Vaccine Survey with Recorded Presentation

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We Would Like To Learn More About You.

We would like to ask you a few questions related to influenza (“flu”) vaccinations. Some of the questions will be repeated in the second part of the survey after a video presentation. Your responses will help us understand beliefs and behaviors related to flu vaccinations in the community. Results from this research survey will help us improve vaccine educational programming in the community.

By answering these questions, you are consenting to participate in this research survey. Your participation is voluntary. The information you provide in this research survey will be released only in summary format.

We will not collect any personal identifiers that can trace responses back to you. Confidentiality will be maintained to the degree permitted by the technology used. Your participation in this online research survey involves risks similar to a person’s everyday use of the Internet.

This research survey is being conducted by faculty at the University of Illinois at Chicago (UIC), College of Pharmacy and the UIC Research Protocol Number is 2020-1364. If you have any questions, please send an e-mail request to Dr. Robert DiDomenico at Rdidom1@uic.edu.

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What is your age?

18 - 64 years old

65 years or older

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Do you have any of the health problems listed below? (Check all that apply)

Diabetes

Heart problems (high blood pressure, heart failure, coronary artery disease, heart attack, etc.)

Respiratory problems (asthma, bronchitis, COPD, etc.)

Immune problems (HIV, take immunosuppressive medications)

I do not have any of the problems listed above

Have you received a flu vaccine in the last 12 months

Yes

I am not sure

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How effective or ineffective do you think the flu vaccines are in preventing the flu and its complications?

Very effective

Somewhat effective

Somewhat ineffective

Very ineffective

I don't know

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In your opinion, how safe or unsafe is the flu vaccine?

Very safe

Somewhat safe

Somewhat unsafe

Very unsafe

I don't know

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Which of the following concerns do you have about getting the flu vaccine? (Check all that apply)

I may get the flu if I receive a flu vaccine.

I’m concerned about the side effects of the vaccine.

I do not trust the government and what it says about the flu each year.

I have no concerns about the flu vaccine.

Sonstiges:

Do you plan to get the flu vaccine during this flu season (now through March 2021)?

Yes

I have not decided.

I already received my flu shot this season.

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Dieses Formular wurde bei University of Illinois Chicago erstellt.