Development of a Chinese version of confidence and perceived-risk subdomains of influenza vaccine hesitancy scale and its validation among parents of school-age children and adolescents

Objective This study aimed to develop a Chinese version of the confidence and perceived-risk subdomains of the influenza vaccine hesitancy scale (VHS-inf-CN) and validate it among parents of school-age children/adolescents. Methods The vaccine hesitancy scale (VHS) developed by the World Health Organization was adapted to form the VHS-inf-CN, including 12 items on a 5-point Likert scale. Socio-demographic data, parental self-reported hesitancy, responses to the VHS-inf-CN, and the influenza vaccination status of children/adolescents in the 2024/2025 season were collected from parents of school-age children/adolescents. Cronbach’s α and the intraclass correlation coefficient (ICC) were used to determine the reliability. Exploratory and confirmatory factor analyses were used to identify latent constructs. Criterion validity was assessed to examine the correlation between the scores of the VHS-inf-CN and influenza vaccination status. Associations between self-reported hesitancy and socio-demographic variables, scores of the VHS-inf-CN and self-reported hesitancy, and scores of the VHS-inf-CN and influenza vaccination status were analyzed. Results A total of 390 parents completed the survey, of whom 17.43% were self-reported hesitant, and 21.03% of their children/adolescents had received the influenza vaccination in the 2024/2025 season. Higher education level and monthly income were observed as significant factors associated with parental self-reported vaccine hesitancy, with the adjusted odds ratio(AOR) of 3.76 and 5.93, respectively. Unvaccinated influenza vaccination status of children/adolescents was significantly associated with parental self-reported vaccine hesitancy, with an AOR of 2.68. Cronbach’s α was 0.86, and the ICC for each item ranged from 0.53 to 0.67. Exploratory and confirmatory factor analysis indicated that the VHS-inf-CN had a two-domain structure, consisting of “confidence” and “risk” with eight and four items, respectively. The VHS-inf-CN score was significantly associated with both the self-reported hesitancy of parents (OR = 2.31) and their children/adolescents’ influenza vaccination status in the 2024/2025 season (OR = 2.28). Conclusion The VHS-inf-CN showed good reliability and validity in a convenience sample. In future research, the scale should be applied in a representative sample under a wide sociocultural contexts or populations to verify their validity and utility.