Development and validation of instruments to assess public acceptance of alternatives to needle and syringe-based vaccination

Thesis

Alternative vaccine delivery technologies such as transcutaneous ultrasound may hold promise to improve vaccination rates worldwide. Yet translational engineering efforts sometimes fail to yield marketable products due to alignment failure with end-user preferences, public sentiment, or stakeholder expectations and funding, and therefore a better understanding of public preferences for these technologies is critical.

This thesis highlights a measurement-first approach to develop brief, psychometrically robust instruments to quantify human factors data early and iteratively, converting nebulous uncertainty regarding adoption likelihood into quantitative risk data. This thesis outlines the development and validation of three instruments: the Oxford Needle Experience (ONE) scale, an instrument to assess public attitudes to needles; the Oxford Vaccine Hesitancy Scale (OVHS), a multidimensional scale to assess vaccine hesitancy; and the Oxford Benchmark Scale for Rating Vaccine Technologies (OBSRVT), a multidimensional instrument that compares responses to the benchmark of needle and syringe-based vaccination. These instruments, along with a range of measures including a discrete choice experiment, stated willingness to pay, and stated preferences, were then used to assess preferences for ultrasound-mediated vaccination and intranasal vaccination, exploring public enthusiasm for these next-generation technologies while also providing additional validity evidence for the underlying instruments.

Across demographically representative samples in the United Kingdom and United States (n=3,980), this thesis highlights the development and validation of these instruments, which exhibited clean, multidimensional structures with strong reliability and validity evidence. In demographically representative populations in both the United Kingdom and United States, ultrasound-mediated vaccination is preferred over both intranasal and needle and syringe-based vaccination, and this preference is particularly pronounced among needle- and vaccine-hesitant individuals.

This thesis also outlines the development of a transferable approach to discrimination and cut-off determination applied to the OVHS, including the development of algorithms that could be broadly applicable to developing cut-off values when faced with large numbers of datasets—useful not only for instrument development, but for human and artificial intelligence decision-making under uncertainty more broadly. Ultimately, this thesis highlights preferences for ultrasound-mediated vaccination while also outlining a transferable approach for biotechnology de-risking.

Authors: Kantor, J

• DOI: 10.5287/ora-7qon8gxmj
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: derisking; vaccination; de-risking
• Subjects: Health attitudes; Vaccine hesitancy