Parent Covid-19 Vaccine Questionnaire
Parent Covid-19 Vaccine Questionnaire
Welcome to the Parent Covid-19 Vaccine Questionnaire, where you can share your insights and preferences regarding the Covid-19 vaccination for children. This quiz aims to gather valuable information and understand parents' perceptions and concerns surrounding the vaccine.
Your responses will help inform discussions regarding child vaccinations in the context of Covid-19. Let's explore important topics:
- Vaccination status
- Concerns about safety
- Influencing factors
Have you received the Covid-19 vaccine?
Yes
No
Are you in the medical profession?
Yes
No
If you are in the medical profession, did this have any bearing on whether or not you chose to vaccinate your child/children against Covid?
Yes
No
N/a
What age group do you children belong to? Select all that apply.
Birth to 4 years old
5 to 11 years old
12 or older
What is your stance on the Covid-19 vaccine specifically for ages 5-11?
Pro- vaccination
Anti- vaccination
Undecided
Have any of your children received the Covid vaccine?
Yes
No
If you had your child vaccinated, did you feel pressured due to travel and other restrictions requiring vaccination for both adults and children?
Yes
No
N/A
Do you or have you had concerns about your child getting vaccinated for Covid?
Yes
No
What concerns, if any, do/did you have in regards to obtaining the Covid vaccine for your child? Select all that apply.
Adverse side effect related to the Covid vaccine
Not enough information regarding long term side effect of the vaccine
The vaccine being a mRNA vaccine
Growth and Development concerns related to the vaccine
All of the above
None of the above
Other
What potential side effects of the Covid-19 vaccines are you concerned about regarding your children and vaccinations? Select all that apply
Immune response (fever, rash, swelling at injection side, fatigue, etc..)
Myocarditis
Unknown side effects
Death
Other
Have any of your children tested positive for Covid-19 since the start of the pandemic?
Yes
No
Do you worry about your child getting seriously ill from Covid-19?
Yes
No
Are you aware that according to recent studies, Covid is listed as one of the leading killers among children?
Yes
No
How does watching the spread of Covid-19 make you feel about getting your child vaccinated?
Increases chance of vaccinating
Decreases chance of vaccinating
I will not have my child vaccinated
My child is already vaccinated
What sources do you commonly use to obtain information about Covid and the Covid vaccine? Select all that apply.
Social media (facebook, tiktok, twitter, etc..)
Medical literature
The News
Medical professionals (doctors, nurses, pharmacist, etc..)
All of the above
None of the above
Do you trust the the CDC recommendations regarding the Covid-19 vaccine for ages 5-11?
Yes
No
Do you trust the American Academy of Pediatrics recommendations and guidelines regarding the administration of Covid vaccines for children?
Yes
No
Does your pediatrician talk to you about recommendations for your children regarding the Covid vaccine?
Yes
No
Do positive studies and literature on the Covid-19 vaccines make you more confident?
Yes
No
Does the fact children 5-11 are only eligible for the Pfizer-BioNTech COVID-19 vaccine have any bearing on whether or not you vaccinate your children?
Yes
No
If Moderna or Johnson and Johnson vaccines were available for children ages 5-11 would this increase your likelihood to obtain vaccination for your children?
Yes
No
Do you take precautions against Covid-19 for you and your children? If yes, what precautions (masking, handwashing, social distancing, etc..
Yes
No
Have you personally been affected by the death or serious illness related to Covid 19?
Yes
No
If yes, did this have any bearing on whether or not you chose to vaccinate your child if eligible?
Yes
No
N/A
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