vaccinate their children based on the Calculation component (i.e., strongly disagree or disagree because it was a reverse-scored item) (Table 4). One possible reason why the results for the Calculation indicator differed from the results of Rees et al. may be the national character of the Japanese people. Previous studies of COVID-19 vaccination intention among adults in Japan have also shown a weak association between Calculation and vaccination intention [29,38]. In addition, in previous studies of COVID-19 vaccination intention among adults, social norms were most strongly associated with vaccination intentions [38]. A second reason is the ethical consideration regarding children. Acceptance of vaccination is associated with the perceived risk of infection and awareness of adverse events associated with vaccination [43]. The baseline survey was conducted before the Omicron epidemic, and at the time there were reports that children were less likely to develop COVID-19, and that the symptoms were milder in children [27,44,45]. In addition, there were reports of vaccine adverse events, such as myocarditis in young adults [46]. Moreover, some people believe that the risks and benefits of vaccinating healthy children against COVID-19 are unknown [47]. In such cases, experts and clinicians should discuss the ethical considerations involved in vaccinating children to enable parents to develop an informed opinion regarding the benefits and risks of vaccination of their children [25].
When the parental vaccination readiness score is low, the likelihood of not vaccinating children is high, suggesting that the specificity of the 7C vaccine readiness score is high. These findings suggest that COVID-19 vaccination rates among children are higher if parents are “vaccination-ready” according to the 7C scale. Therefore, our modified 7C Vaccination Readiness Scale has the potential to be used to construct effective vaccine policies by looking at responses to each component. As stated by Boateng et al. [48], it is expected that the reliability and validity of the scale can be improved by examining and modifying the dimensionality, reliability, and validity of the scale used in this study. In addition, it may also be necessary to evaluate the parents’ responses to each factor, including the pediatricians’ opinions, and revise the questions accordingly.
This study has several strengths. First, a follow-up survey was conducted two years after the baseline survey, allowing for comparisons between the modified 7C scale predictions and children’s COVID-19 vaccination status, thereby evaluating criterion validity Second, the 7C was used to measure readiness to vaccinate children against COVID-19 before the Japanese government approved the vaccination of children aged 5–11 years. As vaccination readiness, willingness, and coverage have been reported to vary by vaccine type and location [21,22,23,24,25,26,27,28], it is useful to determine vaccination intentions for target vaccines in each country. To our knowledge, this is the first report of a readiness scale being used in Japan to assess parental intention to vaccinate their children against COVID-19 prior to the start of COVID-19 vaccination. Third, the sample size was adequate. Finally, respondents were recruited from all parts of Japan, so these results are likely to be generalizable to the country.
However, this study has some limitations. First, the 7C used in this study was a short version. This limited our ability to examine the effects of the intention to vaccinate and the scale-specific components in detail. Therefore, when investigating the effect of an intervention on a specific component, the long version should be used, as described by Rees et al. [26]. Second, the 7C responses were obtained using a 5-point Likert scale, which differs from the 7-point scale used with the original tool [6]. A study, comparing the 5-point Likert scale with the 7-point Likert scale using the WatLX scale reported higher Cronbach alpha values for the 7-point Likert scale [49]. Finally, the participants in the baseline survey had recruited to match the national population distribution, and the follow-up survey was a lower response rate. To improve the reliability and validity of the scale, future studies should increase the follow-up sample size and involve diverse groups of parents.

5. Conclusions

In this study, the modified 7C Vaccination Readiness Scale predicted parental intention to vaccinate their children against COVID-19 with high accuracy, based on structural equation modeling and subsequent vaccination rates. The modified 7C scale may be useful in the development of childhood vaccine interventions.

Author Contributions

Conceptualization, M.H., T.N. and Y.H.; methodology, M.H.; validation, M.H.; formal analysis, M.H.; investigation, M.H., Y.F. and T.K., resources, M.H.; data curation, M.T. and M.H.; writing, original draft preparation, M.T. and M.H.; writing, review and editing, M.H., A.M., Y.F. and T.K., visualization, M.H. and A.M.; supervision, M.H.; project administration, M.H.; funding acquisition, M.H. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by a research grant for Research on Emerging and Re-emerging Infectious Diseases, Health and Labour Science Research Grants from the Ministry of Health, Labour and Welfare, Japan, grant number R2-SHINKOGYOSEI-SHITEI-003,20HA2001 and 24HA2007.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Saga University (approval number: R2–24; date of approval: 30 November 2020).

Informed Consent Statement

Respondents were informed about the survey’s purpose and requirements, were assured of anonymity and data confidentiality, and their submission of responses to the survey was regarded as indicative of informed consent.

Data Availability Statement

The data presented in this study are available on request from the corresponding author (M.T.). The data are not publicly available due to privacy concerns.

Acknowledgments

We would like to thank all those who participated in the survey, Yasuyuki Maeda and Yusuke Takagi for proofreading the manuscript, and Miyuki Fuchigami for providing administrative support.

Conflicts of Interest

Takashi Nakano receives lecture fees from Daiichi Sankyo Co., Ltd., Sanofi Co., Ltd., and Mitsubishi Tanabe Pharma Corporation. The other authors declare no conflicts of interest. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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Hygiene 04 00039 g001
Figure 1. Confirmatory factor analysis of the modified Japanese version of the 7C Vaccination Readiness Scale for parents. Numbers are estimates of standardized factor loadings. p-values were all <0.05. χ2[14] = 83.9, p < 0.001; goodness-of-fit index (GFI) = 0.980; Bentler–Bonett Normed Fit Index (NFI) = 0.948; root mean square error of approximation (RMSEA) = 0.067; standardized root mean square residual (SRMR) = 0.040. The factor saturation (ω) = 0.970, and the Akaike information criterion (AIC) = 112.
Figure 1. Confirmatory factor analysis of the modified Japanese version of the 7C Vaccination Readiness Scale for parents. Numbers are estimates of standardized factor loadings. p-values were all <0.05. χ2[14] = 83.9, p < 0.001; goodness-of-fit index (GFI) = 0.980; Bentler–Bonett Normed Fit Index (NFI) = 0.948; root mean square error of approximation (RMSEA) = 0.067; standardized root mean square residual (SRMR) = 0.040. The factor saturation (ω) = 0.970, and the Akaike information criterion (AIC) = 112.
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Figure 2. Prediction of parental intentions to vaccinate their children against COVID-19. Estimates of standardized factor loadings are shown. p-values were all <0.05. The r-square of the multiple correlation coefficient for “Parental intention to vaccinate their children” was 0.70. χ2[14] = 89.5, p < 0.001; goodness-of-fit index (GFI) = 0.981; Bentler–Bonett Normed Fit Index (NFI) = 0.966; root mean square error of approximation (RMSEA) = 0.057; standardized root mean square residual (SRMR) = 0.035. The factor saturation (ω) = 0.969, and the Akaike information criterion (AIC) = 124.
Figure 2. Prediction of parental intentions to vaccinate their children against COVID-19. Estimates of standardized factor loadings are shown. p-values were all <0.05. The r-square of the multiple correlation coefficient for “Parental intention to vaccinate their children” was 0.70. χ2[14] = 89.5, p < 0.001; goodness-of-fit index (GFI) = 0.981; Bentler–Bonett Normed Fit Index (NFI) = 0.966; root mean square error of approximation (RMSEA) = 0.057; standardized root mean square residual (SRMR) = 0.035. The factor saturation (ω) = 0.969, and the Akaike information criterion (AIC) = 124.
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Table 1. Modification of the Japanese version of the 7C Vaccination Readiness Scale (short version for parents).
Table 1. Modification of the Japanese version of the 7C Vaccination Readiness Scale (short version for parents).
7C Scale Original Version
Short Version		Modified 7C Scale
Version		Modified 7C Scale Japanese Version
ConfidenceI am convinced the appropriate authorities do only allow effective and safe vaccines.I am convinced the appropriate authorities do only allow effective and safe vaccines for children.政府関係機関が小児に対して効果的で安全なワクチンのみを許可すると確信している.
ComplacencyI get vaccinated because it is too risky to get infected.I get my child vaccinated because it is too risky for children to get infected.小児が感染すると非常に危険なので,子どもに予防接種を受けさせる.
ConstraintsVaccinations are so important to me that I prioritize getting vaccinated over other things.Vaccinations are so important for my child that I prioritize getting them vaccinated over other things.予防接種は子どもにとってとても大切なので,他のことよりも優先する.
CalculationI only get vaccinated when the benefits clearly outweigh the risks. (R)I only get my child vaccinated when the benefits clearly outweigh the risks. (R)利益が危険性より明らかに上回る場合にのみ,予防接種を受けさせる.（R）
Collective responsibilityI see vaccination as a collective task against the spread of diseases.I see vaccinations as a collective task against the spread of disease in schools.予防接種は学校での病気の蔓延を防ぐための集団行動だと思う.
ComplianceIt should be possible to sanction people who do not follow the vaccination recommendations by health authorities.It should be possible to sanction parents who do not follow the vaccination recommendations by health authorities.保健機関による予防接種の推奨に従わない人には,制裁を加えることができるようにすべきだ.
ConspiracyVaccinations cause diseases and allergies that are more serious than the diseases they ought to protect from. (R)Vaccinations cause diseases and allergies that are more serious than the diseases they ought to protect from. (R)ワクチンの接種は,それが本来防ぐ病気よりも,もっと深刻な病気やアレルギーを引き起こす.（R）
The original abbreviated version of the “Parental Readiness Scale for Vaccinating Children” and the abbreviated Japanese version developed for this project. The underlined text indicates statements that have been added. ‘R’ marks items scored in a descending order.
Table 2. Parental intention to have their children vaccinated against COVID-19 according to parental characteristics.
Table 2. Parental intention to have their children vaccinated against COVID-19 according to parental characteristics.
CharacteristicWhen a Pediatric Vaccine for COVID-19 Becomes Available, I Will Vaccinate My Childrenp-Value a
Strongly Disagree
(N = 88)
n (%)		Disagree
(N = 154)
n (%)		Undecided
(N = 430)
n (%)		Agree
(N = 405)
n (%)		Strongly Agree
(N = 113)
n (%)
Percent of responses(7.4%)(12.9%)(36.1%)(34.0%)(9.5%)
Sex 0.009
 Male36 (40.9)58 (37.7)171 (39.8)178 (44.0)65 (57.5)
 Female52 (59.1)96 (62.3)259 (60.2)227 (56.1)48 (42.5)
Age (years), mean ± SD37.5 ± 6.536.5 ± 6.637.6 ± 7.840.3 ± 9.039.8 ± 9.0<0.001 b
Residential region 0.544
 Hokkaido4 (4.6)7 (4.6)22 (5.1)19 (4.7)6 (5.3)
 Tohoku6 (6.8)5 (3.3)19 (4.4)22(5.4)7 (6.2)
 Kanto22 (25.0)37 (24.0)136 (31.6)131 (32.4)43 (38.1)
 Chubu14 (15.9)36 (23.4)83 (19.3)80 (19.8)17 (15.0)
 Kinki22 (25.0)30 (19.5)82 (19.1)74 (18.3)24 (21.2)
 Chugoku6 (6.8)7 (4.6)26 (6.1)27 (6.7)5 (4.4)
 Shikoku3 (3.4)2 (1.3)12 (2.8)12 (2.9)2 (1.8)
 Kyusyu11 (12.5)30 (19.5)50 (11.6)40 (9.9)9 (8.0)
Marital status 0.017
 Unmarried7 (8.0)9 (5.8)36 (8.4)13 (3.2)4 (3.5)
 Married81 (92.1)145 (94.2)394 (91.6)392 (96.8)109 (96.5)
Household income 0.365
 <JPY 4 million16 (18.2)15 (9.7)65 (15.1)61 (15.1)12 (10.6)
 ≥JPY 4 million54 (61.4)107 (69.5)278 (64.7)268 (66.2)85 (75.2)
 Unknown18 (20.5)32 (20.8)87 (20.2)76 (18.8)16 (14.2)
Level of education 0.140
 ≤High school15 (17.1)35 (22.7)109 (25.4)84 (20.7)18 (15.9)
 >High school73 (83.0)119 (77.3)321 (74.7)321 (79.3)95(84.1)
Concerns about adverse events
 Strongly disagree6 (6.8)5 (3.3)5 (1.2)1 (0.3)2 (1.8)<0.001
 Disagree4 (4.6)15 (9.7)25 (5.8)14 (3.5)12 (10.6)
 Not sure2 (2.3)18 (11.7)91 (21.2)58 (14.3)24 (21.2)
 Agree10 (11.4)47 (30.5)148 (34.4)209 (51.6)35 (31.0)
 Strongly agree66 (75.0)69 (44.8)161 (37.4)123 (30.4)40 (35.4)
Parental vaccination for COVID-19
 None40 (45.5)32 (20.8)49 (11.4)13 (3.2)4 (3.5)<0.001
 Once1 (1.1)2 (1.3)9 (2.1)7 (1.7)1 (0.9)
 Twice47 (53.4)116 (75.3)364 (84.7)375 (92.6)106 (93.8)
 Three times0 (0.0)4 (2.6)8 (1.9)10 (2.5)2 (1.8)
Number of valid responsesN = 48N = 122N = 381N = 392N = 109
Experienced any adverse events c
 Fever26 (54.2)66 (54.1)234 (61.4)210 (53.6)62 (56.9)0.238 d
 Fatigue27 (56.3)70(57.4)240 (63.0)226 (57.7)60(55.1)0.429 d
 Headache17 (35.4)41 (33.6)140 (36.8)119 (30.4)35 (32.1)0.443 d
 Chill13 (27.1)20 (16.4)78 (20.5)69 (17.6)23 (21.1)0.421 d
 Vomiting0 (0.0)0 (0.0)11 (2.9)5 (1.3)3 (2.8)0.159 d
 Diarrhea1 (2.1)2 (1.6)7 (1.8)14 (3.6)4 (3.7)0.508 d
 Muscular pain15 (31.3)36 (29.5)102 (26.8)104 (26.5)32 (29.4)0.882 d
 Arthralgia5 (10.4)25 (20.5)58 (15.2)64 (16.3)21 (19.3)0.444 d
 Anaphylactic shock0 (0.0)1 (0.8)1 (0.3)1 (0.3)0 (0.0)0.702 d
a. The chi-square test was used to test the characteristics associated with parental intention to vaccinate their children. b. The Kruskal–Wallis test was used to test the characteristics associated with parental intention to vaccinate their children. p-values of ‘a’ and ’b’ with significance level as <0.05/20 = 0.003. c. The number of respondents is shown, excluding missing values. d. Fisher’s exact test was used.
Table 3. Correlation between the “modified Japanese version of the 7C Vaccination Readiness Scale for parents” component and parental intention to vaccinate their children against COVID-19.
Table 3. Correlation between the “modified Japanese version of the 7C Vaccination Readiness Scale for parents” component and parental intention to vaccinate their children against COVID-19.
ComponentWhen a Pediatric Vaccine for COVID-19 Becomes Available, I Will Vaccinate My Childrenρp-Value
Strongly
Disagree
(Mean ± SD)		Disagree
(Mean ± SD)		Neither Agree
Nor Disagree
(Mean ± SD)		Agree
(Mean ± SD)		Strongly
Agree
(Mean ± SD)
Confidence1.91 ± 1.062.58 ± 0.883.03 ± 0.743.49 ± 0.783.91 ± 0.870.513<0.001
Complacency1.82 ± 1.072.56 ± 0.753.06 ± 0.563.74 ± 0.674.27 ± 0.900.667<0.001
Constraints1.98 ± 1.102.40 ± 0.792.97 ± 0.693.58 ± 0.694.14 ± 0.850.610<0.001
Calculation3.16 ± 1.422.69 ± 0.962.58 ± 0.782.50 ± 0.852.50 ± 1.13−0.127<0.001
Collective responsibility2.44 ± 1.263.09 ± 0.863.43 ± 0.763.99 ± 0.614.43 ± 0.790.549<0.001
Compliance1.56 ± 0.961.93 ± 0.922.39 ± 0.942.55 ± 1.052.88 ± 1.270.278<0.001
Conspiracy2.33 ± 1.152.90 ± 0.882.98 ± 0.693.03 ± 0.763.20 ± 1.150.170<0.001
Total vaccination readiness15.19 ± 4.5018.16 ± 2.6220.45 ± 2.3522.87 ± 2.3625.35 ± 3.140.678<0.001
Spearman correlation coefficient values (ρ) are shown for parents’ intention to vaccinate their children against COVID-19 and the score of each component and overall score on the Japanese version of the Vaccination Readiness Scale short scale. The total vaccination readiness score was the sum of the scores for the seven components.
Table 4. Relationship between the modified Japanese version of the 7C Vaccination Readiness Scale (parental component) and child vaccination status.
Table 4. Relationship between the modified Japanese version of the 7C Vaccination Readiness Scale (parental component) and child vaccination status.
Vaccinated Against COVID-19
No
N = 406		Yes
N = 130
Confidence, n (%)
 Strongly disagree30 (85.7)5 (14.3)
 Disagree62 (89.9)7 (10.1)
 Neither agree nor disagree184 (78.6)50 (21.4)
 Agree114 (66.3)58 (33.7)
 Strongly agree16 (61.5)10 (38.5)
Complacency, n (%)
 Strongly disagree20 (80.0)5 (20.0)
 Disagree47 (88.7)6 (11.3)
 Neither agree nor disagree196 (83.4)39 (16.6)
 Agree123 (66.8)61 (33.2)
 Strongly agree20 (51.3)19 (48.7)
Constraints, n (%)
 Strongly disagree27 (90.0)3 (10.0)
 Disagree71 (91.0)7 (9.0)
 Neither agree nor disagree182 (77.4)53 (22.6)
 Agree114 (69.5)50 (30.5)
 Strongly agree12 (41.4)17 (58.6)
Calculation, n (%)
 Strongly disagree11 (73.3)4 (26.7)
 Disagree38 (70.4)16 (29.6)
 Neither agree nor disagree159 (79.5)41 (20.5)
 Agree151 (72.2)58 (27.8)
 Strongly agree47 (81.0)11 (19.0)
Collective responsibility, n (%)
 Strongly disagree18 (85.7)3 (14.3)
 Disagree17 (77.3)5 (22.7)
 Neither agree nor disagree131 (85.1)23 (14.9)
 Agree192 (71.6)76 (28.4)
 Strongly agree48 (67.6)23 (32.4)
Compliance, n (%)
 Strongly disagree123 (89.8)14 (10.2)
 Disagree113 (76.4)35 (23.6)
 Neither agree nor disagree120 (70.2)51 (29.8)
 Agree41 (66.1)21 (33.9)
 Strongly agree9 (50.0)9 (50.0)
Conspiracy, n (%)
 Strongly disagree14 (70.0)6 (30.0)
 Disagree65 (66.3)33 (33.7)
 Neither agree nor disagree222 (79.6)57 (20.4)
 Agree89 (74.8)30 (25.2)
 Strongly agree16 (80.0)4 (20.0)
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Tokiya, M.; Matsumoto, A.; Furukawa, Y.; Kobayashi, T.; Nakano, T.; Hirota, Y.; Hara, M. Validation of the Modified Japanese 7C Readiness Scale for Parental Intentions of Child COVID-19 Vaccination. Hygiene 2024, 4, 515-526. https://doi.org/10.3390/hygiene4040039

AMA Style

Tokiya M, Matsumoto A, Furukawa Y, Kobayashi T, Nakano T, Hirota Y, Hara M. Validation of the Modified Japanese 7C Readiness Scale for Parental Intentions of Child COVID-19 Vaccination. Hygiene. 2024; 4(4):515-526. https://doi.org/10.3390/hygiene4040039

Chicago/Turabian Style

Tokiya, Mikiko, Akiko Matsumoto, Yutaro Furukawa, Takaomi Kobayashi, Takashi Nakano, Yoshio Hirota, and Megumi Hara. 2024. "Validation of the Modified Japanese 7C Readiness Scale for Parental Intentions of Child COVID-19 Vaccination" Hygiene 4, no. 4: 515-526. https://doi.org/10.3390/hygiene4040039

APA Style

Tokiya, M., Matsumoto, A., Furukawa, Y., Kobayashi, T., Nakano, T., Hirota, Y., & Hara, M. (2024). Validation of the Modified Japanese 7C Readiness Scale for Parental Intentions of Child COVID-19 Vaccination. Hygiene, 4(4), 515-526. https://doi.org/10.3390/hygiene4040039

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