Factors of parental COVID-19 vaccine hesitancy: A cross sectional study in Japan

Sayaka Horiuchi; Haruka Sakamoto; Sarah K. Abe; Ryoji Shinohara; Megumi Kushima; Sanae Otawa; Hideki Yui; Yuka Akiyama; Tadao Ooka; Reiji Kojima; Hiroshi Yokomichi; Kunio Miyake; Takashi Mizutani; Zentaro Yamagata

doi:10.1371/journal.pone.0261121

Peer Review History

Original SubmissionNovember 1, 2021
15 Nov 2021 Decision Letter - Bijaya Kumar Padhi, Editor PONE-D-21-34773Factors of parental COVID-19 vaccine hesitancy: a cross sectional study in JapanPLOS ONE Dear Dr. Horiuchi, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by 20 November 2021. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information. Additional Editor Comments: This manuscript investigates parental COVID-19 vaccine hesitancy and its associated factors in Japan. The study has a valid research question and hypothesis. Language and and presentation are clear and adequate, figures and tables are in line with scientific norms and standards. I commend the authors for conceptualizing this study, as the findings certainly add value to the literature. I have following comments: Psychometrics of the survey instruments should be provided. Authors said they used multiple logistic regression model. However, there is a lack of clarity on what basis the model was built. Whether they used a-priori hypothesis or any stepwise input of parameters. This information should be provided in data analysis section. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This subject is absolutely essential for disease prevention and socio-behavioral health. Introduction Well written Methods The participant section provides the detailed registration system of the Nippon Research Center. What is the objective of the registration? Which types of communities are registering? Are both parents reporting? Till the study, how many registered? As it is voluntary, registration may be for those who have positive motivation, they registered. How did you justify your representation of sampling? If possible, clarify, otherwise mention this in limitation. In the data collection section: 1200 is a good sample. How did you select this sample from the register? What is your target population? Results In line 180 Intention to vaccinate themselves (parent), since adult vaccination started long back, it is good to presented vaccinated versus non-vaccinated (why intention to vaccinate) – present parent practice rather than their attitude. Then you can associate parent vaccination status with intension to vaccinate their child. Table 3. Reason of having no intention to vaccinate themselves (N = 315) – present the finding using a figure (pi chart). Combine Table 1 and Table 4 (The variable which described in one table describe it in text) Table 1. Characteristics of study parents in Japan (year 2021) (N = 1,200) Table 4. Crude and adjusted odds ratios of having no intention to vaccine their child 202 (N = 1,200) Discussion Add one paragraph on Implication for policy and practice Reviewer #2: the manuscript s well written with the methodology, results section in aligment to the objective. the discussion part is throughly written and well explained. one suggestion in the analysis section is while looking at level of social relationship satisfaction related to parental vaccine hesitancy, high satifaction can be kept as reference ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Dr. Krushna Chandra Sahoo, ICMR-Regional Medical Research Centre, Bhubaneswar, India Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: Reviewer comments.docx https://doi.org/10.1371/journal.pone.0261121.r001
Revision 1
19 Nov 2021 Author Response Dear Dr Bijaya Kumar Padhi: Thank you for giving me the opportunity to submit a revised draft of my manuscript to PLOS ONE titled “Factors of parental COVID-19 vaccine hesitancy: a cross sectional study in Japan.” We appreciate the time and effort that you and the reviewers have dedicated to providing your valuable feedback on my manuscript. We are grateful to the reviewers for their insightful comments on our paper. We have been able to incorporate changes to reflect most of the suggestions provided by the reviewers and have indicated the changes within the manuscript in red font. Here is a point-by-point response to the reviewers’ comments and concerns. Editor: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Reply: We have carefully reviewed the guidelines and revised the manuscript accordingly. 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information. Reply: We confirm that minors were not included in the study participants. We have added explanation on online informed consent as follows. Lines 84-85 “Participants clicked the checkbox on the screen online to provide informed consent.” Additional Editor Comments: This manuscript investigates parental COVID-19 vaccine hesitancy and its associated factors in Japan. The study has a valid research question and hypothesis. Language and and presentation are clear and adequate, figures and tables are in line with scientific norms and standards. I commend the authors for conceptualizing this study, as the findings certainly add value to the literature. I have following comments: 1. Psychometrics of the survey instruments should be provided. 2. Authors said they used multiple logistic regression model. However, there is a lack of clarity on what basis the model was built. Whether they used a-priori hypothesis or any stepwise input of parameters. This information should be provided in data analysis section. Reply: We appreciate your feedback. 1. We have added the survey instrument as a supporting information file. 2. We selected covariates based on a-priori hypotheses, and attempted to include all of them variables in the multivariate analysis. Finally, two variables were excluded from the model due to multicolinearity. We have added explanation as follows. Lines 157-159 “We selected variables to be included in the multivariate model based on a-priori hypothesis, and included all covariates in the model unless there was an evidence of multicollinearity.” Reviewer 1: This subject is absolutely essential for disease prevention and socio-behavioral health. Introduction Well written Methods The participant section provides the detailed registration system of the Nippon Research Center. What is the objective of the registration? Which types of communities are registering? Are both parents reporting? Reply: The Nippon Research Center is a private entity that subcontracts public and private surveys. To respond needs of its customers, it has built several panels and recruited participants from whole nation. This time, we used the panel for web-based surveys. Only one parent answered the survey. To avoid confusion, we have rephrased parents into other words in the participants section as follows. Lines 95-97 “The eligibility criteria were 1) those who had children aged 3–14 years, and 2) those who resided in Japan at the time of inception of the survey. We did not set an age limit for participants.” Lines 101-104 “The Nippon Research Center is a private entity that subcontracts public and private surveys. To respond needs of its customers, it has built several panels and recruited participants from whole nation.” Till the study, how many registered? Reply: Information of the panel has been added as follows. Line 104 “As of October 2020, about 1.4 million registered in the panel.” As it is voluntary, registration may be for those who have positive motivation, they registered. How did you justify your representation of sampling? If possible, clarify, otherwise mention this in limitation. Reply: We agree that the selected participants were not representative of the Japanese population due to nature of the internet survey. We have included this point as limitation. Lines 263-270 “Owing to the nature of the data collection via an internet-based survey and participation is on voluntary basis, this study is subject to selection bias. Generalizability may be limited, as those who participated may be more interested in the COVID-19 vaccine and have different attitude toward the vaccination. Also, those who had access to internet might be different from those who did not. Therefore, the percentage of vaccine hesitancy may not be representative of the general population, however, identified factors related to vaccine hesitancy can be used to consider targeting people who have active access to internet.” In the data collection section: 1200 is a good sample. How did you select this sample from the register? What is your target population? Reply: Participation to this survey was on voluntary basis. We asked people registered in the panel to join this survey and continued recruitment until the number reached 1200. Lines 112-113 “People registered in the panel participated in this survey on a voluntary basis in response to an invitation. Data collection continued until the sample size reached 1,200.” Results In line 180 Intention to vaccinate themselves (parent), since adult vaccination started long back, it is good to presented vaccinated versus non-vaccinated (why intention to vaccinate) – present parent practice rather than their attitude. Then you can associate parent vaccination status with intension to vaccinate their child. Table 3. Reason of having no intention to vaccinate themselves (N = 315) – present the finding using a figure (pi chart). Reply: We appreciated your suggestion. As we did not have data on vaccine status, it is impossible to analyze data based on parental vaccination status. The eligibility of the COVID-19 vaccine was expanded to people under 65 years of age in May 2021. As this survey was conducted May 25 and June 3, 2021, we decided to ask intention to vaccine assuming that the proportion of vaccinated was very low at the time of survey. We have added “Fig2 Reason of having no intention to vaccinate themselves (N = 315)” according to your suggestion. Combine Table 1 and Table 4 (The variable which described in one table describe it in text) Table 1. Characteristics of study parents in Japan (year 2021) (N = 1,200) Table 4. Crude and adjusted odds ratios of having no intention to vaccine their child 202 (N = 1,200) Reply: We appreciate your suggestion, however, we are afraid that, if combined, Table will get very large and difficult to see for readers. We, therefore, would like to keep separate tables for reporting characteristics of participants and odds ratios. We hope it will be acceptable. Discussion Add one paragraph on Implication for policy and practice Reply: We have added the following sentences in the last paragraph of the discussion section. Lines 281-290 “To address parental vaccine hesitancy, it is necessary to consider how to disseminate correct information other than through public channels to reach people who seek information from social media. Government officials should consider new channels such as social media including collaboration with influencers to disseminate information other than traditional methods such as posting message on their homepages. We also found that mothers are more likely to hesitate to vaccinate their children than fathers, especially among people who had lower satisfaction to social relationship. Therefore, healthcare professionals and government officials need to carefully consider this gender difference, and provide targeted information especially for those who are likely to be socially isolated due to measures of social distancing.” Reviewer 2: the manuscript s well written with the methodology, results section in aligment to the objective. the discussion part is throughly written and well explained. one suggestion in the analysis section is while looking at level of social relationship satisfaction related to parental vaccine hesitancy, high satifaction can be kept as reference Reply: We appreciate your insightful suggestion. To make a reference group as the group at the lowest risk of vaccine hesitancy like other variables in the model, we set the high satisfaction group as reference for univariate, multivariate logistic models as well as interaction analyses. In the interaction analysis, we combined low and middle satisfaction groups to make the statistical analyses stable. The revised results are shown in table 4 and figure 3. Lines 35-38 “People with lower satisfaction to social relationships tended to be more hesitant to vaccinate their child among mothers in contrast to fathers who showed constant or lower hesitancy to vaccinate their child in the lower satisfaction group (LRT p=0.021).” Lines 216-219 “While fathers had constant or more intention to vaccinate their child at the lower level of satisfaction, mothers were more likely to hesitate to vaccinate their child when they had lower satisfaction regarding social relationship (Figure 3).” Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0261121.r002
29 Nov 2021 Decision Letter - Bijaya Kumar Padhi, Editor Factors of parental COVID-19 vaccine hesitancy: a cross sectional study in Japan PONE-D-21-34773R1 Dear Dr. Horiuchi, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Bijaya Kumar Padhi, PhD, MPH Academic Editor PLOS ONE Additional Editor Comments (optional): Thank you for submitting the revised version of your manuscript to PLOS ONE. After careful consideration, we feel that it has merit to meet PLOS ONE’s publication criteria. Reviewers' comments: https://doi.org/10.1371/journal.pone.0261121.r003
Formally Accepted
9 Dec 2021 Acceptance Letter - Bijaya Kumar Padhi, Editor PONE-D-21-34773R1 Factors of parental COVID-19 vaccine hesitancy: a cross sectional study in Japan Dear Dr. Horiuchi: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Bijaya Kumar Padhi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0261121.r004

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