Validation and psychometric evaluation of the Arabic Adult Vaccine Hesitancy Scale

Abstract

Vaccine hesitancy is one of the top ten global health threats, with a culturally adapted, validated tool being essential for accurately measuring it to guide public health interventions. Although translations of the Adult Vaccine Hesitancy Scale (aVHS) to local languages and their validation have occurred in several contexts, no validated Arabic version exists for the Middle East population. This, however, impedes the process of generating locally and regionally reflective data for targeted interventions and evaluation of vaccine outreach efforts. To translate and validate the Adult Vaccine Hesitancy Scale (aVHS) for Arabic-speaking adults. This cross-sectional study followed a five-phase process: translation, expert review, preliminary testing, pilot testing, and validation with psychometric analysis. Translation and back translation were conducted then reviewed by an expert committee. The approved version of the Arabic aVHS (Ar-aVHS) was tested against the English version (E-aVHS) on 50 participants and demonstrated excellent internal consistency (Ar-aVHS Cronbach's α = 0.8699). The overall correlation between Arabic and English scale scores was strong (Spearman's rho = 0.8418, < .001). During pilot phase on 1000 participants, the Ar-aVHS demonstrated adequate internal consistency (Cronbach's α = 0.636 overall). Exploratory factor analysis supported a two-factor structure, confidence in vaccines and risk perception, both explaining 40.5% of total variance. Using the established cutoff score, 66.2% of participants were classified as vaccine hesitant. The results of the study suggest that the Ar-aVHS is a valid, culturally relevant, and psychometrically sound instrument for assessing vaccine hesitancy among Arabic-speaking adults.