Association of parental vaccination readiness and descriptive norms with childhood vaccination status

Maintaining high vaccination coverage requires understanding parental psychological factors, such as readiness conceptualized by the 7C model and descriptive norms, that shape decisions about childhood vaccinations. This study aimed to validate the Japanese short version of the Children-7C (C7C) scale, and examine how parental readiness and descriptive norms relate to vaccination status.

This cross-sectional study analyzed data from 5148 parents in a self-reported online survey. Structural validity and internal consistency were assessed using confirmatory factor analysis and McDonald's omega. Criterion validity was examined using structural equation modeling (SEM) for composite vaccination uptake and acceptance defined as the proportion of age-eligible vaccines received, and received or intended, respectively. Vaccine-specific SEMs were also conducted for all vaccines in the Japanese National Immunization Program-Haemophilus influenzae type b, pneumococcal conjugate vaccine, diphtheria-pertussis-tetanus, hepatitis B, rotavirus, measles-rubella, varicella, Japanese encephalitis, human papillomavirus, and diphtheria-tetanus, as well as mumps, influenza and COVID-19.

The scale demonstrated acceptable structural validity (CFI = 0.97, TLI = 0.96, RMSEA = 0.092, SRMR = 0.028) and internal consistency (ω = 0.88). Factor loadings ranged from -0.51 for calculation to 0.89 for complacency. Collective responsibility, constraints, confidence, and complacency showed strong loadings, whereas compliance (λ = 0.25) and conspiracy (λ = 0.06) showed minimal loadings. Regarding criterion validity, parental readiness was positively associated with both composite uptake and acceptance. Readiness showed similar associations across routine infant vaccines, a strong association for HPV, and a weaker association for COVID-19 and seasonal influenza vaccines. Descriptive norms had a lesser overall loading but were consistently positive.

The Japanese short version of the C7C scale is valid for measuring parental vaccination readiness. Readiness consistently predicted children's vaccination status, underscoring the need to enhance readiness while also considering vaccine- and age-specific strategies.