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Vaccine Questionnaire
1.
Have you participated in a Market Research interview or group discussion in the last 3 months?
Yes
No
2.
Do you, any of your family members or your close friends work in the following industries?
Market Research/ Marketing
Advertising
Media agencies (press/radio/TV)
Government
None of the above
3.
What is your gender?
Male
Female
4.
What age group do you belong to?
20-40 yrs
41-60 yrs
61yrs+
5.
Which race group do you belong to?
White
Coloured
Black
Other
6.
Where do you currently stay?
Western Cape
Gauteng
Free State
Limpopo
Northern Cape
Kwa-Zulu Natal
Eastern Cape
Mpumalanga
North-West
7.
Which income group do you belong to?
Less than R7000 per month
R7001 – R14 000 per month
R14 001+ per month
Do not wish to disclose
8.
Which of the below statements regarding the COVID-19 vaccine do you agre
e with most?
I will definitely get the COVID vaccine when it becomes available in South Africa
I am willing to get the COVID vaccine but I am worried/have a lot of questions about the vaccine and its administration
I am not sure if I will get the COVID vaccine as I have some concerns about it
I am not sure how I feel about the COVID vaccine and whether or not I will get it
I will definitely NOT be getting the COVID vaccine
9.
Thank you for filling in our survey. Are you willing to be contacted for us to get more information regarding your attitudes toward the Covid19 Vaccine? Note* You will only be contacted if you qualify for this survey.
Yes
No
10.
Please provide your contact
number if you are willing for us to contact you
Current Progress,
0 of 10 answered