PATH Vaccine Hesitancy Survey
Please know that this survey is anonymous
Demographics and geography
What is your gender?
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Are you married?
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Do you have children?
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What is your religion affiliation?
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What work do you do?
What is your country of origin?
What is your educational level?
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How long have you been living in the US?
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How long have you been living in the DMV area?
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Healthcare Access & Utilization
Do you have health insurance?
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Do you have a primary healthcare provider?
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Where do you usually go for healthcare services?
How often do you go to see your doctor, nurse, or another healthcare provider?
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What is the reason you usually see a doctor, nurse, or clinic?
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Do you ever go to the emergency room for yourself?
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COVID-19 and Health Information
Have you heard about the coronavirus or COVID-19 pandemic?
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Where do you usually get information about health, including information on COVID-19? Please choose all that apply:
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Do you trust your information source (where you get your information) about COVID 19?
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Do you feel you get enough information on COVID-19 testing, vaccines, and their safety?
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Do you have any concerns about you or your family member or friend getting vaccinated for the COVID virus?
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Are you aware that testing and vaccines are available for the coronavirus?
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Immunization Behavior
Have you been tested for coronavirus?
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Will you be more willing to take the COVID-19 test if it was provided by a healthcare provider you know or are familiar with?
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If you have not been tested yet, are you willing to be tested for the virus?
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Have you been vaccinated for the coronavirus or COVID 19?
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If No, are you willing to be vaccinated for the COVID 19 virus?
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Does it make a difference where you go to get vaccinated or who gives you the shot/vaccination?
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General Perceptions/Beliefs and Attitudes
Do you think a person who is not sick or does not show symptoms can spread the virus?
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Do you think vaccines, such as the one for coronavirus, can strengthen the immune system?
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Have you ever hesitated or refused to get any vaccination- either for yourself or a family member?
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Which of the following statements or phrases do you think applies to vaccines in general?
Parents only: Have you ever decided to have your child get a shot/vaccine for reasons other than illness or allergy?
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Parents only: Are you following the recommended shot schedule for your child or children?
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Would you want an infant to get all the recommended vaccine shots?
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Which of the following beliefs do you agree with?
Parents only: Are you concerned that your child might have a serious side effect from a shot/vaccine?
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Are you concerned that any of the childhood shots/vaccines might not be safe?
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Are you concerned that a shot might not prevent the disease?
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Do you know anyone who has had a bad reaction to a shot/vaccine, including you?
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