Establishment and validation of a prediction model for intention to accept recombinant zoster vaccine among community residents based on reasoned action approach
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摘要:
目的 构建基于理性行为理论的重组带状疱疹疫苗（RZV）接种意愿预测模型，为提高居民RZV接种意愿提供理论依据。 方法 于2022年10 — 11月采用偶遇抽样方法在上海市金山区、闵行区和徐汇区选取4个社区卫生服务中心对前来门诊的1480名社区居民进行RZV接种意愿线上问卷调查；将最终纳入的1471名社区居民随机抽取其中2/3作为训练集（981人），剩余1/3作为验证集（490人），采用Lasso回归分析筛选训练集RZV接种意愿的影响因素，以筛选出的影响因素对训练集进行多因素非条件logistic回归分析建立nomogram预测模型，并通过受试者工作特征曲线 （ROC）及曲线下面积（AUC）评价模型的预测效能。 结果 上海市调查的1471名社区居民中，愿意接种RZV者123人，RZV接种意愿率为8.36%；Lasso回归分析筛选出的9个预测因子分别为感知的能力（β = 0.149）、感染风险（β = 0.074）、道德规范（β = 0.061）、决定的不确定性（β = – 0.060）、对疫苗接种的整体观点（β = – 0.007）、是否感染过带状疱疹（β = 0.812）、经济效益（β = – 0.014）、社会规范（β = 0.019）和态度（β = 0.003）；构建的nomogram预测模型结果显示，如果一个人未感染过带状疱疹，其感知的能力得分为7分、感知的感染风险得分为7分、道德规范得分为7分、决定的不确定性得分为7分、对疫苗接种的整体观点得分为42分、经济效益得分为28分、社会规范得分为49分、态度得分为42分，那么他半年内接种RZV的意愿为9.00%；对建立的nomogram预测模型进行内、外部验证结果显示，模型区分度（训练集的AUC为0.717、验证集的AUC为0.689）和校准度（训练集：χ2 = 9.061，P = 0.337、验证集：χ2 = 12.024，P = 0.150）均良好。 结论 感知的能力、感染风险、道德规范、决定的不确定性、对疫苗接种的整体观点、是否感染过带状疱疹、经济效益、社会规范和态度是影响居民RZV接种意愿的主要预测因子，本研究基于理性行为理论构建的RZV接种意愿预测模型具有良好的预测能力。 -
关键词:
- 重组带状疱疹疫苗(RZV) /
- 接种意愿 /
- 预测模型 /
- 构建 /
- 理性行为理论
Abstract:Objective To construct a prediction model for the intention of accepting recombinant zoster vaccine(RZV) vaccination among community residents based on reasoned action approach for promoting RZV vaccination in the population. Methods Totally 1 480 attendees of four community health service centers were recruited with accidental sampling in three districts of Shanghai city for an online survey conducted during October – November 2022. The vaccination intention scale developed by Vissor et al was translated into Chinese and modified to collect participants′ information relevant to accept RZV vaccination. Of the 1 471 individual data from eligible respondents, 981 and 490 were randomly assigned into a training set and a test set. Lasso regression analysis on the data of training set was performed to explore the determinants of RZV vaccination intention. A nomogram prediction model for RZV vaccination intention was constructed using multivariate logistic regression analysis on the data of training set and the performance of the established model was evaluated with the receiver operating characteristic curve (ROC). Results The intention to have RZV vaccination within 6 months was reported by 8.36% (123) of the eligible respondents. The results of Lasso regression analysis screened out nine predictive factors of RZV vaccination intention, including perception ability (β = 0.149), perceived infection risk (β = 0.074), moral norm (β = 0.061), decisional uncertainty (β = – 0.060), general vaccination beliefs (β = – 0.007), never having herpes zoster infection (β = 0.812), perceived cost-benefit (β = – 0.014), social norm (β = 0.019), and attitude (β = 0.003) and the nine factors were used to construct the prediction model. Based on the nomogram of the established prediction model, the possibility to have RZV vaccination within next 6 months is 9.00% for the respondents never having herpes zoster infection and with following scale items′ scores: 7 for perception ability, 7 for perceived infection risk, 7 for moral norm, 7 for decisional uncertainty, 42 for general vaccination beliefs, 28 for perceived cost-benefit, 49 for social norm, and 42 for the attitude towards RZV vaccination. The results of internal and external validation analysis showed that the established model is of good differentiation and calibration（the area under the curve [AUC]training set = 0.717, AUCtest set = 0.689; χ2training set = 9.061, degree of freedom [df]training set = 8, p training set = 0.337, χ2test set = 12.024, dftest set = 8, ptest set = 0.150）. Conclusion Perception ability, perceived infection risk, moral norm, decisional uncertainty, general vaccination beliefs, whether or not having herpes zoster infection, perceived cost-benefit, social norm, and attitude towards RZV vaccination are main predictive factors for RZV vaccination intention among community residents of Shanghai city. -
图 1 RVZ接种意愿nomogram预测模型
Figure 1. Nomogram prediction model for determinants of RVZ vaccination intention among community residents in Shanghai city
图 2 RVZ接种意愿nomogram预测模型的ROC曲线图
Figure 2. Training set's and test set's ROC curve of the established nomogram prediction model for RVZ vaccination intention among community residents of Shanghai city
图 3 RVZ接种意愿nomogram预测模型的校准曲线图
Figure 3. Training set's and test set's calibration curve of the established nomogram prediction model for RVZ vaccination intention among community residents of Shanghai city
表 1 训练集与测试集差异性检验
Table 1. Differences in age, cognition on and attitude towards RZV vaccination between attendees of community health service centers of training set (n = 981) and test set (n = 490) in Shanghai city
变量 训练集 测试集 t 值 P 值 年龄（岁） 44.31 ± 14.044 43.53 ± 13.093 1.053 0.293 感知的能力 5.11 ± 1.530 5.19 ± 1.479 – 0.938 0.348 感染风险 4.64 ± 1.654 4.64 ± 1.660 0.026 0.979 感染的严重性 5.10 ± 1.525 5.19 ± 1.530 0.026 0.246 不良反应的严重性 4.55 ± 1.618 4.54 ± 1.630 0.130 0.897 道德规范 5.09 ± 1.461 5.11 ± 1.477 – 0.352 0.725 决定的不确定性 4.00 ± 1.728 4.02 ± 1.755 – 0.169 0.866 预期的负面影响 4.08 ± 1.743 4.08 ± 1.746 0.010 0.992 主观能动 5.11 ± 1.549 5.11 ± 1.590 – 0.036 0.971 对疫苗接种的整体观点 28.32 ± 7.335 28.28 ± 7.417 0.107 0.915 自我效能 21.22 ± 5.303 21.49 ± 5.158 – 0.933 0.351 不良反应的风险 10.40 ± 2.656 10.48 ± 2.634 – 0.541 0.589 经济效益 18.96 ± 4.936 19.11 ± 4.771 – 0.565 0.572 社会规范 33.02 ± 9.252 33.30 ± 9.164 – 0.554 0.580 态度 29.71 ± 8.222 30.09 ± 8.072 – 0.851 0.395 
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表 2 训练集RVZ接种意愿影响因素多因素logistic回归分析
Table 2. Determinant factors of RVZ vaccination intention among 981 attendees of community health service centers of training set in Shanghai city: multivariate logistic regression analysis
预测因子 β $S_{\bar x}$ Wald χ2 值 P 值 OR 值 95%CI 感知的能力 0.237 0.169 1.400 0.160 1.268 0.829～3.115 感染风险 0.161 0.114 1.410 0.158 1.175 0.882～2.159 道德规范 0.136 0.172 0.790 0.430 1.145 0.668～2.575 决定的不确定性 – 0.004 0.101 – 0.040 0.970 0.996 0.668～1.475 对疫苗接种的整体观点 – 0.044 0.027 – 1.640 0.101 0.957 0.417～1.080 是否感染过带状疱疹 1.064 0.291 3.660 0.000 2.898 1.639～5.124 经济效益 – 0.060 0.040 – 1.500 0.133 0.942 0.435～1.117 社会规范 0.042 0.027 1.540 0.123 1.043 0.873～3.156 态度 – 0.006 0.033 – 0.180 0.855 0.994 0.434～2.001
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