Structural equation modeling to detect correlates of childhood vaccination: A moderated mediation analysis
Open accessAbstract
OBJECTIVES: This study used a health belief theory derived framework and structural equation model to examine moderators, mediators, and direct and indirect predictors of childhood vaccination. METHODS: A secondary analysis was conducted using data collected from a cross-sectional survey of a random sample of 1599 parents living in urban and rural areas of Mysore district, India. Applying two-stage probability proportionate-to-size sampling, adolescent girls attending 7th through 10th grades in 23 schools were selected to take home a questionnaire to be answered by their parents to primarily assess HPV vaccine intentions. Parents were also asked whether their children had received one dose of Bacillus Calmette-Guérin; three doses of Diphtheria, Pertussis, Tetanus; three doses of oral Polio vaccine; and one dose of Measles vaccine. In addition, parents were asked about their attitudes towards childhood vaccination. RESULTS: Out of the 1599 parents, 52.2% reported that their children had received all the routine vaccines (fully vaccinated); 42.7% reported their children had missed at least one routine vaccine, and 5.2% reported that their children had missed all routine vaccinations. Perceptions about the benefits/facilitators to childhood vaccination significantly predicted the full vaccination rate (standardized regression coefficient (β) = 0.29) directly and mediated the effect of parental education (β = 0.11) and employment (β = -0.06) on the rate of full vaccination. Parental education was significantly associated indirectly with higher rates of full vaccination (β = 0.11). Parental employment was significantly associated indirectly with decreasing rates of full vaccination (β = -0.05). Area of residence moderated the role of religion (β = 0.24) and the 'number of children' in a family (β = 0.33) on parental perceptions about barriers to childhood vaccination. The model to data fit was acceptable (Root Mean Square Error of Approximation = 0.02, 95% CI 0.018 to 0.023; Comparative Fit Index = 0.92; Tucker-Lewis Index = 0.91). CONCLUSIONS: Full vaccination rate was relatively low among children in Mysore, especially among parents who were unsure about the benefits of routine vaccination and those with low educational levels. Interventions increasing awareness of the benefits of childhood vaccination that target rural parents with lower levels of education may help increase the rate of full childhood vaccination in India.
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- Authors
- Degarege, A., Krupp, K., Srinivas, V., Ibrahimou, B., & Madhivanan, P.
- Affiliations
- University of Nebraska Medical Center (US)
- University of Arizona (US)
- Public Health Research Institute Of India (IN)
- Florida International University (US)
- Corresponding author
- Degarege, Abraham
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-10-15
- Volume
- 15
- Issue
- 10
- Pages
- e0240749
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7561155
- OpenAlex
- W3092882583
- Cited by
- 8
- References
- 53
- Citations by year
- 2026: 1 · 2023: 1 · 2022: 5 · 2021: 1
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UA Campus Repository (The University of Arizona) (acceptedVersion, cc-by)
- DigitalCommons@UNMC (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Merck Sharp and Dohme
- Fogarty International Center (D43 TW010540)
- National Institute of Health (R15-AI128714)
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Emergency Medicine › Intramuscular injections and effects
- Keywords
- childhood immunization, vaccination coverage, parental attitudes, parental education, parental employment, number of children, urban-rural differences, Mysore district, routine childhood immunization, barriers to vaccination, BCG vaccine, DTP vaccine, polio vaccine, measles vaccine, vaccination intention, rural parents, India
- MeSH terms
- Latent Class Analysis, Mediation Analysis, Adult, Child, Female, Humans, India, Health Knowledge, Attitudes, Practice, Male, Models, Theoretical, Vaccination
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