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Healthcare & Clinical

Seasonal Flu and COVID-19 Vaccine Intentions Survey

Tracks whether people plan to get vaccinated for flu and COVID-19 this season, what's holding hesitant respondents back, which access barriers get in the way, and which information sources they trust most. An AI follow-up probes the specific concerns behind low intention scores so public health teams can address the actual objection rather than a guess.

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設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全13問・約7分
Q01
メッセージ

Thanks for taking a few minutes to share your thoughts on flu and COVID-19 vaccines this season. There are no right or wrong answers — we're just trying to understand people's plans and concerns. About 4-5 minutes.

Q02
選択式必須

Did you get a flu vaccine last flu season (roughly September through March)?

  • Yes
  • No
  • Not sure
Q03
オピニオンスケール必須

How likely are you to get a flu vaccine this season?

スケール: 1 – 7
最小:Definitely will not最大:Definitely will
Q04
選択式必須

Which best describes your current COVID-19 vaccination status?

  • Never received a COVID-19 vaccine
  • Received initial vaccine series only
  • Received initial series plus one or more boosters, but not the most recent update
  • Up to date with the most recently recommended COVID-19 vaccine
  • Not sure
Q05
オピニオンスケール必須

How likely are you to get the currently recommended COVID-19 vaccine or booster this season?

スケール: 1 – 7
最小:Definitely will not最大:Definitely will
Q06
選択式

Which of the following, if any, describe reasons you might not get a flu or COVID-19 vaccine this season?

  • Concerned about side effects
  • Don't think I need it / low personal risk
  • Don't think it works well enough
  • Had a bad reaction before
  • Haven't gotten around to it
  • Prefer to build immunity naturally
  • Distrust of vaccine safety data
  • Distrust of pharmaceutical companies or government
Q07
AIインタビュー

Explore the reasoning behind this person's likelihood ratings for flu and COVID-19 vaccination, especially if either score was neutral or low. If they selected specific hesitancy reasons, probe what evidence, source, or experience would actually change their mind, and whether their view differs between the flu and COVID-19 vaccines specifically. If they rated both highly, briefly confirm what motivates them to keep up to date rather than assuming it's automatic.

Q08
マトリクス

How much do you trust each of the following sources for information about flu and COVID-19 vaccines?

7行 × 5列
  • Your doctor or nurse
  • Pharmacist
  • Local or state health department
  • CDC or national public health agency
  • Family and friends
  • ほか2件
列: Not at all trustworthy · Slightly trustworthy · Moderately trustworthy · Very trustworthy · Extremely trustworthy
Q09
選択式

In the past 12 months, has anything made it harder for you to get a vaccine you wanted?

  • Cost or insurance concerns
  • Difficulty finding an appointment
  • Not enough time off work or school
  • Transportation issues
  • Nearest location too far away
  • Not sure where to go
Q10
選択式

If you were to get vaccinated this season, where would you most likely go?

  • Pharmacy
  • Doctor's office or clinic
  • Workplace or school vaccination event
  • Community health center or public health clinic
  • Not sure
Q11
選択式

What is your age range?

  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65 or older
  • Prefer not to say
Q12
選択式

What is your health insurance status?

  • Insured through employer
  • Insured through government program (e.g., Medicare, Medicaid)
  • Individually purchased insurance
  • Uninsured
  • Not sure
  • Prefer not to say
Q13
メッセージ

Thank you for sharing your perspective. Your responses will be combined with others to help public health teams understand vaccine plans and reduce barriers to access — no individual answers will be shared.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Directly tracks intention for both flu AND COVID-19 vaccines in the same instrument, with separate status and likelihood questions for each rather than treating vaccination as one generic topic.
  • Uses an AI follow-up interview (AI follow-up interview block) to probe the actual reasoning behind a respondent's likelihood ratings, so low scores get diagnosed instead of just recorded.
  • Includes a dedicated reasons/barriers multiple-choice question plus a separate access-barrier question, letting public health teams distinguish 'won't' from 'can't' get vaccinated.
  • Captures a trust-in-sources matrix and channel/location preference alongside age and insurance status, giving segmentable data for targeting outreach and messaging.

QuestionPro

COVID-19 Survey Template + Sample Questionnaire

This is a general COVID-19 questionnaire template on an established survey platform, not a template purpose-built for tracking dual flu/COVID vaccine intentions or hesitancy reasoning. It's fielding-ready in the sense of being a static, editable questionnaire, but it isn't focused on the intention-vs-barrier-vs-trust structure this topic needs. Useful as a broad pandemic-attitudes starting point rather than a vaccination-intention diagnostic tool.

優れている点

  • Backed by a mature, full-featured survey platform with extensive logic and reporting tools
  • Provides a ready sample questionnaire so researchers aren't starting from a blank page
  • Easy to customize question wording and branching within QuestionPro's builder

物足りない点

  • Static question set with no adaptive AI follow-up to probe the specific reasons behind vaccine hesitancy
  • No automated per-response quality scoring or transparent prompt methodology
  • Not structured around the flu+COVID dual-intention, trust-source, and access-barrier framework this topic calls for

よくあるご質問

「Seasonal Flu and COVID-19 Vaccine Intentions Survey」テンプレートにはどのような設問が含まれていますか？

すぐに使える設問が13問含まれており、最初の設問は次のとおりです：「Thanks for taking a few minutes to share your thoughts on flu and COVID-19 vaccines this season. There are no right or w…」・「Did you get a flu vaccine last flu season (roughly September through March)?」・「How likely are you to get a flu vaccine this season?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか？

回答者は通常、13問を約7分で回答し終えます。

テンプレートは編集できますか？

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか？

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか？

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

このテンプレートを使う無料で始める

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