Parental Polio Vaccine Attitude, Disease Knowledge, and Characteristics

Abstract

Parental knowledge and attitudes towards vaccination impact vaccine uptake, which is essential in maintaining population immunity. We assessed the psychometric validity of a questionnaire assessing parental knowledge, attitudes, and practices regarding polio immunization. A questionnaire assessing polio disease knowledge and attitudes was designed and administered to parents of children receiving care at a hospital-based metropolitan primary care pediatric clinic. Psychometric analysis using RStudio (Version 2025.05) was performed to validate domains of disease knowledge and vaccine attitudes, including exploratory factor analysis (EFA) to identify underlying constructs and group questions by construct for cumulative scoring. Relationships between demographic characteristics, questionnaire constructs, and vaccination status, were evaluated using mean comparison tests. Delayed polio immunization status was defined as no doses by 2 months of age, <2 doses by 4 months, <3 doses by 18 months, and <4 doses by 6 years of age. Of the 228 parental participants, 82% self-identified their child participant as Black/African-American; the mean age of the children of enrolled participants was 3.83 [± 3.29] years. EFA supported two underlying construct groups (disease knowledge and vaccine attitude) with a strong model fit (RMSEA < 0.001; TLI=1.009). Parents with lower educational attainment (F = 3.095, p = 0.018) and non-full-time employment (F = 4.034, p = 0.004) had significantly lower knowledge scores. On-time polio immunization was associated with more responses of “I Don’t Know” or “Prefer Not to Say” (p < 0.001) and from respondents with older children (p < 0.001) compared to delayed polio-immunization (Table 1). The responses from parents of children with on-time polio immunization had higher polio knowledge scores (p = 0.001) and differed from those who were polio vaccine delayed by employment status (p = 0.033, Table 1). Higher composite vaccine attitude scores (indicating more vaccine concerns) were strongly associated with total vaccine refusal (p = 0.012), supporting the convergent validity of this instrument in distinguishing polio vaccine acceptance behaviors (Figure 1). Concerns about vaccine safety and efficacy, as well as patterns of ambiguous responding, reflected caregiver hesitancy, attitudes, and knowledge gaps, which may have contributed to delayed or complete avoidance of polio vaccination of their children. Our results suggest that this 6-item survey could be administered to identify families who might benefit from targeted vaccine resources, education, and counseling. Identifying and addressing the needs of parents with knowledge gaps and concerns is critical to improving polio vaccine uptake and reaching polio eradication.