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. 2021 Jul 1;35(5):509–517. doi: 10.1016/j.pedhc.2021.04.005

SUPPLEMENTARY TABLE 2.

COVID vaccine hesitancy questionnaire (adapted from Opel et al., 2011 [13])

Please indicate your response with a checkmark (√) in the appropriate box, using the scale below:
1 = strongly disagree
2 = disagree
3 = neither agree nor disagree
4 = agree
5 = strongly agree
1. I want a COVID vaccine for my child?
2. What are parents’ attitudes toward a possible vaccine for COVID?
3. My child is up-to-date on all their other vaccines.
4. Regarding the COVID vaccine, I have less hesitancy than with previous vaccinations?
5. Live with people at home who are considered at high risk for COVID?
6. Is your child considered at higher risk (chronic condition)?
7. Level of concern about COVID?
8. How concerned are you that a COVID shot might not prevent the disease?
9. How concerned are you that your child might have a serious side effect from a COVID shot?