Mnaamodzawin Vaccine Survey

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* 1. If offered, how likely are you to get the covid vaccine? On a scale of 1-5

1 - very unlikely

2 - unlikely

3 - neutral

4 - likely

5 - very likely

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* 2. If yes, which reasons would you say influenced your decision? (select all that apply)

To protect my health

To protect a family member's health

To protect the health of the community

To protect people I work with / get back to the workplace

To end the lockdown / so local businesses can open up

So the world can go back to normal (seeing friends and family , travel, etc)

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* 3. Do you have concerns about the safety of the vaccine?

yes

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* 4. If yes, can you describe your concern? (open ended Q)

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* 5. Will this affect whether or not you choose to get the vaccine?

yes

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* 6. Do you have concerns about possible side effects of the vaccine?

yes

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* 7. Will this affect whether or not you get the vaccine?

yes

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* 8. If you are going to decline the vaccine, is there another reason? Please describe. (open ended)

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* 9. Which sources do you see as most reliable for your covid information? (select all that apply)

TV news

Radio news

Announcements from Ontario Public Health

Announcements from the Whitefish River Health Centre

Facebook / Instagram

Other

Mnaamodzawin Vaccine Survey

Question Title

* 1. If offered, how likely are you to get the covid vaccine? On a scale of 1-5

Question Title

* 2. If yes, which reasons would you say influenced your decision? (select all that apply)

Question Title

* 3. Do you have concerns about the safety of the vaccine?

Question Title

* 4. If yes, can you describe your concern? (open ended Q)

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* 5. Will this affect whether or not you choose to get the vaccine?

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* 6. Do you have concerns about possible side effects of the vaccine?

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* 7. Will this affect whether or not you get the vaccine?

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* 8. If you are going to decline the vaccine, is there another reason? Please describe. (open ended)

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* 9. Which sources do you see as most reliable for your covid information? (select all that apply)

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* 10. Do you have any questions that you’d like answered by a community health nurse? (open ended)