Northeast Tri County Health District Parent Vaccine Survey Question Title * 1. Zip code you consider home: Question Title * 2. How old are you? 15-25 25-35 35-45 45 and over Question Title * 3. How many children live in your home? Question Title * 4. Where are your children currently enrolled in school? Public Private Homeschooled Other (please specify) Question Title * 5. Who do you trust the most and who do you trust the least for information regarding the vaccines, disease they prevent, safety of vaccines, and scheduling of the vaccine series? Rank most trustworthy at the top and least trustworthy at the bottom. (most trustworthy (1) to least trustworthy (7)) 1 2 3 4 5 6 7 N/A Primary Care Provider/Doctor N/A 1 2 3 4 5 6 7 N/A Pharmacist N/A 1 2 3 4 5 6 7 N/A Family N/A 1 2 3 4 5 6 7 N/A Friends N/A 1 2 3 4 5 6 7 N/A Internet N/A 1 2 3 4 5 6 7 N/A Government N/A 1 2 3 4 5 6 7 N/A Health District N/A Question Title * 6. Did you have an experience or know of someone who experienced an event in the past that would discourage you from getting a vaccine(s) for yourself or your child(ren)? Yes No If yes, can you describe it? Question Title * 7. Do you know anyone who does not take a vaccine because of religious or cultural reasons? Yes No Question Title * 8. Do you believe that there are other (better) ways to prevent vaccine preventable diseases than with a vaccine? Yes No If yes, explain: Question Title * 9. Which vaccine(s), if any, do you think are important for you? For your child(ren)? For your community? examples: Measles, Mumps, Rubella (MMR), Varicella (Chickenpox), Diphtheria-Tetanus-Pertussis (DTap, Tdap), Pneumococcal conjugate, Haemophilus influenzae type b, Polio, Influenza, Rotavirus, Hepatitis A and B... Question Title * 10. Do you feel that you know which vaccines you should get for yourself? Your child(ren)? Yes No Question Title * 11. Do you believe vaccine preventable diseases can be serious? Which one(s)? Yes No If yes, explain: Question Title * 12. Do you want more information/material/education about vaccines and the disease it prevents? Yes No Question Title * 13. Have you ever felt confused about number/scheduling of vaccines? Yes No Question Title * 14. Are you satisfied with your healthcare providers answers for your questions related on immunization? Yes No Question Title * 15. Are you concerned about any risks with vaccines? What kind of risks? Yes No If yes, explain: Question Title * 16. Do you think that vaccine benefits, in general, are larger than their risks? Yes No Question Title * 17. Do you think it is important for everyone to get recommended vaccines for themselves and their children? Yes No Question Title * 18. Did you feel social pressure to get the vaccine? Yes No Question Title * 19. Are most people you know vaccinated and/or are getting their children vaccinated? Yes No Question Title * 20. When a new vaccine is introduced, would you consider getting the vaccine? Yes No Question Title * 21. What is the first thing you want to know when a new vaccine is introduced or announced? Question Title * 22. Is access to immunization easy? Convenient in location? Yes No Other (please specify) Question Title * 23. What are the barriers for receiving vaccine(s) on time for you? For your child(ren)? Question Title * 24. Do you feel confident that the health center or doctor’s office will have the vaccine you need when you need them? Yes No Question Title * 25. Do you think it is possible to have too many vaccines? Yes No Question Title * 26. Is it better for a child to have multiple vaccines in one shot with fewer injections or to have individual vaccines? Multiple vaccines in one shot Individual vaccines Question Title * 27. Did a healthcare professional recommend that you do a delayed/alternative vaccine schedule? Yes No If yes, please describe: Question Title * 28. What is your gender: Male Female Nonbinary Other (please specify) Question Title * 29. How do you describe yourself? American Indian or Alaska Native Asian Black or African American Native Hawaiian/Pacific Islander White Hispanic, Spanish, Latina/o Multiracial Do not want to say Other (please specify) Question Title * 30. What is the highest level of education you completed? Less than high school High school or equivalent (GED) Some college Bachelor’s degree or higher Done