Development, validity, and reliability of the Japanese version of the 7C of vaccination readiness scale


      • The Japanese version of 7C of the vaccination readiness scale was developed.
      • The validity and reliability of the Japanese scale was assessed.
      • The Japanese version of the scale showed acceptable validity and reliability.



      The 7C of vaccination readiness scale measures the seven psychological components that structure people's vaccination readiness. We aimed to develop the Japanese version of this scale (7C scale Japanese version) and to assess its validity and reliability.


      The full and short versions of 7C scale Japanese were developed based on translation guidelines provided by the ISPOR Task Force. An Internet survey, including 709 participants, was performed to assess the scale's validity and reliability within a confirmatory factor analysis (CFA) framework (men: 38.8%, age range: 20–92 years). Invariance analysis using multiple-group CFA was conducted to test cross-cultural validity between participants in this study and those in the 7C original version study. McDonald's omega and intraclass correlation coefficient were calculated to evaluate internal consistency and test-retest reliability, respectively. To clarify the criterion validity, regression analysis, with previous COVID-19 vaccination status as the dependent variable, was performed to calculate pseudo R2.


      The 7C scale Japanese version exhibited good content validity, structural validity, configural invariance, and criterion validity. The results showed good internal consistency, and test-retest reliability, except for the “calculation” component.


      7C scale Japanese version exhibited acceptable reliability and validity; however, “calculation” may be a less reliable subscale.


      List of abbreviations:

      COVID-19 (Coronavirus disease 2019), 7C scale (The 7C of vaccination readiness scale), 7C scale Japanese version (Japanese version of the 7C of vaccination readiness scale), COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments), 7C scale original version (Original version of the 7C of vaccination readiness scale), CFA (Confirmatory Factor Analysis), CFI (Comparative fit index), TLI (Tucker-Levis index), RMSEA (Root mean square error of approximation), SRMR (Standardized root mean square residual), MGCFA (Multiple-group Confirmatory Factor Analysis), ICC (Intraclass correlation coefficient)
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        • de Figueiredo A
        • Simas C
        • Karafillakis E
        • Paterson P
        • Larson HJ.
        Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: A large-scale retrospective temporal modelling study.
        Lancet. 2020; 396: 898-908
        • Dubé E
        • Gagnon D
        • Nickels E
        • Jeram S
        • Schuster M.
        Mapping vaccine hesitancy–Country-specific characteristics of a global phenomenon.
        Vaccine. 2014; 32: 6649-6654
        • MacDonald NE
        • SAGE Working Group on Vaccine Hesitancy
        Vaccine hesitancy: Definition, scope and determinants.
        Vaccine. 2015; 33: 4161-4164
        • World Health Organization
        Ten threats to global health in 2019, 2019.
        2022 ([Cited 29 June]. Available from)
        • Sallam M.
        COVID-19 Vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates.
        Vaccines. 2021; 9: 160
        • Cascini F
        • Pantovic A
        • Al-Ajlouni Y
        • Failla G
        • Ricciardi W.
        Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review.
        EClinicalmedicine. 2021; 40101113
      1. Assessing the state of vaccine confidence in the United States: Recommendations from the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on June 9, 2015 [corrected].
        Public Health Rep. 2015; 130: 573-595
        • Butler R
        • MacDonald NE
        • SAGE Working Group on Vaccine Hesitancy
        Diagnosing the determinants of vaccine hesitancy in specific subgroups: The Guide to Tailoring Immunization Programmes (TIP).
        Vaccine. 2015; 33: 4176-4179
        • Schmid P
        • Rauber D
        • Betsch C
        • Lidolt G
        • Denker ML.
        Barriers of Influenza Vaccination Intention and behavior - A systematic review of Influenza Vaccine Hesitancy, 2005 - 2016.
        PLOS ONE. 2017; 12e0170550
        • Geiger M
        • Rees F
        • Lilleholt L
        • Santana AP
        • Zettler I
        • Wilhelm O
        • Betsch C
        • Böhm R.
        Measuring the 7Cs of vaccination readiness.
        Eur J Psychol Assess. 2021; 0: 1-9
        • Betsch C
        • Schmid P
        • Heinemeier D
        • Korn L
        • Holtmann C
        • Böhm R.
        Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination.
        PLOS ONE. 2018; 13e0208601
        • Opel DJ
        • Taylor JA
        • Zhou C
        • Catz S
        • Myaing M
        • Mangione-Smith R.
        The relationship between parent attitudes about childhood vaccines survey scores and future child immunization status: A validation study.
        JAMA Pediatr. 2013; 167: 1065-1071
        • Gilkey MB
        • Reiter PL
        • Magnus BE
        • McRee AL
        • Dempsey AF
        • Brewer NT.
        Validation of the Vaccination Confidence Scale: A brief measure to identify parents at risk for refusing adolescent vaccines.
        Acad Pediatr. 2016; 16: 42-49
        • Larson HJ
        • de Figueiredo A
        • Xiahong Z
        • Schulz WS
        • Verger P
        • Johnston IG
        • et al.
        The state of vaccine Confidence 2016: Global insights through a 67-country survey.
        EBiomedicine. 2016; 12: 295-301
        • Vallée-Tourangeau G
        • Promberger M
        • Moon K
        • Wheelock A
        • Sirota M
        • Norton C
        • et al.
        Motors of influenza vaccination uptake and vaccination advocacy in healthcare workers: Development and validation of two short scales.
        Vaccine. 2018; 36: 6540-6545
        • Frew PM
        • Murden R
        • Mehta CC
        • Chamberlain AT
        • Hinman AR
        • Nowak G
        • et al.
        Development of a US trust measure to assess and monitor parental confidence in the vaccine system.
        Vaccine. 2019; 37: 325-332
        • Chen IH
        • Ahorsu DK
        • Ko NY
        • Yen CF
        • Lin CY
        • Griffiths MD
        • et al.
        Adapting the motors of Influenza Vaccination Acceptance Scale into the motors of COVID-19 Vaccination Acceptance Scale: Psychometric evaluation among mainland Chinese university students.
        Vaccine. 2021; 39: 4510-4515
        • Shapiro GK
        • Holding A
        • Perez S
        • Amsel R
        • Rosberger Z.
        Validation of the vaccine conspiracy beliefs scale.
        Papillomavirus Res. 2016; 2: 167-172
        • Sarathchandra D
        • Navin MC
        • Largent MA
        • McCright AM.
        A survey instrument for measuring vaccine acceptance.
        Prev Med. 2018; 109: 1-7
        • Martin LR
        • Petrie KJ.
        Understanding the dimensions of anti-vaccination attitudes: The Vaccination Attitudes Examination (VAX) Scale.
        Ann Behav Med. 2017; 51: 652-660
        • Olarewaju VO
        • Jafflin K
        • Deml MJ
        • Gültekin N
        • Muggli F
        • Schärli S
        • et al.
        The Youth Attitudes about vaccines (YAV-5) scale: Adapting the parent attitudes about childhood vaccines short scale for use with youth in German, French, and Italian in Switzerland, exploratory factor analysis and mokken scaling analysis, French.
        Hum Vaccin Immunother. 2021; 17: 5183-5190
        • Nicholls LAB
        • Gallant AJ
        • Cogan N
        • Rasmussen S
        • Young D
        • Williams L.
        Older adults’ vaccine hesitancy: Psychosocial factors associated with influenza, pneumococcal, and shingles vaccine uptake.
        Vaccine. 2021; 39: 3520-3527
        • Machida M
        • Nakamura I
        • Kojima T
        • Saito R
        • Nakaya T
        • Hanibuchi T
        • et al.
        Trends in COVID-19 vaccination intent from pre- to post-COVID-19 vaccine distribution and their associations with the 5C psychological antecedents of vaccination by sex and age in Japan.
        Hum Vaccin Immunother. 2021; 17: 3954-3962
        • Freeman D
        • Waite F
        • Rosebrock L
        • Petit A
        • Causier C
        • East A
        • et al.
        Coronavirus conspiracy beliefs, mistrust, and compliance with government guidelines in England.
        Psychol Med. 2022; 52: 251-263
        • Romer D
        • Jamieson KH.
        Conspiracy theories as barriers to controlling the spread of COVID-19 in the U.S.
        Soc Sci Med. 2020; 263113356
        • Geiger M
        • Rees F
        • Lilleholt L
        • Santana AP
        • Zettler I
        • Wilhelm O
        • et al.
        7C scale of vaccination readiness Measure.
        2022 ([Cited 29 June]. Available from)
        • Mokkink LB
        • de Vet HCW
        • Prinsen CAC
        • Patrick DL
        • Alonso J
        • Bouter LM
        • et al.
        COSMIN Risk of Bias checklist for systematic reviews of patient-reported outcome measures.
        Qual Life Res. 2018; 27: 1171-1179
        • Hannah Ritchie EM
        • Rodés-Guirao L
        • Appel C
        • Giattino C
        • Ortiz-Ospina E
        • Hasell J
        • et al.
        Coronavirus pandemic (COVID-19).
        2022 ([Cited 29 June]. Available from)
        • Our world in data
        Coronavirus (COVID-19) Cases.
        2022 ([Cited 29 June]. Available from)
        • Our world in data
        COVID-19 vaccine doses administered by manufacturer.
        2022 ([Cited 29 June]. Available from)
        • Our world in data
        Coronavirus (COVID-19) vaccinations.
        2022 ([Cited 29 June]. Available from)
        • Wild D
        • Grove A
        • Martin M
        • Eremenco S
        • McElroy S
        • Verjee-Lorenz A
        • et al.
        ISPOR Task Force for Translation and Cultural Adaptation. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation.
        Value Health. 2005; 8: 94-104
      2. Ministry of Health, Labour and Welfare, Japan. COVID-19 vaccination Q & A. [Cited 29 June 2022]. Available from: Japanese

        • Prime minister of Japan and His cabinet
        COVID-19 vaccines.
        2022 ([Cited 29 June]. Available from)
        • Hamby T
        • Taylor W.
        Survey satisficing inflates reliability and validity measures: An experimental comparison of college and Amazon mechanical Turk samples.
        Educ Psychol Meas. 2016; 76: 912-932
        • Maniaci MR
        • Rogge RD.
        Caring about carelessness: Participant inattention and its effects on research.
        J Res Pers. 2014; 48: 61-83
        • Bentler PM.
        Comparative fit indexes in structural models.
        Psychol Bull. 1990; 107: 238-246
        • Lt Hu
        • PM Bentler
        Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.
        Struct Equ. Model. 1999; 6: 1-55
        • Steiger JH.
        Structural model evaluation and modification: An interval estimation approach.
        Multivariate Behav Res. 1990; 25: 173-180
      3. Geiger M, Rees F, Lilleholt L, Santana AP, Zettler I, Wilhelm O, et al. Measuring the 7Cs of vaccination readiness, data_7c_vaccination.csv. [Cited 29 June 2022]. Available from:

        • Cheung GW
        • Rensvold RB.
        Evaluating goodness-of-fit indexes for testing measurement invariance.
        Struct Equ. Model Multidiscip J. 2002; 9: 233-255
        • Landis JR
        • Koch GG.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Hofstede insights
        Country comparison what about Japan.
        2022 ([Cited 29 June]. Available from)
        • Statistics Bureau of Japan
        2020 Summary of the results and statistical tables.
        2022 ([Cited 29 June]. Available from)