| Question | Answers | Source | Source Link | Dates Used | |
|---|---|---|---|---|---|
| 1 | Has your child(ren) missed a scheduled vaccine this year? | • Yes • No | Developed by RAPID Team | NA | 11/17/2020-11/19/2020 12/01/2020-12/03/2020 02/03/2021-02/06/2021 02/17/2021-02/19/2021 03/17/2021-03/20/2021 04/14/2021-04/16/2021 05/12/2021-05/14/2021 06/09/2021-06/11/2021 07/07/2021-07/09/2021 |
| 2 | Have you ever delayed having your child get a shot for reasons other than illness or allergy? Select all that apply | •Yes, prior to the COVID-19 pandemic (prior to 2020) •Yes,since the COVID-19 pandemic (2020 and later) •No •I don't know | RAPID Team modified | https://www.ncbi.nlm.nih.gov/pmc/articles/PMCMarch 17 - March 2057941/ | 11/17/2020-11/19/2020 12/01/2020-12/03/2020 02/03/2021-02/06/2021 02/17/2021-02/19/2021 03/17/2021-03/20/2021 04/14/2021-04/16/2021 05/12/2021-05/14/2021 06/09/2021-06/11/2021 07/07/2021-07/09/2021 |
| 3 | Have you ever decided not to have your child get a shot for reasons other than illness or allergy? Select all that apply. | •Yes, prior to the COVID-19 pandemic (prior to 2020) •Yes,since the COVID-19 pandemic (2020 and later) •No •I don't know | RAPID Team modified | https://www.ncbi.nlm.nih.gov/pmc/articles/PMCMarch 17 - March 2057941/ | 11/17/2020-11/19/2020 12/01/2020-12/03/2020 02/03/2021-02/06/2021 02/17/2021-02/19/2021 03/17/2021-03/20/2021 04/14/2021-04/16/2021 05/12/2021-05/14/2021 06/09/2021-06/11/2021 07/07/2021-07/09/2021 |
| 4 | Did you receive an influenza (Flu) vaccine for the 2019 flu season? | •Yes •No •Unsure | RAPID Team modified | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923753/ | 11/17/2020-11/19/2020 12/01/2020-12/03/2020 02/03/2021-02/06/2021 02/17/2021-02/19/2021 |
| 5 | Did your child(ren) aged 0-5 receive an influenza (Flu) vaccine for the 2019 flu season? | •Yes •No •Unsure | RAPID Team modified | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923753/ | 11/17/2020-11/19/2020 12/01/2020-12/03/2020 02/03 /2021-02/06/2021 02/17/2021-02/19/2021 |
| 6 | How likely are you to get a flu vaccination this season (2020-2021)—that is, this Fall or Winter? | • Already received • Will definitely get one • Will probably get one •Will probably not get one • Will definitely not get one | RAPID Team modified | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923753/ | 11/17/2020-11/19/2020 12/01/2020-12/03/2020 02/03/2021-02/06/2021 02/17/2021-02/19/2021 |
| 7 | How do you feel about the COVID-19 vaccine in terms of its safety and effectiveness, and what are your plans in terms of whether or not to get it? | Open ended response | RAPID Team Developed | NA | 03/17/2021-03/20/2021 04/14/2021-04/16/2021 05/12/2021-05/14/2021 06/09/2021-06/11/2021 07/07/2021-07/09/2021 09/15/2021-09/17/2021 |
| 8 | How likely are you to get the first generation COVID-19 vaccine as soon as it's available? | • Already received • Very likely • Somewhat likely • Not very likely • Not at all likely | RAPID Team modified | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923753/ | 11/17/2020-11/19/2020 12/01/2020-12/03/2020 02/03/2021-02/06/2021 02/17/2021-02/19/2021 |
| 9 | How likely are you to get your child(ren) aged 0-5 a flu vaccination this season (2020-2021)—that is, this Fall or Winter? | • Already received • Will definitely get one • Will probably get one •Will probably not get one • Will definitely not get one | RAPID Team modified | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923753/ | 11/17/2020-11/19/2020 12/01/2020-12/03/2020 02/03/2021-02/06/2021 02/17/2021-02/19/2021 |
| 10 | How likely are you to get your child under 12 years of age the COVID-19 vaccine as soon as it's available? | • Already received • Very likely • Somewhat likely • Not very likely • Not at all likely | RAPID Team modified | https://www.ncbi.nlm.nih.gov/pmc/articles/PMCMarch 17 - March 2057941/ https://www.ipsos.com/en-us/news-polls/axios-ipsos-coronavirus-index | 11/17/2020-11/19/2020 12/01/2020-12/03/2020 02/03/2021-02/06/2021 02/17/2021-02/19/2021 03/17/2021-03/20/2021 04/14/2021-04/16/2021 05/12/2021-05/14/2021 06/09/2021-06/11/2021 07/07/2021-07/09/2021 09/15/2021-09/17/2021 12/08/2021-12/14/2021 |