{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T21:27:19Z","timestamp":1793741239755,"version":"4.6.1"},"reference-count":62,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2019,6,17]],"date-time":"2019-06-17T00:00:00Z","timestamp":1560729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Health systems all over the world are confronted with an alarming rise of cases in which individuals hesitate, delay, and even refuse vaccination, despite availability of quality vaccine services. In order to mitigate and combat this phenomenon, which are now defined by the World Health Organization (WHO) as vaccine hesitancy (VH), we must first understand the factors that lead to its occurrence in an era characterized by wide access to safe and effective vaccines. To achieve this, we conducted field testing of the Vaccine Hesitancy Scale (VHS), as it was developed by the Strategic Advisory Group of Experts Working Group (SAGE WG), in Cluj-Napoca city, Cluj County, Romania. The scale is designed to quantify VH prevalence in a population, establish which vaccines generate the highest percentage of hesitancy, and allow a qualitative assessment of the individual\u2019s reasons for hesitance. Materials and Methods: We conducted an observational cross-sectional survey, which was comprised of descriptive, analytical, and qualitative elements regarding VH. The necessary sample size was 452 individuals. The VHS and Matrix of Determinants (recommended by SAGE WG) for reasons people gave to justify their hesitance, was interpreted by qualitative thematic analysis (QTA) to ensure the validity and reliability in detecting hesitancy across various cultural settings and permit global comparisons. Results: We found a VH of 30.3% and 11.7% of parents reported refusing to vaccinate their child. Among the VH responders, the varicella vaccine generated 35% hesitancy, measles vaccine 27.7%, Human Papillomavirus (HPV) 24.1%, and mumps vaccine 23.4%, respectively. The QTA values for percent agreement ranged from 91% to 100%. Cohen\u2019s Kappa values ranged from 0.45 to 0.95. Contextual influences identified for VH were \u201cmedia,\u201d \u201cleaders and lobbies,\u201d and \u201cperception of the pharmaceutical industry.\u201d Individual and group influences for VH were \u201cbeliefs,\u201d \u201cknowledge,\u201d and \u201crisk\/benefits (perceived).\u201d Vaccine and vaccination specific issues for VH were \u201crisk\/benefit (rational)\u201d and \u201chealth care practitioners (trustworthiness, competence).\u201d Conclusions: One-third of the investigated population had expressed VH, and a further one-third of these had refused a vaccine for their child. Chicken Pox, Measles, Mumps, Rubella (MMR), and HPV vaccines generated the most hesitation. Negative information from the media was the most frequently evoked reason for VH.<\/jats:p>","DOI":"10.3390\/medicina55060282","type":"journal-article","created":{"date-parts":[[2019,6,19]],"date-time":"2019-06-19T02:42:46Z","timestamp":1560912166000},"page":"282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Qualitative Assessment of Vaccine Hesitancy in Romania"],"prefix":"10.3390","volume":"55","author":[{"given":"David","family":"Miko","sequence":"first","affiliation":[{"name":"Iuliu Ha\u021bieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Costache","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Iuliu Ha\u021bieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9675-2893","authenticated-orcid":false,"given":"Hora\u021biu Alexandru","family":"Colosi","sequence":"additional","affiliation":[{"name":"Department of Medical Education, Division of Medical Informatics and Biostatistics, Iuliu Ha\u021bieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6099-4631","authenticated-orcid":false,"given":"Vlad","family":"Neculicioiu","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Iuliu Ha\u021bieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana Alina","family":"Colosi","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Iuliu Ha\u021bieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,6,17]]},"reference":[{"key":"ref_1","unstructured":"World health Organization (2019, April 24). 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