Development and validation of COVID-19 vaccination perception (CoVaP) instrument among healthcare workers in Malaysia

Healthcare workers (HCWs) play an essential role in facilitating coronavirus disease 2019 (COVID-19) vaccination, and their confidence in vaccination is crucial. Nevertheless, valid instruments for assessing the HCWs' perceptions of COVID-19 vaccination were lacking. This study aims to develop and validate the COVID-19 Vaccination Perceptions (CoVaP) instrument among HCWs in Malaysia.

A literature review and discussion with research teams were conducted to identify the content to be considered. The instrument was developed in Malay language and underwent back-to-back translations to the English version. The initial CoVaP instrument was unidimensional with 12 items. The Malay and English versions underwent a content validation process by seven expert panels. However, only the Malay version underwent face and construct validation. Face validity was assessed using 30 HCWs. The construct validation was conducted in a two-step process using data from two cross-sectional study samples, including 125 and 300 HCWs for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. It was a self-administered questionnaire, and the data were collected using both face-to-face and online platforms. The data were analysed using Analysis of Moment Structure version 28.0 and Statistical Packages for the Social Sciences version 26.

The analysis showed excellent content (item content validity index (I-CVI) = 0.83 to 1.0, average content validity index (S-CVI/Ave) = 0.97) and face (item face validity index (I-FVI) = 0.87 to 1.0, average face validity index (S-FVI/Ave) = 1.02) validity. The EFA analysis revealed seven items with two domains. Subsequent analysis using CFA demonstrated a two-factor model of seven items with an acceptable level of goodness of fit indexes (comparative fit index = 0.999, Tucker-Lewis index = 0.999, incremental fit index = 0.987, chi-squared/degree of freedom = 1.039, and root mean square error of approximation = 0.011). Finally, the Cronbach's alpha was satisfactory for both domains (0.899 and 0.815).

The CoVaP instrument is a valid and reliable tool for measuring perceptions of COVID-19 vaccination among HCWs. The high validity and reliability of the CoVaP instrument underscore its utility in capturing the unique cultural and contextual factors influencing vaccine perceptions among Malaysian HCWs. Understanding these factors is essential for designing effective public health interventions to address vaccine hesitancy and improve vaccination rates.