Childhood National Immunization Coverage Survey  - 2013

Status of Records (SOR) - Question identifier:SOR_R01

The following questions are about childhood immunizations. Immunizations provide immunity against particular diseases.

Status of Records (SOR) - Question identifier:SOR_Q01

Has ^FNAME ever received any immunizations?

• 1: Yes
• 2: No

Status of Records (SOR) - Question identifier:SOR_Q02

What are the reasons that ^FNAME has not received immunizations?

• 01: No access to health care or no health care provider available
• 02: Didn't know how to access health care services
• 03: Concerns about safety of vaccines
• 04: Immune system may not be able to handle immunization
• 05: Too many immunizations are required
• 06: Vaccines are not effective
• 07: Philosophical reasons (e.g. don't believe in them)
• 08: Religious reasons
• 09: Forgot (did not remember)
• 10: Other - Specify
• 98: RF
• 99: DK

Status of Records (SOR) - Question identifier:SOR_R03

You may recall receiving an introductory package in the mail describing the purpose of the Childhood National Immunization Coverage Survey. In our letter to you, we asked that you have your child's immunization record close at hand during the interview.

Status of Records (SOR) - Question identifier:SOR_Q03

Do you have a copy of ^FNAME's official Immunization Card or booklet?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_Q04

Do you have it on hand?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_Q05

What is the main reason you do not have ^FNAME's immunization card or booklet?

• 1: I lost it
• 2: My health care provider keeps it
• 3: One was never provided to me
• 4: Other - Specify
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_Q06

I have a few questions about the specific immunizations that ^FNAME has received, including the dates of each immunization. Do you have any other immunization card or booklet, such as a school record, or any personal records, such as a baby book or calendar, available at home that would help you remember this information?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_Q07

Were you able to find an immunization record?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_Q08

What immunization record did you find?

• 1: Card/booklet issued by immunization provider/health authority
• 2: Baby book
• 3: Calendar
• 4: School-based record
• 5: Other - Specify
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_Q09

It is important that we have the most accurate information about your child's immunizations. Do you think that you could find an immunization record in the next few days?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Status of Records (SOR) - Question identifier:SOR_R10

DT_SORR10E
Now I would like to ask you some questions that may be answered without the immunization record.

Identify Record Status (REC) - Question identifier:REC_R01

I need to record the name and date of each immunization listed on ^FNAME's immunization record. Let's start with the first immunization on your child's record.

First I will ask you to read the date, and then which vaccines were received on that date.

Have Immunization Record (HIR) - Question identifier:HIR_Q01

What was the year of the immunization?

Min = 1870; Max = 2100

Have Immunization Record (HIR) - Question identifier:HIR_Q02

Are you unable to provide the year of the immunization because it is blank, illegible or for some other reason?

• 1: Year is blank
• 2: Year is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Have Immunization Record (HIR) - Question identifier:HIR_Q03

What was the month?

• 01: January
• 02: February
• 03: March
• 04: April
• 05: May
• 06: June
• 07: July
• 08: August
• 09: September
• 10: October
• 11: November
• 12: December
• 98: RF
• 99: DK

Have Immunization Record (HIR) - Question identifier:HIR_Q04

Are you unable to provide the month of the immunization because it is blank, illegible or for some other reason?

• 1: Month is blank
• 2: Month is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Have Immunization Record (HIR) - Question identifier:HIR_Q05

What was the day?

Min = 01; Max = 31

Have Immunization Record (HIR) - Question identifier:HIR_Q06

Are you unable to provide the day of the immunization because it is blank, illegible or for some other reason?

• 1: Day is blank
• 2: Day is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Have Immunization Record (HIR) - Question identifier:HIR_Q07

What immunization(s) did ^FNAME receive on that date?

• 01: Chickenpox (Varicella) (V) (Varivax)
• 02: Diphtheria
• 03: DaPTP-Hib
• 04: DaPTP
• 05: DTaP-IPV-Hib (Pentacel)
• 06: DTaP-IPV (Quadracel)
• 07: DTaP / DTP
• 08: Hepatitis B / HBV
• 09: Hib (Haemophilus influenzae type b)
• 10: HPV (human papilloma virus) (Gardasil) (Cervarix)
• 11: Influenza (flu)
• 12: Measles
• 13: Meningococcal conjugate (MC) / Men C conjugate / Menjugate
• 14: MMR (Measles, Mumps, Rubella)
• 15: Mumps
• 16: Pertussis
• 17: Pneumococcal conjugate (PC) / Pneumo conjugate (Prevnar) (PCV7)
• 18: Polio (IPV)
• 19: Rotavirus
• 20: Rubella
• 21: Tetanus
• 22: TdaP (Adacel)
• 23: Other - Specify
• 98: RF
• 99: DK

Have Immunization Record (HIR) - Question identifier:HIR_Q08

Are you unable to provide the name of the immunization because it is blank, illegible or for some other reason?

• 1: Immunization is blank
• 2: Immunization is illegible
• 3: Some other reason
• 8: RF
• 9: DK

Have Immunization Record (HIR) - Question identifier:HIR_Q09

Are there any other dates listed on the immunization record?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

No Immunization Record (NIR) - Question identifier:NIR_Q01

Has ^FNAME ever received a flu shot to prevent seasonal influenza?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

No Immunization Record (NIR) - Question identifier:NIR_Q02

Has ^FNAME ever received an immunization shot for Hepatitis B at school or elsewhere?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

No Immunization Record (NIR) - Question identifier:NIR_Q03

In what year did ^FNAME receive the immunization shot for Hepatitis B?

Min = 1870; Max = 2100

No Immunization Record (NIR) - Question identifier:NIR_Q04

What was the month?

• 01: January
• 02: February
• 03: March
• 04: April
• 05: May
• 06: June
• 07: July
• 08: August
• 09: September
• 10: October
• 11: November
• 12: December
• 98: RF
• 99: DK

No Immunization Record (NIR) - Question identifier:NIR_Q05

Do you recall what grade ^FNAME was in when he received the immunization shot for Hepatitis B?

Min = 0; Max = 12

No Immunization Record (NIR) - Question identifier:NIR_N06

This is the end of the component. Return to previously answered questions to make any necessary corrections, or select <Exit> to exit the component.

• 1: Exit

Human Papilloma Virus (HPV) - Question identifier:HPV_Q01

Has ^FNAME ever been vaccinated for the human papilloma virus, also referred to as HPV?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Human Papilloma Virus (HPV) - Question identifier:HPV_Q02

In what year did ^FNAME receive the immunization for the human papilloma virus (HPV)?

Min = 1870; Max = 2100

Human Papilloma Virus (HPV) - Question identifier:HPV_N04

This is the end of the component. Return to previously answered questions to make any necessary corrections, or select <Exit> to exit the component.

• 1: Exit

Not on Immunization Record (NOR) - Question identifier:NOR_Q01

Has ^FNAME received any other immunization shots that are not listed on his immunization record [, for example, shots received elsewhere, such as at school]?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Immunizations (OTH) - Question identifier:OTH_Q01

What was the year of the immunization?

Min = 1870; Max = 2100

Other Immunizations (OTH) - Question identifier:OTH_Q02

What was the month?

• 01: January
• 02: February
• 03: March
• 04: April
• 05: May
• 06: June
• 07: July
• 08: August
• 09: September
• 10: October
• 11: November
• 12: December
• 98: RF
• 99: DK

Other Immunizations (OTH) - Question identifier:OTH_Q03

What was the day?

Min = 1; Max = 31

Other Immunizations (OTH) - Question identifier:OTH_Q04

What immunization(s) did ^FNAME receive on that date?

• 01: Chickenpox (Varicella) (V) (Varivax)
• 02: Diphtheria
• 03: DaPTP-Hib
• 04: DaPTP
• 05: DTaP-IPV-Hib (Pentacel)
• 06: DTaP-IPV (Quadracel)
• 07: DTaP / DTP
• 08: Hepatitis B / HBV
• 09: Hib (Haemophilus influenzae type b)
• 10: HPV (human papilloma virus) (Gardasil) (Cervarix)
• 11: Influenza (flu)
• 12: Measles
• 13: Meningococcal conjugate (MC) / Men C conjugate / Menjugate
• 14: MMR (Measles, Mumps, Rubella)
• 15: Mumps
• 16: Pertussis
• 17: Pneumococcal conjugate (PC) / Pneumo conjugate (Prevnar) (PCV7)
• 18: Polio (IPV)
• 19: Rotavirus
• 20: Rubella
• 21: Tetanus
• 22: TdaP (Adacel)
• 23: Other - Specify
• 98: RF
• 99: DK

Other Immunizations (OTH) - Question identifier:OTH_Q05

Are there any other dates when ^FNAME received an immunization shot or shots?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Missed Opportunities for Immunization (MOI) - Question identifier:MOI_Q01

Has ^FNAME been to see a health care provider (e.g. a doctor, paediatrician or nurse) within the last year?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Missed Opportunities for Immunization (MOI) - Question identifier:MOI_Q02

Did any health care provider discuss his immunizations with you (within the past year)?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 1 (KN1) - Question identifier:KN1_Q01

To the best of your knowledge, how up-to-date is ^FNAME on immunizations recommended for his age? Is he...?

• 1: Completely up-to-date
• 2: Somewhat up-to-date
• 3: Not at all up-to-date
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 1 (KN1) - Question identifier:KN1_Q02

What challenges, if any, do you face when trying to keep ^FNAME's immunizations up-to-date?

• 01: Immunization record kept at health care provider's office/health clinic
• 02: Misplaced child's immunization record
• 03: Moved to another city (in same province)
• 04: Moved to another province
• 05: Find information about child's immunizations confusing
• 06: Do not have a health care provider
• 07: None
• 08: Other - Specify
• 98: RF
• 99: DK

Knowledge, Attitudes and Awareness - Part 1 (KN1) - Question identifier:KN1_Q03

Have you ever decided not to immunize ^FNAME with a particular vaccine?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 1 (KN1) - Question identifier:KN1_Q04

What vaccine or vaccines did you decide not to give ^FNAME?

• 01: Chickenpox (Varicella) (V) (Varivax)
• 02: Diphtheria
• 03: DaPTP-Hib
• 04: DaPTP
• 05: DTaP-IPV-Hib (Pentacel)
• 06: DTaP-IPV (Quadracel)
• 07: DTaP / DTP
• 08: H1N1
• 09: Hepatitis B / HBV
• 10: Hib (Haemophilus influenzae type b)
• 11: HPV (Human Papilloma Virus) (Gardasil) (Cervarix)
• 12: Influenza (flu)
• 13: Measles
• 14: Meningococcal conjugate (MC) / Men C conjugate / Menjugate
• 15: MMR (Measles, Mumps, Rubella)
• 16: Mumps
• 17: Pertussis
• 18: Pneumococcal conjugate (PC) / Pneumo conjugate (Prevnar) (PCV7)
• 19: Polio (IPV)
• 20: Rotavirus
• 21: Rubella
• 22: Tetanus
• 23: TdaP (Adacel)
• 24: Other - Specify
• 98: RF
• 99: DK

Immunizations Not Given (ING) - Question identifier:ING_Q01

What is the main reason that you decided not to immunize ^FNAME with ^DT_KN1Q04E?

• 01: Lack of a publicly-funded immunization program for the vaccine
• 02: Cost of the vaccine
• 03: Did not consider it necessary for my child
• 04: Concerns about safety of vaccines
• 05: Asked health care provider for the vaccine and was told to wait for a later date, (e.g. child was sick)
• 06: [Not confident in the flu (influenza) vaccine(s)/empty]
• 07: [Did not consider chickenpox (varicella) to be a serious disease/empty]
• 08: Other - Specify
• 98: RF
• 99: DK

Knowledge, Attitudes and Awareness - Part 2 (KN2) - Question identifier:KN2_Q10

For each of the following statements, please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree.

In general, childhood vaccines are safe.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 2 (KN2) - Question identifier:KN2_Q11

(Please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree.)

In general, childhood vaccines are effective.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 2 (KN2) - Question identifier:KN2_Q12

(Please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree.)

In general, childhood vaccines are important for your child's health.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 2 (KN2) - Question identifier:KN2_Q13

(Please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree.)

In general, you understand how vaccines work.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 2 (KN2) - Question identifier:KN2_Q14

(Please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree.)

In general, you are concerned about the potential side effects from vaccines.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 2 (KN2) - Question identifier:KN2_Q15

(Please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree.)

In general, a vaccine can give you a serious case of the very same disease it was meant to prevent.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 2 (KN2) - Question identifier:KN2_Q16

(Please tell me if you strongly agree, somewhat agree, somewhat disagree or strongly disagree.)

In general, the use of alternative practices, such as homeopathy or chiropractics, can eliminate the need for vaccination.

• 1: Strongly agree
• 2: Somewhat agree
• 3: Somewhat disagree
• 4: Strongly disagree
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_R17

This next section asks about various diseases. Please stop me at anytime if you would like more information about a particular disease.

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q17

I would like you to tell me whether you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:

Chickenpox, also known as Varicella

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q18

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

Diphtheria

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q19

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

German measles, also known as rubella

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q20

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

Hepatitis B

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q21

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

The Flu, also known as Influenza

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q22

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

Measles

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q23

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

Mumps

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q24

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

Pneumococcal disease including pneumonia

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q25

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

Polio

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q26

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

Meningitis

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q27

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

Tetanus, also known as lock jaw

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 3 (KN3) - Question identifier:KN3_Q28

(Do you think it is very important, important, somewhat important or not important at all to immunize your child against the following diseases:)

Whooping cough, also known as Pertussis

• 1: Very important
• 2: Important
• 3: Somewhat important
• 4: Not important at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 4 (KN4) - Question identifier:KN4_R29

The following questions are about vaccine safety.

Vaccine safety refers to side effects or a reaction a person may have shortly after receiving the vaccine. It can also refer to how the vaccine is made, what it contains, and how it is administered.

Knowledge, Attitudes and Awareness - Part 4 (KN4) - Question identifier:KN4_Q29

Are you very concerned, concerned, somewhat concerned or not concerned at all about the safety of the following vaccines:

...Chickenpox or Varicella vaccine?

• 1: Very concerned
• 2: Concerned
• 3: Somewhat concerned
• 4: Not concerned at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 4 (KN4) - Question identifier:KN4_Q30

(Are you very concerned, concerned, somewhat concerned or not concerned at all about the safety of the following vaccines:)

...D-T-P, or Diphtheria, Tetanus, and Pertussis vaccine?

• 1: Very concerned
• 2: Concerned
• 3: Somewhat concerned
• 4: Not concerned at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 4 (KN4) - Question identifier:KN4_Q31

(Are you very concerned, concerned, somewhat concerned or not concerned at all about the safety of the following vaccines:)

...Hepatitis B vaccine?

• 1: Very concerned
• 2: Concerned
• 3: Somewhat concerned
• 4: Not concerned at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 4 (KN4) - Question identifier:KN4_Q32

(Are you very concerned, concerned, somewhat concerned or not concerned at all about the safety of the following vaccines:)

...Influenza, or the flu vaccine?

• 1: Very concerned
• 2: Concerned
• 3: Somewhat concerned
• 4: Not concerned at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 4 (KN4) - Question identifier:KN4_Q33

(Are you very concerned, concerned, somewhat concerned or not concerned at all about the safety of the following vaccines:)

...M-M-R, or Measles, Mumps and Rubella vaccine?

• 1: Very concerned
• 2: Concerned
• 3: Somewhat concerned
• 4: Not concerned at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 4 (KN4) - Question identifier:KN4_Q34

(Are you very concerned, concerned, somewhat concerned or not concerned at all about the safety of the following vaccines:)

...Polio vaccine?

• 1: Very concerned
• 2: Concerned
• 3: Somewhat concerned
• 4: Not concerned at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 4 (KN4) - Question identifier:KN4_Q35

(Are you very concerned, concerned, somewhat concerned or not concerned at all about the safety of the following vaccines:)

...Pneumococcal vaccine, which protects against pneumonia?

• 1: Very concerned
• 2: Concerned
• 3: Somewhat concerned
• 4: Not concerned at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 4 (KN4) - Question identifier:KN4_Q36

(Are you very concerned, concerned, somewhat concerned or not concerned at all about the safety of the following vaccines:)

...Hib vaccine, which protects against one type of bacterial meningitis?

• 1: Very concerned
• 2: Concerned
• 3: Somewhat concerned
• 4: Not concerned at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 4 (KN4) - Question identifier:KN4_Q37

(Are you very concerned, concerned, somewhat concerned or not concerned at all about the safety of the following vaccines:)

...Meningococcal group C vaccine, which protects against another type of bacterial meningitis?

• 1: Very concerned
• 2: Concerned
• 3: Somewhat concerned
• 4: Not concerned at all
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 5 (KN5) - Question identifier:KN5_Q38

Thinking about a time when you needed immunization information, what was the main source you consulted to obtain this information?

• 01: Health care provider
• 02: Walk-in clinic
• 03: CLSC or Community health centre
• 04: Emergency department
• 05: Telephone help line
• 06: Specialist's clinic
• 07: Internet
• 08: Pharmacy
• 09: Other - Specify
• 98: RF
• 99: DK

Knowledge, Attitudes and Awareness - Part 5 (KN5) - Question identifier:KN5_Q39

Do you feel you have enough information about immunization?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Knowledge, Attitudes and Awareness - Part 5 (KN5) - Question identifier:KN5_Q40

What is the main reason you do not have enough information about immunization?

• 01: Did not receive any/enough information from provider
• 02: Did not know where to get information
• 03: Appointments were rushed
• 04: Felt uncomfortable asking questions
• 05: Did not take the time to review the information available to me
• 06: Did not understand the information provided
• 07: Language difficulty
• 08: Other - Specify
• 98: RF
• 99: DK

Education Highest Degree Block v.1 (EHG1) - Question identifier:EHG1_R01

Now, I would like to ask you some general background questions.

Education Highest Degree Block v.1 (EHG1) - Question identifier:EHG1_Q01

What is the highest certificate, diploma or degree that you have completed?

• 1: Less than high school diploma or its equivalent
• 2: High school diploma or a high school
  equivalency certificate
• 3: Trade certificate or diploma
• 4: College, CEGEP or other non-university
  certificate or diploma (other than trades
  certificates or diplomas)
• 5: University certificate or diploma below the
  bachelor's level
• 6: Bachelor's degree (e.g. B.A., B.Sc., LL.B.)
• 7: University certificate, diploma, degree above the
  bachelor's level
• 8: RF
• 9: DK

Immigration minimum block (IMM) - Question identifier:IMM_Q01

In what country were you born?

• 1: Search
• 2: Other - Specify
• 8: RF
• 9: DK

Immigration minimum block (IMM) - Question identifier:IMM_Q05

In what year did you first come to Canada to live?

Min = 1870; Max = 2100

Immigration minimum block (IMM2) - Question identifier:IMM2_Q01

In what country was your child, ^FNAME, born?

• 1: Search
• 2: Other - Specify
• 8: RF
• 9: DK

Immigration minimum block (IMM2) - Question identifier:IMM2_Q05

In what year did ^FNAME first come to Canada to live?

Min = 1870; Max = 2100

Total Household Income (THI) - Question identifier:THI_Q01

Now a question about your total household income.

What is your best estimate of your total household income received by all household members, from all sources, before taxes and deductions, during the year ending December 31, ]?

Income can come from various sources such as from work, investments, pensions or government. Examples include Employment Insurance, Social Assistance, Child Tax Benefit and other income such as child support, spousal support (alimony) and rental income.

Min = -9000000; Max = 90000000

Total Household Income (THI) - Question identifier:THI_Q02

Can you estimate in which of the following groups your household income falls? Was the total household income during the year ending December 31, ]... ?

• 1: Less than $50,000, including income loss
• 2: $50,000 and more
• 8: RF
• 9: DK

Total Household Income (THI) - Question identifier:THI_Q03

Please stop me when I have read the category which applies to your household.

Was it... ?

• 1: Less than $5,000
• 2: $5,000 to less than $10,000
• 3: $10,000 to less than $15,000
• 4: $15,000 to less than $20,000
• 5: $20,000 to less than $30,000
• 6: $30,000 to less than $40,000
• 7: $40,000 to less than $50,000
• 8: RF
• 9: DK

Total Household Income (THI) - Question identifier:THI_Q04

Please stop me when I have read the category which applies to your household.

Was it... ?

• 1: $50,000 to less than $60,000
• 2: $60,000 to less than $70,000
• 3: $70,000 to less than $80,000
• 4: $80,000 to less than $90,000
• 5: $90,000 to less than $100,000
• 6: $100,000 to less than $150,000
• 7: $150,000 and over
• 8: RF
• 9: DK

Knowledge and Demographic CAI shut-off block (KND) - Question identifier:KND_N01

This is the end of the component. Return to previously answered questions to make any necessary corrections, or select <Exit> to exit the component.

• 1: Exit

Validation Recruitment (VAL) - Question identifier:VAL_R01

We have now completed the survey.

Validation Recruitment (VAL) - Question identifier:VAL_R02

We appreciate your taking the time to talk about ^FNAME's immunizations today.

Validation Recruitment (VAL) - Question identifier:VAL_R03

If you would like to have some time to find ^FNAME's immunization record, I can make an appointment to call you back.

Validation Recruitment (VAL) - Question identifier:VAL_N07

Set an appointment to call back the PMK. Select In Progress outcome code 24-Soft appointment; call-back required.

Press <1> to continue.

Validation Recruitment - 2 (VALS) - Question identifier:VALS_R04

We would [also/empty] like to contact the health care provider(s) who have given ^FNAME the vaccines. All information obtained will be kept strictly confidential and is for research purposes only.

Validation Recruitment - 2 (VALS) - Question identifier:VALS_R05

To do this, we need to get your written consent and the contact information for all of the health care providers in Canada who have given ^FNAME immunizations. [In the next couple of days you/You] will receive a package with a consent form to fill out the names and contact information for ^FNAME's immunization providers and a postage-paid return envelope. When you have filled out the form and signed it, please return it by mail at your earliest convenience.

Validation Recruitment - 2 (VALS) - Question identifier:VALS_N06

Mail consent form to respondent?

• 1: Yes
• 2: No

Validation Recruitment - 2 (VALS) - Question identifier:VALS_N07

This is the end of the component. Return to previously answered questions to make any necessary corrections, or select <Exit> to exit the component.

• 1: Exit