Objective To construct a vaccine literacy evaluation system for community adults and to provide a basis for developing vaccine literacy measurement tools.

Methods The initial pool of vaccine literacy indicators was developed through a systematic literature review and group discussions, with reference to existing scales. Experts in immunization programs, disease control, epidemiology and related fields were invited to participate in two rounds of Delphi consultations. Indicators were screened and refined using importance scores, coefficients of variation, and full-score rates to form the evaluation system. Subsequently, selected indicators were converted into questionnaire items, and a convenience sample of community residents was surveyed for preliminary reliability and validity testing.

Results A total of 25 experts participated in the consultation. The effective response rates for the two rounds of questionnaires were 100.00% and 92.00%, respectively, and the expert authority coefficient was 0.90. Kendall’s concordance coefficients (Kendall’s W) for the two rounds were 0.386 and 0.413, respectively (both P<0.001). In the second round, the overall scores for the indicators ranged from 4.04 to 5.00, with coefficients of variation ranging from 0 to 0.25. After two rounds of expert consultation and revision, a vaccine literacy evaluation index system was established, comprising 53 indicators across five dimensions, including knowledge, ability, decision-making, vaccine-specific literacy, and recommendation literacy. Selected Likert-scaled items were converted into a questionnaire for preliminary reliability and validity analyses among residents. The overall Cronbach’s α was 0.850, and the KMO value was 0.91. Exploratory factor analyses identified three common factors, explaining 54.8% of the total variance, with all factor loadings above 0.4.

Conclusion The vaccine literacy evaluation index system for community adults in Shanghai, developed in this study, can serve as a reference for comprehensive assessment of population vaccine literacy, community vaccine health education, and improvement of immunization services.