Vaccine confidence
Vaccine confidence survey
This is a NO JUDGEMENT, ANONYMOUS survey. The results will go to Clayton Calling the Shots Vaccine Grant team.
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1.
Have you received a COVID-19 vaccine?
(Required.)
Yes (Click done. You are finished)
No (Please answer the next five questions)
2.
If you answered no, please select from the following reasons.
I am concerned side effects will prevent me from going to work
I can’t go on my own (I have a physical limitation)
It’s too far away
I don’t know where to go to get vaccinated.
I have a medical reason that makes me ineligible to get vaccinated (e.g., I have had a severe allergy to vaccines in the past).
I do not feel that it is safe.
I have already had COVID
Other (please specify)
3.
What would motivate you to get vaccinated? (Select all that apply)
Protect my health.
Protect the health of my family/friends
Protect the health of my coworkers
Protect the health of my community
To get back to work/school
To resume social activities
To resume travel
Because my family/friends encouraged me
Because my employment requires it
Other (please specify)
4.
Choose the top 3 ways in which you receive information about COVID vaccinations.
Employer
Social media (Facebook, Twitter, Instagram, TikTok)
CDC (Centers for Disease Control)
Medical websites such as MayoClinic or WebMD
Personal healthcare provider (Personal physician, nurse practitioner, physician assistant)
Family and friends
FDA (Federal Drug Administration)
News sources (e.g., television, internet, and radio)
Religious leaders
Other (please specify)
5.
If safety is a concern, what are the top two reasons for not getting vaccinated?
The vaccine has not been studied long enough.
Concerned about blood clots.
Concerned about the vaccine affecting my reproduction.
Concerned that some ingredients for vaccines may not be safe long-term
Natural immunity from catching COVID-19 is safer and/or better than immunity from a vaccine
Other (please specify)
6.
If your concerns and questions are answered, how likely is it that you will receive the vaccine?
Very likely
Likely
Neither likely nor unlikely
Unlikely
Very unlikely
Current Progress,
0 of 6 answered