Chapman, G.B. & Coups, E.J. Predictors of Influenza Vaccine Acceptance Among Healthy Adults

Appendix: Questions included in Studies 1 and 2.

S1 S2
x x 1. Did you receive a flu shot this Fall (1997)? (Y/N)
x 2. If you did receive a flu shot, approximately when did you receive it? (early Oct., late Oct., early Nov., late Nov.).
x 3. Did you know that your workplace was offering free flu shots this Fall? (Y/N)
x 4. Were you at your workplace when free flu shots were available? (Y/N)
x 5. Over the past 3 months, how has your overall quality of health been? (scale 1)
x 6. Do you have any flu symptoms right now? (Y/N)
x x 7. Last year, did you get a bad case of the flu? (Y/N)
x x 8. Did you have a flu shot last year (winter of 1996-97)? (Y/N)
x 9. How about the previous year-- did you have a flu shot? (winter of 1995-96)? (Y/N)
x x 10. Have you ever received a flu shot? (Y/N)
x x 11. Have you ever felt sick as result of the flu shot? (Y/N)
x x 12. How likely do you think it is that the flu vaccine would cause a person to have a severe reaction? (scale 2)
x x 13. How effective do you think the flu shot is, for example, in reducing your chances of getting the flu, or in reducing the severity of the flu if you do get it? (scale 2)
x 14. Of all the employees at your workplace similar to you in age and health status offered a flu shot, what percentage do you think accepted it? (10%, 30%, 50%, 70%, 90%)
x 15. Compared to all patients similar to you who did [did not] get a flu shot, how likely do you think you are to get the flu? (scale 3)
x 16. If you were to get the flu this winter, how severe would it be, compared to all patients similar to you who did [did not] get a flu shot? (scale 2)
x x 17. There are a number of things my doctor can do to ensure that I do not get the flu. (scale 4)
x x 18. There are a number of things I can do to ensure that I do not get the flu. (scale 4)
x x 19. Whether I get the flu or not is determined by chance factors. (scale 4)
x x 20. What was the most important reason for your decision about whether to have a flu shot? (free response)
21. For each of the following, tell me whether you have had this screening in the past 2 years:
x x      a. dental check up (Y/N
x x      b. general physical exam (Y/N)
x x      c. eye exam (Y/N)
Scale 1: (1) poor, (2) fair, (3) good, (4) very good, (5) excellent

Scale 2: (1) not at all, (2) a little, (3) somewhat, (4) moderately, (5) very much

Scale 3: (1) much less, (2) slightly less, (3) about the same, (4) slightly more, (5) much more

Scale 4: (1) disagree strongly, (2) disagree, (3) neither agree nor disagree, (4) agree, (5) agree strongly