Appendix A: Survey in English and in Spanish Language Preference
In what language do you prefer to answer these questions?
¿En qué lenguaje prefiere responder a estas preguntas?
a. English
b. Spanish
Employee Covid Vaccination Survey 1. Which statement is true for you?
a. I scheduled an appointment to receive the COVID-19 vaccine as soon as I was told I was able to.
b. I waited for some time before scheduling the COVID-19 vaccination, but eventually scheduled an appointment to receive the vaccination.
c. I have not scheduled an appointment to receive the COVID-19 vaccine but intend to, eventually.
d. I do not intend to receive the COVID-19 vaccine.
e. I am undecided about receiving the COVID-19 vaccine.
Programming notes: If response to Q1 is a or b go to Q2;
If response to Q1 is c or d or e then skip to Q4
2. Which statement is true for you? (check all that apply)
a. I received at least one dose of the COVID-19 vaccine at a Stanford Medicine site (SHC, LPCH, SHC-VC, or UHA), such as Occupational Health Services or a Stanford Medicine community vaccination site.
b. I received at least one dose of the COVID-19 vaccine outside of Stanford Medicine, such as a local pharmacy or other non-Stanford vaccination site.
3. What factors led to you to receive the vaccine (please check the top 2 that most apply)?
a. Peers/colleagues at work
b. Influenced by family and/or friends
c. Concern for health of family and/or friends d. Supervisor
e. Concern for personal health f. Assistance with scheduling
g. Information on social media and/or internet h. Stanford Medicine Townhalls
i. StanfordMed LIVE event
j. Community outreach, e.g. church
k. Desire to obtain herd immunity (civic duty) l. Other __________________________________
Programming notes: SKIP TO Q11—this ends the main survey for those vaccinated/scheduled
4. Which of the following statements is true for you regarding the COVID-19 vaccine (please check the top 2 that most apply)?
a. Scheduling the vaccine is inconvenient b. I am unable to schedule the vaccine
c. I am not able to take time out/off to get the vaccine
d. I have religious reasons that affect my decision to take the vaccine e. I have concerns about safety of vaccine
f. I have personal health concerns that make the vaccine suboptimal for me g. I would not benefit from the vaccine
h. Getting COVID-19 is less concerning than getting the vaccine
i. Information about the vaccine is not available in my preferred language j. People I trust are suggesting I do not need the vaccine
k. Other______________________________
5. What factors led you to DELAY or NOT receive the vaccine (please check the top 2 that most apply)?
a. Desire for additional studies showing safety of vaccine b. Desire to choose which vaccine I want to get
c. Desire for money or paid-time off to complete and recover from the vaccination d. Inability to be vaccinated in my unit or at my place of work
e. Inability to get the vaccine without an appointment f. Nothing would ever influence me to get vaccinated g. Other_______________
6. I have all the information I need to make a decision about the COVID-19 vaccine.
Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree 7. I have easy access to getting the COVID-19 vaccine.
Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree 8. Please indicate which source(s) of COVID-19 vaccine information would be helpful to
you (please check the top 2 that most apply):
a. Information from peers
b. Information from community leaders c. Information from supervisor
d. Information from your health care provider e. Information from friends and/or family members f. Information from CEO or Dean
g. Paper handout or brochure
h. Townhalls
i. Small group session j. Social media
k. Videos l. Website
9. What messaging, if any, might convince you to receive the vaccination / have received the vaccination as soon as possible (please check the top 2 that most apply)?
a. “So many Americans need a path to get back to work. We can help them.” [Common enemy: unemployment]
b. Knowing your favorite celebrity was vaccinated [Observability: celebrity]
c. Knowing your local religious leader was vaccinated [Observability: religious leader]
d. “You’d be more likely to get hit by lightning than to die from Covid after getting vaccinated.” [Analogy: statistics]
e. Personal story from a nurse or physician [Personal story]
f. “What would change in your family if you became a Covid long- hauler and had permanent lung or heart damage?” [Anticipated regret]
g. “I’ve seen the crushing guilt of families that lose someone to Covid after not being quite careful enough — don’t do that to yourself.” [Anticipated regret]
h. One or more days off of work to be vaccinated with fun home care package to recover [FOMO]
i. Appointment with a nurse or physician to address how the vaccine might interact with your unique health conditions [Uniqueness neglect]
j. “mRNA is like a teacher that shows the body how to make the antibodies that fight off Covid.” [Analogy: process]
10. What thoughts do you have, if any, about the above messaging campaigns? [Open- ended]
11. Have you or a close family member ever been diagnosed with COVID-19 (check all that apply)?
a. Yes - Me
b. Yes - Household Family Member c. Yes - Non-household Family Member d. No
12. What is your primary clinical work location?
□ LPCH □ SHC □UHA □Valley Care □PCHA □SOM (Non-Clinical) 13. What is your profession?
□ Administration □ APP □Call Center □Dietary □ED tech □ Environmental Services
□LVN □Medical Assistant □Nursing Asst/Unit Secretary □Pharmacy □Phlebotomy/ Lab
□Physician □Radiology □ Registered Nurse □ Rehab (PT, OT, SLP) □Respiratory
Therapist □Security □Social Work/Case Management □Food Services □Basic Science Faculty □Medical Student □IT □Clinical Nutritionist □Other____________________
14. With which gender do you most identify?
□ Female □Male □Other 15. What is your age?
□ Under 25 □ 26-34 □35-44 □45-54 □55-64 □Over 65 Progrmming Notes: Alphabetize drop down list for Q15
16. Which race and ethnicity do you identify with? Please choose all that apply:
□ Latinx (Latino, Latina, Hispanic) □American Indian or Alaska Native □Asian or Asian American □Black or African American □Native Hawaiian or Other Pacific Islander
□White
□Other________________
17. How many years have you worked in your current profession?
□ <1 year □1-4 □5-9 □10+ years
Thanks for taking this survey. Please see a link to additional information from Stanford Health Care on the COVID-19 vaccination.
