! ! Vaccine'Hesitancy'Survey'Questions'Related'to'SAGE'Vaccine'Hesitancy' Matrix'' Examples)of)survey)questions)designed)to)assess)determinants)of)vaccine) hesitancy) ) Vaccine!hesitancy!is!an!emerging!term!in!the!literature!and!discourse!on!vaccine!decision5making! and!determinants!of!vaccine!acceptance.i!To!date!various!surveys!have!been!developed!to!assess! individual!attitudes!as!well!as!concerns!around!the!risks!and!benefits!immunizationii,iii,iv,v,vi,vii!yet!few! surveys!are!available!to!specifically!assess!or!measure!the!prevalence!or!degree!of!vaccine!hesitancy! in!a!populationviii,ix.!Even!less!surveys!have!been!validatedx,xi.!In!addition!the!majority!of!available! surveys!has!been!conducted!in!high!income!countries!and!predominately!focuses!on!identifying! vaccine!hesitancy!at!the!individual!level!only!and!not!its!underlying!determinants.!!
A!universally!validated!compendium!of!survey!questions!is!needed!to!identify!vaccine!hesitant! populations!and!the!drivers!of!their!reluctance!at!the!global,!national!or!subnational!level,!in!order! to!tailor!targeted!interventions!aiming!at!increasing!vaccine!acceptance!and!ultimately!immunization! rates.!A!standardized!compendium!of!survey!questions!would!further!ensure!intra5!and!intercountry! comparison!of!the!determinants!leading!to!vaccine!hesitancy.!!!! The!SAGE!Working!Group!on!Vaccine!Hesitancyxii!defined!the!term!Vaccine!Hesitancy:! “Vaccine!hesitancy!refers!to!delay!in!acceptance!or!refusal!of!vaccines!despite!availability!of!vaccine! service.!Vaccine!hesitancy!is!complex!and!context!specific!varying!across!time,!place!and!vaccines.!It! is!influenced!by!factors!such!as!complacency,!convenience!and!confidence.”! ! In!addition!the!Working!Group!developed!a!model!of!determinants!of!vaccine!hesitancy,!based!on!a! systematic!review!of!literature!i!!and!interviews!with!immunization!managers,!which!categorized! drivers!into!contextual!influences,!individual!and!group!influences!and!vaccine!or!vaccination!specific! issuesxiii.!The!model!of!determinants!was!seen!as!a!useful!tool!to!guide!the!selection!of!survey! questions!sensitive!and!specific!to!vaccine!hesitancy!in!order!to!provide!information!not!only!on!the! overall!prevalence!of!vaccine!hesitancy!but!also!its!underlying!determinants.!!
The!Working!Group!developed!de5novo!survey!questions!tailored!to!the!specific!determinant.!In! addition,!survey!questions!x!from!a!validated!parental!assessment!instrument!of!vaccine!hesitancy! were!categorized!to!fit!the!specific!determinants.!! The!working!group!notes!that!these!example!survey!questions!represent!a!range!of!questions!to! draw!from!which!could!be!considered!based!on!the!circumstances!and!context.!The!list!of!example! survey!questions!can!be!found!in!the!Table!A5.3!.1,!Table!A5.3.1!and!Table!A5.3.2!below.!Questions! highlighted!in!italics!bold,!are!question!within!the!18!item5containing!!validated!Parent!Attitudes! about!Childhood!Vaccines!(PACV)!survey!to!assess!vaccine!hesitant!parents!in!the!US!x.!Factor! analysis!was!used!to!confirm!survey!sub5domains!and!Cronbach's!α!to!determine!the!internal! consistency!reliability!of!sub5domain!scales.!Construct!validity!was!assessed!by!linking!parental! responses!to!their!child's!immunization!record!xi.! The!listed!example!questions!are!not!intended!to!all!be!used!within!one!questionnaire!but!rather! present!a!set!of!questions!to!be!considered!and!chosen!from!based!on!the!individual!needs.!The! Working!Group!acknowledges!that!the!survey!question!selection!needs!to!fit!the!context!they!are! used!in.!Construct!and!content!validity!to!assess!the!individual!determinant!of!vaccine!hesitancy!of! this!survey!question!compendium!needs!to!be!assessed.!To!further!ensure!that!the!objective!of!the! compendium!is!met,!the!assessment!of!vaccine!hesitancy!and!its!determinants!within!various! settings!covering!all!levels!income,!pilot5testing!of!these!survey!questions!needs!to!be!ensured!in! low5,!middle!and!high5income!countriesxiv!within!all!6!WHO!regionsxv.!!Particular!attention!needs!to! be!given!to!ensuring!validity!when!translating!the!compendium!to!languages!other!than!English.! Based!on!the!results!of!this!pilot5testing,!questions!may!need!to!be!added!or!altered.!!
1! ! ! ! Table A5.3 .1: Survey questions to assess contextual influences of vaccine hesitancy
CONTEXTUAL*INFLUENCES* Influences*arising*due*to*historic,*socio>cultural,*environmental,*health*system/institutional,*economic*or*political*factors* a. Communication*and* b.*Influential*leaders,** c.*Historical*influences* d.*Religion/culture/gender/* e.!Politics/policies!! f.*Geographic*barriers!! g.*Pharmaceutical* media*environment** gatekeepers*and** ! socio>economic*! (Mandates)! ! industry!! ! anti>*or*pro>vaccination* ! ! lobbies* Media!and!social!! Community!leaders!and! Negative!historic! A!few!examples!of!the! Vaccine!mandates!can! A!population!can!have! Industry!may!be!distrusted! media!can!create!a! influencers,!including! influences!such!as!the! interplay!of!religious/cultural! provoke!vaccine!hesitancy! general!confidence!in!a! and!influence!vaccine! negative!or!positive! religious!leaders!in!some! Trovan!trial/!Wakefield! influences!include:! not!necessarily!because!of! vaccine!and!health!service,! hesitancy!when!perceived! vaccine!sentiment!and!can! settings,!celebrities!in! MMRDautism!scare!can! ! safety!or!other!concerns,! and!be!motivated!to! as!driven!only!by!financial! provide!a!platform!for! others,!can!all!have!a! undermine!public!trust! Some!religious!leaders!prohibit! but!due!to!resistance!to! receive!a!vaccine!but! motives!and!not!in!public! lobbies!and!key!opinion! significant!influence!on! and!influence!vaccine! vaccines! the!notion!of!!forced! hesitate!as!the!health! health!interest;!This!can! leaders!to!influence!others;! vaccine!acceptance!or! acceptance,!especially! ! vaccination!! center!is!too!far!away!or! extend!to!distrust!in! social!media!allows!users!! hesitancy.!! when!combined!with! Some!cultures!do!not!want! ! access!is!difficult.!! government!when! to!freely!voice!opinions! ! pressures!of!influential! men!vaccinating!children! ! perceived!that!they!are! and!experiences!and!it!can! leader/media.!Community! ! also!being!pushed!by! facilitate!the!organization! experience!isn’t! Some!cultures!value!boys!over! industry!and!not! of!social!networks!for!or! necessarily!limited!to! girls!and!fathers!don’t!allow! transparent.! against!vaccines.! vaccination!but!may!affect! children!to!be!vaccinated).! ! it.! Who!do!you!trust!the!most! Some!groups!or!leaders!do! Do!you!remember!any! Do!you!know!anyone!who! Do!you!trust!(or!distrust)! Has!distance,!timing!of! Do!you!believe!the!vaccine! for!information?! not!agree!to!vaccination! events!in!the!past!that! does!not!take!a!vaccine! that!your!government!is! clinic,!time!needed!to!get! producers!are!interested! Who!do!you!trust!the! for!different!reasons.!In! would!discourage!you! because!of!religious!or! making!decisions!in!your! to!clinic!or!wait!at!clinic! in!your!health?! least?! general,!do!you!agree!or! from!getting!a!vaccine(s)! cultural!reasons?!Do!you! best!interest!with!respect! and/or!costs!in!getting!to! disagree!with!these! for!yourself!or!your! agree!or!disagree!with!these! to!what!vaccines!are! clinic!prevented!you!from! groups?!! children?! persons?!Do!you!think!they! provided?!! getting!your!child! are!risking!their!health!or!the! ! immunized?! health!of!their!child!if!they!do! not!take!a!vaccine?!! Have!reports!you! Do!leaders!(religious,! Can!you!name!an!event!in! Does!your!religion/! Did!you!ever!disagree! The!time/cost/effort!of! Do!you!think!governments! heard/read!in!the!media/! political,!teachers,!health! the!past!that!diminished! philosophy/!culture! with!the!choice!of!vaccine! traveling!to!the! are!“pushed”!by!lobbyists! on!social!media!made!you! care!workers)!in!your! your!trust!in!vaccination?!! recommend!against!(a!certain)! or!vaccination! doctor/health!post/!clinic! or!industry!to!recommend! reEconsider!the!choice!to! community!support! ! vaccination?!If!so,!which/all! recommendation! with!young!children!is!not! certain!vaccines?! have!your!child! vaccines!for!infants!and! vaccines?!What!is!the!reason?! provided!by!your! worth!for!receiving! vaccinated?! children?! ! government?! vaccination!only?!
2! ! ! ! Do!you!share!information! Would!it!trigger!doubts!to! Has!your!community!ever! What!do!you!consider!more! I’m!convinced!that!my! What!is!the!maximum! Do!you!trust! related!to!vaccination! have!your!child! felt!the!need!to!urgently! importantE!vaccination!of! government!purchases! amount!of!time!you!would! pharmaceutical!companies! within!your!social!media! vaccinated,!if!a!celebrity! introduce!a!new!vaccine?! boys!or!vaccination!of!girls?! the!highest!quality! be!able!or!willing!to!spend! to!provide!safe!and! network?!What!type!of! advocates!against!(a! Why?! vaccines!available.!! to!get!a!vaccine!for! effective!vaccines?! information?! certain)!vaccine?! yourself!or!your!children?!
Do!you!recall!a!vaccine! Has!your!imam/priest/! Has!your!community!in! Have!you!ever!refused!a! Did!you!ever!have!the! If!you!have!to!spend!more! ! that!was!positively! rabbi!ever!advocated! the!past!refused!to!accept! vaccine!as!you!considered!it! impression!your! than!one!hour!getting!a! debated!in!the!media?!If! against!vaccination?!Did! certain!vaccines?!Which! to!include!porcine!or!other! government/health!care! vaccine,!is!it!important! so,!which!one!and!would! you!follow!this!advice?! vaccine(s)!and!why?! animal!derived!ingredients! provider!did!not!provide! enough!to!travel!for!it?!! you!still!want!this!vaccine! ! (nonEhalal,!nonEkosher)?! you!with!the!best!vaccine! for!yourself/!your!child?! on!the!market?! Do!you!believe!in!reports! ! ! Would!you!refuse!a!vaccine! The!only!reason!I!have! Has!your!lifeEstyle! ! in!the!media!by!parents! for!you/your!child!if!the! my!child!get!shots!is!so! (nomadic/!located!in! claiming!to!have!lost!a! vaccinator!was!male/female! they!can!enter!daycare!or! different!places!throughout! child!to!a!vaccine! or!from!a!different!ethnic! school.!! the!course!of!the!year)! preventable!disease?!Does! background/religion!than! ever!prevented!you!to! this!affect!your!decision!to! yourself?! receive!a!vaccine!for! vaccinate!your!child?! yourself/your!child?! ! ! ! ! Does!your!child’s! ! ! daycare/!school!require/! advice!to!have!your! children!vaccinated?!Do! you!agree?! !
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3! ! ! ! Table A5.3.1: Survey questions to assess individual and group influences of vaccine hesitancy
INDIVIDUAL*and*GROUP**INFLUENCES* Influences*arising*from*personal*perception*of*the*vaccine*or*influences*of*the*social/peer*environment! a.*Experience*with*past* b.Beliefs,*attitudes*about* c.Knowledge/awareness* d.*Health*system*and*providers> e.*Risk/benefit*(perceived,* f.*Immunisation*as*a*social* vaccination* health*and*prevention** ! trust*and*personal*experience.! heuristic)** norm*vs.*not*needed/harmful! ! ! ! Past!negative!or!positive! Vaccine!hesitancy!can!result! Decisions!to!vaccinate!or!not!are! Trust!or!distrust!in!government! Perceptions!of!risk!as!well!as! Vaccine!acceptance!or!hesitancy! experience!with!a!particular! from!1)!beliefs!that!vaccine! influenced!by!a!number!of!the! or!authorities!in!general,!can! perceptions!of!lack!of!risk!can! is!influenced!by!peer!group!and! vaccination!can!influence! preventable!diseases!(VPD)!are! factors!addressed!here,! affect!trust!in!vaccines!and! affect!vaccine!acceptance.! social!norms! hesitancy!or!willingness!to! needed!to!build!immunity!(and! including!level!of!knowledge!and! vaccination!programmes! Complacency!sets!in!when!the! ! vaccinate.!! that!vaccines!destroy!important! awareness.!Vaccine!acceptance! delivered!or!mandated!by!the! perception!of!disease!risk!is!low! Knowledge!of!someone!who! natural!immunity)!or!2)!beliefs! or!hesitancy!can!be!affected!by! government.!Past!experiences! and!little!felt!need!for! suffered!from!a!VPD!due!to!nonD! that!other!behaviors! whether!an!individual!or!group! that!influence!hesitancy!can! vaccination.!E.g.!Patient’s!or! vaccination!may!enhance! (breastfeeding,! has!accurate!knowledge,!a!lack! includes!system!procedures!that! caregiver’s!perceptions!of!their! vaccine!acceptance.!Personal! traditional/alternative!medicine! of!awareness!due!to!no! were!too!long!or!complex,!or! own!or!their!children’s!risk!of! experience!or!knowledge!of! or!naturopathy)!are!as!or!more! information,!or!misperceptions! personal!interactions!were! the!natural!disease!or! someone!who!experienced!an! important!than!vaccination!to! due!to!misinformation.!! difficult.* caregivers’!perceptions!of!how! AEFI!(adverse!event!following! maintain!health!and!prevent! Accurate!knowledge!alone!is!not! ! serious!or!life!threatening!the! immunization)!can!also! VPDs.!! enough!to!ensure!vaccine! VPD!is.! influence!hesitancy.! ! acceptance,!and!misperceptions! ! may!cause!hesitancy,!but!still! result!in!vaccine!acceptance.! ! Have!you!ever!not!accepted!a! Can!you!tell!me!what!a!vaccine! Do!you!feel!that!you!know! Information!on!sideEeffects! How!concerned!are!you!that! I!agree!that!it!is!important!for! vaccination!for!your!child?!! is?!What!does!it!do!to!the!body?! which!vaccines!you!should!get! following!immunization!is! any!one!of!the!childhood!shots! everyone!to!get!the! What!was!the!reason?! ! for!yourself?!Your!children?! discussed!openly!by!the! might!not!be!safe?!! recommended!vaccines!for! authorities.! ! themselves!and!their!children.!! Most!children!tolerate! It!is!my!role!as!a!parent!to! Do!the!vaccinators!in!doorEtoE Have!you!ever!felt!healthcare! Do!you!think!vaccines!are!still! Do!you!think!that!most!parents! vaccination!very!well.!! question!shots.!! door!or!mass!immunization! professional,!government,!local! needed!even!when!the!disease! like!you!have!their!children! ! campaigns!provide!you!with! authorities!are!pushing!you!into! is!no!longer!prevalent?! vaccinated!with!all!the! sufficient!information!to! a!vaccination!decision!you!did! recommended!vaccines?! address!your!concerns!around! not!fully!support?!Why?!! vaccination?! Have!you!or!someone!you!know! Do!you!think!it!is!possible!to! Did!you!ever!inform!yourself!on! Does!having!the!same!provider! I!believe!that!many!of!the! Do!you!think!it’s!important!to! ever!had!a!bad!reaction!to!a! have!received!too!many! a!certain!vaccine!and!then! give!all!the!infant!vaccines!make! illnesses!shots!prevent!are! get!a!vaccine!to!protect!those! vaccine!which!made!you! vaccines!at!one!time?! decide!against!it/delay!receiving! you!more!likely!to!accept! severe.!! that!cannot!get!vaccinated?! reconsider!getting!vaccines?! it?!If!so,!why,!which!vaccine!and! vaccines!than!having!a!different! what!resources!did!you!use?! provider!each!time!vaccines!are! due?!
4! ! ! ! Do!you!know!of!a!child!with!a! Do!you!think!vaccines!overload! Do!you!feel!you!get!enough! I!am!able!to!openly!discuss!my! How!concerned!are!you!that! Do!the!mothers/fathers!in!your! serious!disease/!disability! the!immune!system?! information!about!vaccines!and! concerns!about!shots!with!my! your!child!might!have!a!serious! community/!circle!of!friends! because!they!were!not! ! their!safety?!! child’s!doctor.!! side!effect!from!a!shot?!x! have!their!child!vaccinated?!Do! vaccinated?! ! ! ! you!have!your!child!vaccinated?! ! Why?! Do!you!know!of!anyone!who! It!is!better!for!my!child!to! Would!you!prefer!to!receive! I!trust!the!information!I!receive! How!concerned!are!you!that!a! Do!you!believe!that!if!you! has!had!a!bad!reaction!to!a! develop!immunity!by!getting! more!information!on! about!shots.!! shot!might!not!prevent!the! vaccinate!your!child,!others!are! shot?!! sick!than!to!get!a!shot.!! vaccination!at!your!health! ! disease?!! protected!as!well?! center?!Do!you!think!this!would! change!your!choice!in!favor!of!a! vaccine?!!! Have!you!heard!of!anyone!who! Do!you!believe!that!there!are! My!health!professional/HCW’s! Do!you!feel!that!your!health! Measles/polio/diphtheria!is!not! Are!you!worried!that!some! was!disabled!after!receiving!a! other!(better)!ways!to!prevent! provides!me!with!all!the! care!provider!cares!about!what! common!where!I!live.!That’s! mothers!in!your!community!are! vaccine?!Did!this!make!you! diseases!which!can!be! information!I!need!to!my! is!best!for!your!child?! why!I!decided!against!the! delaying!or!refusing!vaccines,! reconsider!your!choice!to!get! prevented!by!a!vaccine?! questions!on!immunization.! ! vaccine.! putting!your!infant!at!risk!for! yourself/!your!child!vaccinated?! these!diseases!e.g.!pertussis!?! Do!experiences!with!pain!with! Do!you!believe!that!it!is!better! Do!you!consider!that!some! ! Do!you!believe!that!vaccines!are!! ! past!immunization!prevent!you! for!the!child!to!start!to!receive! vaccines!are!more!important! still!needed!when!diseasesare! or!your!child!form!being! them!only!when!over!one!year! than!other?!Which!vaccine(s)! rare?! immunized?! of!age?!!! and!why?! ! ! Do!you!believe!that!shots!are! ! given!to!babies!when!they!too! young?!! !
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5! ! ! ! Table A5.3.2: Survey questions to assess vaccine/vaccination specific issues of vaccine hesitancy
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VACCINE/*VACCINATION*>specific*issues** Directly*related*to**vaccine*or*vaccination! a.**Risk/*Benefit* b.*Introduction*of**a* c.*Mode*of* d.*Design*of* e.*Reliability*and/or* f.*Vaccination*schedule** g.*Costs! h.*Role*of*healthcare* (scientific*evidence)* new*vaccine*or*new* administration! vaccination* source*of*vaccine* ! professionals** ! formulation** program/Mode*of* supply* ! ! delivery!! ! Scientific!evidence!of! Individuals!may!hesitate! Mode!of!administration! Delivery!mode!can! Individuals!may! Although!there!may!be! An!individual!may!have! Health!care! risk/benefit!and!history! to!accept!a!new!vaccine! can!influence!vaccine! affect!vaccine! hesitate!if!they!do!not! an!appreciation!for!the! confidence!in!a! professionals!are! of!safety!issues!can! when!they!feel!it!has! hesitancy!for!different! hesitancy!in!multiple! have!confidence!in!the! importance!of! vaccine’s!safety!and! important!role!models! prompt!individuals!to! not!been!used/tested! reasons.!E.g.!oral!or! ways.!Some!parents! system’s!ability!to! preventing!individual! the!system!that!delivers! for!their!patients;!if! hesitate,!even!when! for!long!enough!or!feel! nasal!administrations! may!not!have! provide!vaccine(s)!or! vaccine!preventable! it,!be!motivated!to! they!hesitate!for!any! safety!issues!have!been! that!the!new!vaccine!is! are!more!convenient! confidence!in!a! might!not!have! diseases,!there!may!be! vaccinate,!but!not!be! reason!(e.g.!due!to!lack! clarified!and/or! not!needed,!or!do!not! and!may!be!accepted! vaccinator!coming! confidence!in!the! reluctance!to!comply! able!to!afford!the! of!confidence!in!a! addressed! see!the!direct!impact!of! by!those!who!find! houseDtoDhouse;!or!a! source!of!the!supply! with!the!recommended! vaccine!or!the!costs! vaccine’s!safety!or! e.g.!suspension!of! the!vaccine!(e.g.!HPV! injections!fearful!or! campaign!approach! (e.g.!if!produced!in!a! schedule!(e.g.!multiple! associated!with!getting! need)!!it!can!influence!! rotavirus!vaccine!due! vaccine!preventing! they!do!not!have! driven!by!the! country/culture!the! vaccines!or!age!of! themselves!and!their! their!clients’!willingness! to!intussusception;! cervical!cancer).! confidence!in!the! government.! individual!is!suspicious! vaccination).! child(ren)!to!the! to!vaccinate!! GuillainDBarre! Individuals!may!be!more! health!workers!skills!or! Alternatively!if!a!health! of);!HCWs!may!also!be! ! immunization!point.! ! syndrome!following! willing!(i.e.!not! devices!used.! center!is!too!far!or!the! hesitant!to!administer! Vaccination!schedules! Alternatively,!the!value! swine!flu!vaccine! complacent)!to!accept!a! ! hours!are!inconvenient! a!vaccine!(especially!a! have!some!flexibility! of!the!vaccine!might!be! (1976)!or!narcolepsy! new!vaccine!if! ! new!one)!!if!they!do!not! that!may!allow!for! diminished!if!provided! (2011)!following! perception!of!the!VPD! have!confidence!that! slight!adjustment!to! for!free.! (A)H1N1!!vaccination;! risk!is!high.!! the!supply!will!continue! meet!individual!needs! ! milder,!local!adverse! ! as!it!affects!their!clients! and!preferences.!!While! events!can!also! trust!in!them.! this!may!alleviate! provoke!hesitancy.! Caregivers!may!not! hesitancy!issues,! ! have!confidence!that!a! accommodating! needed!vaccine!and/or! individual!demands!are! health!staff!will!be!at! not!feasible!at!a! the!health!facility!if! population!level.! they!go!there.! ! Do!you!believe! What!is!the!first!thing!! Is!there!any!mode!of! Is!the!vaccination! Do!you!feel!confident! Are!there!any!vaccines! Would!the!cost!of!a! Did!healthcare! vaccines!are!safe!for! you!want!to!know!when! vaccination!you!would! process!welcoming?! that!the!health!center! that!are!difficult!for!you! vaccine!prevent!you! professionals!ever!treat! yourself?!Your! a!new!vaccine!is!! not!want?! Are!there!any!things! or!doctor’s!office!will! to!get!because!of!the! from!getting!it,!even!if! you!without!respect! child/children?!For! introduced!or!! that!could!be!done!to! have!the!vaccine!you! schedule?! you!felt!you!or!your! (e.g.!in!regard!to!your! those!in!your! announced?!Would!you! make!it!easier!for!you! need,!when!you!need! child!needed!it?! appearance,!education!! community?!! rather!wait! to!get!vaccines!(on! them?! or!!cultural!background)!so! and!see!what!other!! time)!for!yourself!or! that!you!will!hesitate!to! 6! ! ! ! people!do?! your!children?! return!to!the!healthcare! ! facility?!
Me!or!my!child!never! I!consider!rotavirus! Do!you!fear!the!pain/! Would!you!rather! Did!you!ever!not! How!sure!are!you!that! Which!medication!do! Did!you!choose!your! experienced!severe! vaccine/!HPV!vaccine/! to!you/your!child!or! receive!a!vaccine!as! return!to!a!health! following!the! you!consider!more! doctors!based!on!their! adverse!reactions! meningococcal!vaccine/! fear!the!needles!when! conveniently!as! center/!your!doctor! recommended!shot! effectiveE!the!freeEofE willingness!to!alter!or! following! pentavalent!vaccine!to! receiving!a!vaccine! possible!or!with!as! after!not!receiving!the! schedule!is!a!good!idea! charge!drugs!provided! delay!the!vaccination! immunization.! be!safe.! make!you!hesitate!be! much!medical! vaccine!during!an! for!your!child?!! at!your!health!care! schedule!according!to! experience!an!AEFI!and!! ! to!immunized?!! consultation!as! initial!visit?!What!were! center/doctor/!by!your! your!requests?! ! possible?!Why?! the!reasons!why!you! government!or!the! ! did!not!receive!the! ones!you!need!to!pay! vaccine!initially?! for!yourself?!Why?! Do!you!consider!some! Do!you!feel!your!child! Has!pain!following! What!would!you!prefer! Have!you!ever!been! If!you!had!another! Do!you!consider!all! Has!your!healthcare! vaccine!products! to!be!at!risk!of!diarrhea/! immunization!ever! for!yourself/your!child:! sent!home!from!the! infant!today,!would! important!vaccines! provider!ever!advised!! preventing!a!disease! cervical!cancer?!Do!you! made!you!reconsider! Receive!a!vaccine!at! health!center/!doctor’s! you!want!him/her!to! provided/!covered!by! you!that!a!certain!! (influenzaELAIV!or! think!a!vaccine!is! to!have!yourself/!your! your!health!center/! office!due!to!lack!of! get!all!the! your!health!insurance/! vaccine!was!not!! standard/!measles!(M! needed!to!prevent! child!vaccinated?! from!your!doctor!or! vaccine?!If!so,!did!you! recommended!shots?!! health!care!plan/! necessary!or!had!too!! only!or!MMR)!safer! these!diseases?!! from!doorEtoEdoor! go!again!to!try!and! ! health!care!provider?! many!side!effects?!! than!others?! ! vaccinators/!during! receive!it?!! Would!you!pay!for! Which!one?! mass!vaccination! ! additional!vaccines! ! campaigns/!schoolE yourself?! based!programs?!Why?!! ! Before!administering! New!vaccines!are!not! Would!you!be!willing!to! Would!you!let!your! At!your!health!center,! Children!get!more! I!wouldn’t!mind!taking! Was!your!doctor!ever! the!vaccine,!my!health! trialed!to!the!same!! accept!more!vaccines! child!get!vaccinated! did!you!ever!not! shots!than!are!good! time!off!from!work!to! reluctant!to!administer! care!worker!(HCW)! rigorous!standard!as!! for!yourself/!your!child! within!a!schoolEbased! receive!a!vaccine!as! for!them.!! make!sure!my!child! a!vaccine!you!wanted!! always!provided!me! any!normally!prescribed! if!there!was!no!pain! immunization! the!HCW!indicated! ! gets!vaccinated?! for!yourself/!your! with!enough! drug?! involved?! program?!If!yes,!what! there!were!too!few! ! child?!Which!vaccine!! information!on!the! are!the!advantages?! people!to!start! and!why?! sideEeffects!that!might! vaccinating?! follow.! ! Have!you!ever!delayed! Do!you!trust!your!HCW! Did!you!ever!refrain! Did!you!ever!decide! It!is!better!for!children! Would!you!be!willing!to! Do!you!trust!the!doorE! vaccinating!your!child! to!safely!administer!the! from!having!yourself/! against!a!vaccine!as!it! to!get!fewer!vaccines! pay!for!a!vaccine! toEdoor!vaccinators?!! with!a!newly! vaccine!to!you/!your! your!child!vaccinated! was!produced!by!a! at!the!same!time.!! privately?!If!so,!for! introduced/! child?! during!a!mass! manufacturer!you!did! ! which!ones?! recommended!vaccine?! immunization! not!trust?!Do!you! ! Why?! campaign?!Why?! believe!vaccines!made! in!Europe!or!America! are!safer!than!those! made!in!middle! income!countries?!
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! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! References(for(Example(Survey(Questions(on(Vaccine(Hesitancy(! i!Larson!HJ,!Jarrett!C,!Eckersberger!E,!Smith!DM,!Paterson!P.!Understanding!vaccine! hesitancy!around!vaccines!and!vaccination!from!a!global!perspective:!a!systematic!review!of! published!literature,!2007I2012.!Vaccine.!2014!Apr!17;32(19):2150I9! ii!Gellin!BG,!Maibach!EW,!Marcuse!EK.!Do!parents!understand!immunizations?!A!national! telephone!survey.!Pediatrics.!2000;106:1097–102.! iii!Marshall!H,!Clarke!M,!Sullivan!T.!Parental!and!community!acceptance!of!the!benefits!and! risks!associated!with!meningococcal!B!vaccines.!Vaccine.!2014!Jan!9;32(3):338I44.! iv!Wolff!ER,!MadlonIKay!DJ.!Childhood!vaccine!beliefs!reported!by!somali!and!nonIsomali! parents.!J!Am!Board!Fam!Med.!2014!JulIAug;27(4):458I64.!! v!Madhivanan!P,!Li!T,!Srinivas!V,!Marlow!L,!Mukherjee!S,!Krupp!K.!Human!papillomavirus! vaccine!acceptability!among!parents!of!adolescent!girls:!obstacles!and!challenges!in!Mysore,! India.!Prev!Med.!2014!Jul;64:69I74! vi!Stöcker!P,!Dehnert!M,!Schuster!M,!Wichmann!O,!Deleré!Y.!Human!papillomavirus!vaccine! uptake,!knowledge!and!attitude!among!10th!grade!students!in!Berlin,!Germany,!2010.!Hum! Vaccin!Immunother.!2013!Jan;9(1):74I82! vii!Casiday!R,!Cresswell!T,!Wilson!D,!PanterIBrick!C.!A!survey!of!UK!parental!attitudes!to!the! MMR!vaccine!and!trust!in!medical!authority.!Vaccine.!2006!Jan!12;24(2):177I84.! viii!Gowda!C,!Schaffer!SE,!Kopec!K,!Markel!A,!Dempsey!AF.!Does!the!relative!importance!of! MMR!vaccine!concerns!differ!by!degree!of!parental!vaccine!hesitancy?:!An!exploratory! study.!Hum!Vaccin!Immunother.!2013!Feb;9(2):430I6! ix!Luthy!KE,!Beckstrand!RL,!Callister!LC.!Parental!hesitation!in!immunizing!children!in!Utah.! Public!Health!Nurs.!2010!JanIFeb;27(1):25I31! x!Opel!DJ,!MangioneISmith!R,!Taylor!JA,!Korfiatis!C,!Wiese!C,!Catz!S,!and!Martin!DP.! Development!of!a!survey!to!identify!vaccineIhesitant!parents.!The!Parent!Attitudes!about! Childhood!Vaccines!survey.!Hum!Vaccin.!Apr!2011;!7(4):!419–425.!!! xiOpel!DJ,!Taylor!JA,!Zhou!C,!Catz!S,!Myaing!M,!MangioneISmith!R.!The!relationship!between! parent!attitudes!about!childhood!vaccines!survey!scores!and!future!child!immunization! status:!a!validation!study.!JAMA!Pediatr.!2013!Nov;167(11):1065I71.! xii!SAGE!Working!Group!on!Vaccine!Hesitancy:! http://www.who.int/immunization/sage/sage_wg_vaccine_hesitancy_apr12/en/,!accessed! January!2016! xiii!Model!of!determinants!of!vaccine!hesitancy!developed!by!the!Working!Group!on!Vaccine! Hesitancy:! http://www.who.int/immunization/sage/meetings/2013/april/1_Model_analyze_driversofv accineConfidence_22_March.pdf?ua=1,!accessed!January!2016! xiv!World!Bank,!country!level!of!income:!http://data.worldbank.org/about/countryIandI lendingIgroups!,!accessed!January!2016! xv!WHO!regions:!http://www.who.int/about/regions/en/,!accessed!January!2016! ! ! ( !
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