The validation of the Slovak vaccination attitudes examination (VAX) scale and pilot study

The resurgence of vaccine-preventable diseases poses a significant global public health challenge, exacerbated by the rise of anti-vaccination attitudes. The aim of this study was to validate the Slovak version of the Vaccination Attitudes Examination (VAX) questionnaire and to examine the attitudes towards vaccination in Slovakia. The VAX scale questionnaire, translated into Slovak and validated, was used for the survey. The VAX scale uses 12 statements assessing anti-vaccination attitudes. Each statement is scored on a 6-point Likert scale, with higher total score indicates more negative attitudes towards vaccinations. Our questionnaire also included demographic questions (age, gender, residence, education level, profession, and economic activity). For validation, the questionnaire was translated into the Slovak using forward and backward translations. The validation survey was conducted on the sample size of 115 participants. Correlation was calculated using Pearson's correlation coefficient, internal consistency was tested. Confirmatory factor analysis (CFA) was performed to assess validity. Subsequently, a pilot study was conducted in March 2023 with a sample size of 473 participants. The VAX scale demonstrated strong internal consistency (Cronbach's alpha = 0.925) and reliability. The results of the CFA were comparable to findings from other languages versions. The pilot study revealed that parents, non-healthcare professionals, and older individuals exhibited higher anti-vaccination attitudes. In contrast, healthcare professionals had the lowest VAX scores, reflecting more pro-vaccination attitudes. These findings highlight the need for targeted educational and communication strategies to address vaccine hesitancy. By identifying demographic patterns and potential hotspots of vaccine skepticism, public health initiatives can be better tailored to improve vaccination rates. The validated Slovak VAX scale provides a reliable tool for ongoing assessment and intervention efforts. • Parents, non-healthcare workers, and older individuals (26+) show higher anti-vaccination attitudes. • Healthcare professionals exhibit the lowest VAX scores, indicating pro-vaccination attitudes. • About 20 % of participants hold negative views towards Slovakia's vaccination schedule.