COVID-19 vaccine hesitancy among Mexican outpatients with rheumatic diseases

Figures & data

Table 1. No (%) of patients with at least one visit to the outpatient clinic with the ten most frequent diagnoses specified (January 2019 to December 2019)

Outpatient clinic INCMyN-SZ n = 4476		Outpatient clinic HGM n = 12935
Specific rheumatic diagnosis^a	no (%)	Specific rheumatic diagnosis^a	no (%)
Systemic Lupus Erythematosus	1652 (36.9)	Rheumatoid Arthritis	5673 (43.9)
Rheumatoid Arthritis	1578 (35.3)	Systemic Lupus Erythematosus	3109 (24)
Systemic Sclerosis	239 (5.3)	Osteoarthritis	851 (6.6)
Systemic Vasculitis	220 (4.9)	Fibromyalgia	773 (6)
Primary Sjögren’s Syndrome	190 (4.2)	Gout	759 (5.9)
Spondyloarthritis	174 (3.9)	Systemic Sclerosis	691 (5.3)
Inflammatory myopathies	150 (3.4)	Inflammatory myopathies	373 (2.9)
PAPS	150 (3.4)	Ankylosing Spondylitis	283 (2.2)
MCTD	94 (2.1)	Human Adjuvant Disease	259 (2)
Adult Still disease	29 (0.6)	PAPS	164 (1.3)

PAPS = Primary Anti-Phospholipid Syndrome; MCTD = Mixed Connective Tissue Disease.

^aDiagnosed based on the attending rheumatologist criteria. INCMyN-SZ = Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. HGM = Hospital General de México Dr. Eduardo Liceaga.

Table 2. COVID-19 VH questionnaire feasibility

Feasibility categories	n (%) of patients
Adequate time to fill the questionnaire	50 (100)
Incomplete questionnaires^a	2 (4)
Perceived instructions clarity	49 (98)
Perceived items clarity	49 (98)
Perceived items scale response clarity	49 (98)
Format acceptance	49 (98)

^aTwo patients referred skipped items. Mean ± SD minutes to fill the questionnaire was: 1.6 ± 0.6.

Table 3. Summary of the translation and adaptation to RMDs of the Oxford COVID-19 vaccine hesitancy scale

STEPS	MODIFICATIONS AND INCORPORATIONS
Preparation	Two local collaborators were recruited; both were bilingual (Spanish, English) and specialists in infectious diseases and rheumatology. In addition, the Oxford COVID-19 Vaccine Hesitancy Scale developer (Daniel Freeman) agreed to collaborate.
Forward translation	Two independent forward translations were received (English-Spanish), which were identical. Translations were provided by two different certified translators.
Reconciliation of the forward translation into one single forward translation and adaptation to RMDs	The translation was adapted to RMDs by two rheumatologists and one PhD in Health Sciences (expert in RMDs). Each one proposed one RMDs-adapted version. RMDs-adapted versions were evaluated by an experts-committee, integrated by nine patients with RMDs, five rheumatologists, four infectious diseases specialists, one general physician and one psychologist. Experts evaluated items and instructions from each version and a final version was integrated after ≥ 80% of the participants agreed.
Back translation	One backward translation into the source language (English) was performed by a certified translator (version 1).
Back translation review	The developer of the original instrument approved the back translation, although suggested modifications to item one and to item six (version 2).
Harmonization	The project responsible (VPR) did not identify potential problematic items.
Cognitive debriefing	The version 2 was evaluated and approved by nine outpatients with RMDs: three patients had Rheumatoid Arthritis, two patients had Systemic Lupus Erythematosus, two patients had IgG4-related disease, one patient had Primary Antiphospholipid Syndrome and one patient had Overlap Disease.
Review of cognitive debriefing results and finalization	The version 2 was approved by the project responsible. Terms were harmonized along the questionnaire.
Proofreading	The version 2 was proofread by the project responsible and the local collaborators.
Final report	Elaborated by the responsible of the project.

Table 4. Description of the samples´ characteristics

	S-1 n = 50	S-2 n = 208	S-3 n = 600
Sociodemographic characteristics
Female sex*	45 (90)	185 (88.9)	519 (86.5)
Years of age	47 (36.8–56)	48 (36–58.8)	46 (35–56)
Years of formal education	12 (9–17)	12 (9–16)	12 (9–15)
Formal and non-formal job*	24 (48)	83 (39.9)	252 (42)
Married or Living with a partner*	22 (44)	101 (48.6)	314 (52.3)
Universal access to health care*	11 (22)	56 (26.9)	148 (25.5)
Disease related-variables
Patients with RA diagnosis*	15 (30)	71 (34.1)	202 (33.7)
Patients with SLE diagnosis*	21 (42)	90 (43.3)	245 (40.8)
Years of disease duration	10.5 (6–17)	12 (6–20.8)	9 (4–16)
Rheumatic Diseases Comorbidity Index score	1 (0–1)	1 (0–1)	0 (0–1)
One year-previous hospitalizations*	5 (10)	33 (15.9)	48 (13)
Patients with adequate disease activity control*	37 (74)	155 (74.5)	453 (75.6)^b
Treatment-related variables
Immunosuppressive drugs*	44 (88)	165 (79.3)	529 (88.2)
No of immunosuppressives/patient^a	2 (1–2)	2 (1–2)	1 (1–2)
Corticosteroids use*	23 (46)	103 (49.8)	259 (43.2)
Treatment direction (after consultation)*^b
No changes	29 (58)	116 (55.8)	294 (49.1)
Treatment intensification	8 (16)	47 (22.6)	153 (25.5)
Treatment reduction	12 (24)	35 (16.8)	112 (18.7)
Treatment changes because adverse events	1 (2)	9 (4.3)	17 (2.8)

Data presented as median (Q25-Q75) as otherwise indicated.

*Number (%) of patients.

^aAmong those with the characteristic.

^bSeven missing data.

Figure 1. Rheumatic diagnoses distribution in S-1, S-2 and S-3.

Table 5. Item loadings for the 1-factor of the C19-VH questionnaire

	1
Would you take a COVID-19 vaccine (approved for use in the Mexico) if offered?	0.791
Currently there are different COVID-19 vaccines. You consider that:	0.853
I would describe my attitude toward receiving a COVID-19 vaccine as:	0.800
If a COVID-19 vaccine was available for you, you would:	0.781
If my family or friends were thinking of getting a COVID-19 vaccination, I would:	0.740
Regarding COVID-19 vaccination, I would describe myself as:	0.812
I consider that taking a COVID-19 vaccination is:	0.663

Matrix to 1-component extracted with the method of principal component analysis.

Table 6. Psychometric characteristics of the C19-VH questionnaire

	Median (Q25-Q75)	Cronbach Alpha^a	ICC (95% CI)^b	Floor/ceiling effects (%)
Item 1. Would you take a COVID-19 vaccine (approved for use in Mexico) if offered?	1 (1–2)	0.891	0.765 (0.645–0.845)	67.3/3.4
Item 2. Currently there are different COVID-19 vaccines. You consider that:	2 (1–2)	0.874	0.807 (0.709–0.873)	45.2/2.4
Item 3. I would describe my attitude toward receiving a COVID-19 vaccine as:	2 (1–3)	0.863	0.646 (0.466–0.766)	24/1
Item 4. If a COVID-19 vaccine was available for you, you would:	1 (1–1)	0.873	0.721 (0.578–0.816)	79.8/2.4
Item 5. If my family or friends were thinking of getting a COVID-19 vaccination, I would:	2 (1–2)	0.875	0.781 (0.668–0.856)	40.9/1
Item 6. Regarding COVID-19 vaccination, I would describe myself as:	2 (2–2)	0.880	0.804 (0.703–0.871)	21.6/1
Item 7. I consider that taking a COVID-19 vaccination is:	1 (1–2)	0.871	0.506 (0.257–0.672)	55.8/1
COVID-19 VH questionnaire	1.6 (1.3–2)	0.889	0.933 (0.898–0.956)	12/0.5

^aIf item deleted (but for COVID-19 VH questionnaire data).

^bIn 91 randomized patients from S-2. ICC: Intraclass correlation coefficient. CI: Confidence Interval.