Validation of the Behavioural and Social Drivers of Influenza Vaccination Survey in Australia: Cognitive Interviews and Psychometric Evaluation

BackgroundUnvaccinated individuals are at greater risk of seasonal influenza. In Australia, vaccination coverage is consistently low among the most at risk groups eligible for free influenza vaccine. To establish an annual national monitoring of the behavioural and social drivers of influenza vaccination, we validated the World Health Organizations Behavioural and Social Drivers of Influenza Vaccination survey. This is the first study reporting the validation results of the newly developed survey. MethodsTwo stages of validation occurred. First, we conducted cognitive interviews and revised survey items based on feedback. Then, we collected quantitative data and performed psychometric analysis, including explanatory and confirmatory factor analysis. We also assessed the association between the survey items and the intention to receive an influenza vaccine using polychoric correlation and used a random forest model to identify the importance of each item in predicting the intention to receive an influenza vaccine. ResultsWe modified nine of the 31 survey items based on cognitive interviews with 16 adults. Based on the psychometric evaluation of 2055 respondents, we identified and validated five factors that underlie the survey structure and aligned well with the domains of the BeSD framework: Thinking and Feeling, Social Processes, Motivation, and Practical Issues. Each item correlated with the intention to receive influenza vaccine, particularly those related to perceived vaccine importance and social responsibility. Only one item - autonomy of decision-making about influenza vaccination - showed no significant association with the intention to receive influenza vaccination and no significant correlation with its underlying factor. ConclusionThe cognitive interviews and psychometric evaluation of the survey showed strong validity in an Australian population. We recommend further validation of the survey in various contexts, with a particular focus on assessing its predictive validity with actual vaccination uptake.