Adapting and piloting a vaccine hesitancy questionnaire in rural Guatemala

•We adapted a Spanish language vaccine hesitancy tool to Guatemala with implementation science.•We piloted it with 150 parents, scoring it from 0 (not hesitant) to 10 (most hesitant).•45% (n = 67) parents scored 0, 41% (n = 61) scored 1–3, and 15% (n = 22) scored ≥ 4.•Most parents scoring > 0 worried children get more vaccines than are good for them.•Children of parents scoring ≥ 4 had decreased odds of timely vaccination at age 19 months. We sought to (i) adapt a Spanish-language vaccine hesitancy (VH) tool to rural Guatemala, (ii) pilot the tool with 150 parents of children ≤ 5 years, and (iii) measure if parent scores associated with child under-vaccination. We used implementation science to develop the adapted Guatemalan Vaccine Attitudes (GuaVA) tool, piloting it with 150 parents of children ≤ 5 years, and performing descriptive and adjusted regression analyses. Of 150 parents (response rate 99%), 55% (n = 83) of parents expressed a degree of VH. Children of parents with highly hesitant scores (n = 22) had 2.5 times the odds (OR 2.5; 95% CI: 1.2, 5.4) of being undervaccinated at 19 months, referent children of non-hesitant parents (n = 67). Vaccine hesitancy may be more prevalent in rural Guatemala than suspected. Implementation science facilitated the adaptation of a VH tool to rural Guatemala and may assist investigators in other settings.