COVID-19 Vaccine Attitudes Questionnaire
Please share your perspectives on COVID-19 vaccines. Your responses are anonymous and will help us better understand public attitudes.
Which age group do you belong to?
*
Please Select
Under 18
18–24
25–34
35–44
45–54
55–64
65 or older
What is your current COVID-19 vaccination status?
*
Fully vaccinated (all recommended doses)
Partially vaccinated
Not vaccinated
Prefer not to say
If not fully vaccinated, do you intend to get the COVID-19 vaccine in the future?
*
Yes, as soon as possible
Yes, but later
Undecided
No
Not applicable (already fully vaccinated)
What are your main reasons for getting or considering the COVID-19 vaccine? (Select all that apply)
*
To protect myself from illness
To protect others
To help end the pandemic
To comply with work/school requirements
To travel or attend events
Other
If you are hesitant or undecided about the COVID-19 vaccine, what are your main concerns? (Select all that apply)
Potential side effects
Vaccine developed too quickly
Doubts about effectiveness
Prefer natural immunity
Distrust in health authorities
Religious or philosophical reasons
Other
How much do you trust the safety of COVID-19 vaccines?
*
Do not trust at all
1
2
3
4
Trust completely
5
1 is Do not trust at all, 5 is Trust completely
How effective do you believe the COVID-19 vaccines are at preventing serious illness?
*
Not effective
1
2
3
4
Very effective
5
1 is Not effective, 5 is Very effective
Which sources do you trust most for information about COVID-19 vaccines? (Select up to 2)
*
Healthcare professionals
Government health agencies
Friends or family
Traditional media (TV, newspapers, radio)
Social media
Community or religious leaders
Other
How much do your family, friends, or community influence your decision about COVID-19 vaccination?
*
No influence
1
2
3
4
Strong influence
5
1 is No influence, 5 is Strong influence
Please share any additional comments or thoughts about COVID-19 vaccines (optional)
Submit
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