COVID-19 Vaccine Readiness Survey - Disability Community

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COVID-19 Vaccine Readiness Survey - Disability Community

Your Thoughts on the COVID-19 Vaccine

Disabilty Rights California in partnership with Tarjan Center at UCLA, State Counsel on Developmental Disabilities, California Foundation of Independent Living Centers, UC Davis MIND Institute and USC Center for Excellence in Developmental Disabilities Education, Research and Service is seeking your input with respect to accessing COVID-19 Vaccines in an effort to understand barriers people with disabilities are having accessing the COVID-19 Vaccine. We are interested in finding out if you have gotten the COVID-19 vaccine, reasons you may or may not have gotten the vaccine, and plans to get the booster shot. You are being asked to complete this survey because you are person with a disability, a family member of a person with disability, or someone who works with people with disabilities. It is expected to take 10 minutes. There are no right or wrong answers. Your answers are confidential.

1. Have you gotten the COVID-19 vaccine?
If you have not received any COVID-19 vaccine, go to the next question.
3. What are/were your concerns about getting the vaccine? (Check all that apply.)
4. What are some of the things that make/made it difficult to get the COVID-19 vaccine? (Check all that apply.)
5. Will you get the COVID-19 booster shot?
7. How often do you get the flu shot?

Where You Get Your COVID-19 Vaccine Information?

Tell us a little about where you get information about the COVID-19 vaccine and who you turn to for vaccine information.

8. How do you get information about the COVID-19 vaccine? (Check all that apply.)
Questions Very likely Somewhat likely Not likely at all

A Little About You

We are almost done. The next questions are to give us an idea of who is completing the survey.

11. What is your gender identity?
12. Which do you identify with..?
13. What age group are you in?
15. I am...
16. What disability/disabilities do you have? (Check all that apply.)
17. Did someone help you complete this survey?

Information About Your Child(ren)

We are interested in learning about children you have and whether you plan to have them vaccinated or not.

18. Do you have children?
(If you do not have any children, you can go to the end of the survey and click Done to submit your responses .)
21. What disability/disabilities does your child(ren) have? (Check all that apply.)
22. Once there is a COVID-19 vaccine available for your child’s age group, will you...?