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Pudong New Area Questionnaire about vaccination among students in international school
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If you are the parent who takes care for the child’s vaccination, please fill out this questionnaire. If not, please have the one who does answer the questions. Thank you!
A Basic information
Part one: personal information of your child (student)
*
1、Name of student:(yon can also fill in nickname)
*
2、Gender of student:
① Male
② Female
*
3、Date of birth: MM / DD /YYYY:
*
4、Nationality
*
5、Grade
early childhood-（PS)
early childhood-（PK)
early childhood-（K)
elematory school—grade1（G1）
elematory school—grade2（G2）
elematory school—grade3（G3）
elematory school—grade4（G4）
middle school—grade5（G5）
middle school—grade6（G6）
G5middle school—grade7（G7）
middle school—grade8（G8）
high school—grade9（G9）
high school—grade10（G10）
high school—grade11（G11）
high school—grade12（G12）
*
6、Residence status in Shanghai
1) Living in Shanghai since birth
2) From other places and living in Shanghai for over 3 months
3) From other places and living in Shanghai for shorter than 3 months.
Part two: your own personal information (parent of the student surveyed)
*
1、Your gender:
① Male
② Female
*
2、Your age:
（从15到90）
*
3、Nationality
*
4、Relationship to child
① Mother
② Father
③ Others .
*
5、Education:
① Master's degree or above
② Bachelor's degree
③ Bachelor's degree below
*
6、Occupation
① Enterprise manager
② Teacher
③ Medical staff
④Enterprise staff
⑤ Others
*
7、Religion:
① Christianity
② Islam
③ Buddhism
④ Others:
⑤ No
*
8、The number of people in your family(only for the nuclear family with the children and their parents included) ：
2
3
4
5
＞5
*
9、Annual family income (only for the nuclear family with the children and their parents included)
① ≥ 500000RMB
② 300000-500000 RMB
③ ＜300000 RMB
B Your own views on vaccination for children
*
1、Do you think it necessary to have your child vaccinated?
①Yes
②No
*
2. Do you take your child to get vaccinated as appointed?
①Yes
②No
*
3、If you choose "① Yes" in "question 2" , skip this question; If you choose "② No", the reason is (multiple choices):
【多选题】
① It doesn't matter if it's a little late.
② I don't know where to go to vaccinate children
③ I'm worried that varvice quality of the clinic.
④ I’m distrustful of the medical service quality of the clinic.
⑤ Others:
*
4. When the child moves to a new residence, do you think you should contact the clinic to arrange the vaccination for the child as soon as possible?
①Yes
②No
③ It doesn't matter
*
5. Do you agree that the purpose of vaccination is mainly to prevent the infection of contagious diseases?
①Yes
②No
*
6. Do you think children will need vaccination records when they go to college in the future?
①Yes
②No
③ Not clear
*
7. Do you think children's vaccination records should be properly kept?
①Yes
②No
*
8、Do you know which of the following vaccines that are
routinely administered
to children? (multiple choices)
【多选题】
① BCG vaccine
②rabies
③DPT vaccine
④hepatitis B vaccine
⑤Measles rubella mumps vaccine
⑥polio vaccine
⑦new crown vaccine
⑧Japanese encephalitis vaccine
⑨meningococcal vaccine
⑩hepatitis A vaccine
⑾Diphtheria tetanus vaccine
⑿influenza vaccine
*
9. Do you know that a person should stay in the clinic for medical observation after vaccination?
①Yes
②No
③Not clear
*
10. Did you think that you should tell doctors about the child's health status and allergy history before vaccination?
①Yes
②No
*
11. If, on the scheduled date for vaccination, the child reports a body temperature at 37.5 ℃, do you think he/she should be vaccinated or not?
①Yes
②No
*
12. Do you agree a child only needs medical observation at home with no special treatment required if he/she develops slight red and swelling spots at the injection point within 3 days after vaccination?
①Yes
②No
*
13、Do you agree a child only needs medical observation at home with no special treatment required if he/she reports no discomfort except a low fever within 3 days after vaccination?
①Yes
②No
*
14. Do you agree that a child, when moving to a new country or region, should get his/her vaccination program retuned to the local situations such as disease control?
①Yes
②No
*
15. Do you think your child has completed the vaccination as recommended by his/her doctor ?
①Yes,all done
②No
③Not clear
*
16. If the school informs you to take your child to get vaccination shots missed, will you do so in time?
①Yes
②No
③Not clear
Thank you very much!
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