Measuring hesitancy toward childhood vaccines before birth: validation of the Vaccine Hesitancy Scale in pregnant women and its association with health locus of control
This study validates a modified Vaccine Hesitancy Scale for pregnant women in Turkey, confirming its ability to measure pre-birth hesitancy toward childhood vaccines and demonstrating that higher hesitancy is associated with lower internal and professional health locus of control.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every parent faces a moment of decision when their child is born: whether to follow the standard schedule of vaccinations that protects infants from serious diseases. In many places, including Turkey, the first of these shots is given within the first day of life. This means the choice is not made in the hospital nursery, but much earlier, while the mother is still pregnant. The decision often hinges on a feeling known as vaccine hesitancy—a delay in acceptance or a refusal to vaccinate, even when the services are available. This hesitation is not just a personal preference; it is a growing global concern that threatens the health of entire communities. While doctors have long studied why parents of already-born children might hesitate, they have lacked a reliable way to measure these feelings in women who are expecting a baby. Without a tool to gauge these attitudes before birth, health workers cannot identify worried mothers early enough to offer support before the first vaccine is due.
To fill this gap, a team of researchers in Turkey set out to adapt an existing survey tool for use with pregnant women. They took a well-known questionnaire called the Vaccine Hesitancy Scale, which was originally designed for parents of children, and carefully rewrote the questions to refer to an unborn child. Instead of asking about a child's past shots, the questions asked about the mother's feelings regarding the vaccines her baby would receive in the future. The team tested this new version on 330 pregnant women visiting a university hospital. They wanted to see if the survey worked as a reliable measuring stick and to understand how a mother's belief about who controls her health influenced her willingness to vaccinate.
The researchers found that the adapted survey worked well. When they analyzed the answers, the questions naturally grouped into two main categories. The first and strongest group dealt with a lack of confidence in the vaccines themselves, covering doubts about their safety and necessity. The second group, which was much smaller and less consistent, focused on specific fears about risks. The survey proved to be a sharp tool for distinguishing between women who were open to vaccination and those who were not. For instance, women who had previously refused a tetanus shot for themselves during their current pregnancy scored significantly higher on the hesitancy scale than those who accepted it. The survey was also able to identify women whose previous children had not received all their scheduled shots, suggesting that a mother's attitude toward vaccines for her unborn child is often consistent with her past actions.
A key part of the study explored the connection between vaccine hesitancy and a concept called health locus of control. This idea describes where a person believes the power to manage their health lies. Some people feel they are in charge of their own health, while others believe that doctors and medical professionals hold the power, and some feel that health is simply a matter of chance or luck. The study revealed that women who believed that health professionals controlled their health outcomes, or who felt they had personal control over their own well-being, were less likely to hesitate about vaccinating their unborn child. Conversely, those who felt that health was mostly a matter of chance did not show the same level of confidence. The researchers noted that when they added these beliefs about control to their analysis, it explained a significant portion of the differences in hesitancy among the women, even after accounting for their education level or where they got their information.
The findings suggest that the time to address vaccine concerns is during pregnancy, long before the baby is born and the first shot is scheduled. Because the survey successfully identified hesitancy in the prenatal period, doctors and nurses can use it to spot mothers who might need extra support or conversation. The study indicates that simply providing facts might not be enough for everyone. For women who lack confidence, building a trusting, continuous relationship with a healthcare provider appears to be crucial. For those who view health as a matter of chance, framing vaccination as a concrete, protective step that a parent can actively take might be more effective. By understanding these different perspectives before the baby arrives, health teams can tailor their approach, potentially ensuring that more children receive the protection they need from the very first day of life.
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