“Measuring Social behavior and cultural drivers of vaccination”

“Measuring Social behavior and cultural drivers of vaccination”

Validation Study
Dear Expert,

I am Dr. Khaula Noreen, a PhD scholar in Public Health at the Health Services Academy, Islamabad, Pakistan. My doctoral research, supervised by Professor Samina Naeem Khalid, focuses on measuring social behaviours and cultural drivers of HPV vaccination. Thank you for taking part in the content validation of this questionnaire, which forms an integral part of my PhD project.

This Inventory contains 5 domains and 67 items related to behavior social and cultural drivers of vaccination. This tool has 67 questions that fall into the following five domains:

1. Thinking & Feeling

2. Social process

3. Motivation

4. Practical Issues

5. Cultural Integration

Kindly review this tool and provide your feedback on the following:

1.The relevance of each question in the tool (how important is the question)

2. The clarity of each question (how clear is the wording)

3. Recommendations for improvement of each question

I need your expert judgement on the degree of relevant item to the measured domains. Your review should be based on the definition and relevant terminologies that are provided to you. Please be as objective and constructive as possible in your review and use the rating scale provided:

Relevant Scale:

1= Not relevant

2 = Somewhat relevant

3 = Quite relevant

4 = Very relevant

Clarity Scale:

1= Not clear

2 = Somewhat clear

3 = Quite clear

4 = Very clear

The questionnaire will take on average 25-30 minutes to complete but this may vary depending on how much you wish to write. If there are no suggestions , please write NA(Not Applicable). If you have any questions or comments please do not hesitate to contact me. Thank you for your time and contribution.
Informed Consent
I agree to take part in this study. I understand that participation in this study is voluntary and that I can withdraw from the study at any time. I confirm that I have read and understood the information sheet provided for this study. I understand that my data will be used in an anonymized format and my name will not be used in any reports or publications resulting from the study. I understand the meaning of the above statements. I have read the information sheet and understand the aim of the research. The purpose of my participation in this study has been explained to me and is clear.

YesNo

Domain 1: Thinking & Feeling

Includes people’s cognitive and emotional responses to the vaccine preventable diseases and vaccine.

Thinking & Feeling

Rows	How relevant is this item	How clear is this item	Suggestions (if any)
1. To what extent do you agree that early screening and preventive measures, such as vaccination, are necessary to protect women from serious illnesses? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
2. Do you agree that vaccines administered in Pakistan could be used for experimental purposes?(Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
3. Have you ever heard that vaccines may contain haram (prohibited) ingredients such as pork? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
4. Do you think the HPV vaccine is being introduced unnecessarily?(Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
5. To what extent do you believe that the HPV vaccine protects against cervical cancer? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
6. Do you feel you are fully informed about the benefits of the HPV vaccine? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
7. How much do you trust the HPV vaccine being introduced in your country?(Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
8. Do you think that if the government makes the HPV vaccine mandatory, some people will try to get a vaccination card without actually being vaccinated? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
9. If the HPV vaccine were offered free of cost, do you think people would hesitate to receive it? (Not at all hesitant, somewhat hesitant, Neutral, Quite hesitant, Extremely hesitant)
10. Do you think the HPV vaccine could be part of efforts to control the population? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
11. Do you believe the HPV vaccine is acceptable in a Muslim society? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
12. To what extent do you agree that all girls aged 9 to 14 years should be vaccinated against HPV?(Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
13. If you believe your daughter is at low risk of cervical cancer, would you still get her vaccinated against HPV?(Certainly no, Probably no, Neutral, Probably yes, Certainly yes)
14. Do you think the HPV vaccine will help protect your daughter from serious illness? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
15. Do you think strong immunity reduces the importance of the HPV vaccine?(Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
16. To what extent are you concerned about the possible adverse effects of the HPV vaccine? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
17. Do you think the HPV vaccine could negatively affect reproductive health? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
18. How much do you trust social media to get information about the HPV vaccine? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)

Domain 2: Social Processes

Includes people’s experiences related to vaccination when interacting with others, including family friends, and their broader social network.

Social Processes

Rows	How relevant is this item	How clear is this item	Suggestions (if any)
19. How often do you hear rumors or misconceptions about the HPV vaccine in your community? (Never, Rarely. Neutral, Sometimes, Always)
20. To what extent do religious beliefs in your community influence decisions about the HPV vaccine? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
21. Would people in your community trust information about the HPV vaccine available on social media?(Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
22. Do you think married and unmarried women may have different opinions about the HPV vaccine? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
23. Will you wait to observe its effects on others before deciding to get your daughter vaccinated?(Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
24. If a trusted person in your community recommends the HPV vaccine, would you be more willing to get your daughter vaccinated?(Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
25. Will you talk to your daughter about the HPV vaccine before deciding to get her vaccinated?(Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
26. If you get your daughter vaccinated with the HPV vaccine, would you recommend it to others as well?(Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
27. Do you prefer that the primary healthcare provider educating about the HPV vaccine be a female doctor?(Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
28. Who do you trust most for accurate information about the HPV vaccine? (doctor, teacher, religious leader, community leader or elder, family member, friend)
29. From which sources do you get information about the HPV vaccine? (religious leader, poster, healthcare worker, neighbour, social media, TV)

Domain 3: Motivation

Includes people’s wanting the vaccine or willingness to get it, as well as hesitancy to get vaccinated.

Motivation

Rows	How relevant is this item	How clear is this item	Suggestions (if any)
30. When the HPV vaccine campaign begins, do you intend to register your daughter?(Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
31.Do you believe vaccinating girls against HPV is as important as other childhood vaccines? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
32. If you know that cervical cancer cases are increasing among young women in your area, will it motivate you to get your daughter vaccinated? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
33. If the government makes the HPV vaccine mandatory, will you get your daughter vaccinated? (Certainly no, Probably no, Neutral, Probably yes, Certainly yes)
34. If any of your children has ever experienced side effects from routine vaccination, would you still decide to get your daughter vaccinated with the HPV vaccine? (Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
35. Compared to other vaccines, how much do you trust the safety of the HPV vaccine? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
36. If you are given scientifically based information about the HPV vaccine, would you consider getting your daughter vaccinated? (Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
37. If you learn that other countries are administering the HPV vaccine, would it increase your trust in vaccination? (Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)

Domain 4: Practical Issues

Includes the experiences people have when trying to get vaccinated, e.g., related to accessing vaccination services.

Practical Issues

Rows	How relevant is this item	How clear is this item	Suggestions (if any)
38. Would you get your daughter vaccinated even though the HPV vaccine is currently used on a limited scale in Pakistan?(Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
39. If hospital staff provide limited information about the HPV vaccine, will you still choose to get your daughter vaccinated?(Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
40. If government offers monetary benefits for getting the HPV vaccine, would people be more willing to get vaccinated?(Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
41. Do you trust that the HPV vaccine will be safely administered in schools? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
42. Do you think school administrations will actively support the HPV vaccination program? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
43. Do you agree that public and private schools have different attitudes towards vaccination campaigns? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
44. Do you think teachers should be given specific training to raise awareness about the HPV vaccine among adolescent girls?(Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
45. Do you think girls should be given awareness about the HPV vaccine in schools? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
46. Do you trust outreach vaccination services for your daughter’s HPV vaccination? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
47. Do you agree that people are concerned about the brand of the vaccine being used? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
48. Does the vaccination staff cooperate with you during the routine vaccination process? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
49. Where would you prefer your daughter to receive the HPV vaccine? (public hospital, private hospital, outreach service, school, others)
50. What barriers do you think exist in your community regarding access to vaccines? (long distance, lack of information, affordability issues, work or family responsibilities, unavailability of the vaccine, lack of transport, clinic timings)
51. How long do you usually wait at the health center for routine vaccination? (<10 min, 10 to 20 min, 21 to 30 min, >30 min)
52. Which social media platforms do you trust most for vaccine-related information? Select all that apply. ( Tik-Tok, Facebook, Instagram, YouTube, Twitter, Other )
53. How helpful do you think reminders (e.g. mobile messages, school announcements) are to ensure timely vaccination? (Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
54. How often do you receive vaccine-related information through TV, radio or mobile phone? (Never, Rarely. Neutral, Sometimes, Always)

Domain 5: Cultural Integration

This domain includes important cultural factors embedded in traditional values, identity and cultural background, which remained inadequately addressed by established four domains.

Cultural Integration

Rows	How relevant is this item	How clear is this item	Suggestions (if any)
55. Who usually makes health decisions in your household? (Maternal grandparents, Paternal grandparents, Mother, Father, others)
56. Do you feel comfortable discussing reproductive health during family conversations? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
57. Do you think men should also be educated about the HPV vaccine through awareness campaigns?(Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
58. Would you choose to get your daughter vaccinated against HPV even if your family opposes it? (Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
59. If your daughter wishes to receive the HPV vaccine but you have some reservations, how would you react? (Strongly oppose, Oppose, Neutral, Support, Fully support)
60. If people you know get their daughters vaccinated against HPV, would you be more willing to do the same? (Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
61. Do you think that hearing real stories of cervical cancer patients would increase parents’ trust in the HPV vaccine? (Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
62. If you see health care professionals vaccinating their own daughters against HPV, would you feel more confident about doing the same?(Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)
63. Do you agree that a female vaccinator should administer the HPV vaccine to girls?(Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
64. Do you agree that people in community hesitate to get the HPV vaccine due to social reasons? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
65. Do you think it is appropriate to choose only girls for the HPV vaccine? (Strongly disagree, Disagree, Neutral, Agree, Strongly agree)
66. Do you think people from different ethnic backgrounds may hesitate to vaccinate their daughters against the HPV vaccine? (Not at all, To some extent, Neutral, To a considerable extent, To a great extent)
67. Would you agree that the HPV vaccine should be administered to your daughter at school without your permission? (Extremely unlikely, Unlikely, Neutral, Likely, Extremely likely)

Should be Empty:

“Measuring Social behavior and cultural drivers of vaccination”

Informed Consent

Expert's background and demographic details

Domain 1: Thinking & Feeling

Domain 2: Social Processes

Domain 3: Motivation

Domain 4: Practical Issues

Domain 5: Cultural Integration