What is your age? * must provide value
18-29 years
30-39 years
40-59 years
60-79 years
80 years and above
Please indicate your gender. * must provide value
Male
Female
Please indicate your marital status* must provide value
Single, never married
Married
Divorced
Widowed
Cohabiting
Please select the ethnic descent that best describes you.* must provide value
African
Afro-Caribbean
Asian
Caucasian
Chinese
Hispanic
Indian
Indo-Caribbean
Middle Eastern
Native American
Other, Please specify
Please specify
Please select the district that you reside in.
* must provide value
1
2
3
4
5
6
7
8
9
Please select your community.* must provide value
Dawson
Belmont
West End
Fresh Water Pond
Cart Path
Towers
Recovery
Daseys
Boway
Long Bay
Zion Hill
Little Apple Bay
Cappoon's Bay
Apple Bay
Carrot Bay
Windy Hill
Sage Mountain
Other:
Please select your community. Jost Van Dyke East
Jost Van Dyke West
Jost Van Dyke Central
Great Tobago
Cable Rock
King Rock
Little Tobago
Green Cay
Sandy Cay
Sandy Spit
Ballast Bay
Arundell
Mayaba
Shannon
Hodge
Cane Garden Bay
McIntosh
Ross
Soldier Hill
Martin
Little Bay
Brewers Bay
Anderson
Mt. Healthy
Todman
New Bush
Green Bank
Meyers
Chalwell
Edney
Doty
Martin Joes Hill
Long Bush
Great Mountain
Larmer's Bay
Spooner
Henley
Georges North Side
Diamond
Leonards Joes Hill
Primrose Garden
Harrigans.
Other:
Please select your community.* must provide value
Road Reef
Fisher
Slaney
Duffs Bottom
Albion
Nibbs
Threlfall
Mt. Fertile
Part of Sage Mountain (between Pleasant Valley and Pockwood Pond)
Sea Cow Bay including Parsons
Hannah
Havers
Pleasant Valley
Pockwood Pond
Coxheath
Nanny Cay.
Other:
Please select your community. * must provide value
Fort Burt
Macnamara
Road Town
Blyden
Long Bush
Lower Estate
Wickhams Cay I
Russell Hill
Georges Hollow
Norman Island
Pelican Island
Peter Island
Dead Man Chest
Salt Island
Cooper Island
The Indians
Carrot Rock.
Other:
Please select your community.* must provide value
John's Hole
Botanic Station
Horse Path
Pickering
Primrose Garden
Diamond
Northern Part of Johnson's Ghut,
Northern Part of Purcell
Huntums Ghut
Part of Great Mountain
Pasea
Wickham's Cay II.
Great Mountain
George's North Side
Lormer Bay
Cooper Bay
Turnbull Hill (including Long Trench)
Fahie Hill
Johnson's Ghut
Trunk Bay
Rogues Bay (including Manchester)
Butu Mountain
Carrot Bay
Cooten Bay.
Other:
Please select your community.* must provide value
Southern Part of Purcell
Free Bottom
Port Purcell
Baughers Bay
Jean Hill
Fish Bay
Kingstown
Belle Vue
Josiah Bay
Butu Mountain
Cooten Bay.
Other:
Please select your community. * must provide value
Buck Island
Brandywine Bay
Paraquita Bay
Half Moon Bay
Hetherington Spring Ghut
Martin Spring Ghut
Nottingham
Crabbe Hill
Long Look
Southern Part of Old Plantation
Vanterpool
Fat Hog's Bay
Quick Hill
Hodges Creek
Whelk Point
Other:
Please select your community. * must provide value
Lower Hope
Upper Hope
Josiahs Bay
Carberry Hill
Lambert
Balsam Ghut
Hawks Nest
Lloyds
Thomas Lands
East End
Parham Town
Red Bay
Tarris Hill
James Young
Major Bay
Old Plantation
Shepherd Hill
Greenland
Jennings Hill
Little Dicks Hill
Long Swamp
Other:
Please select your community.* must provide value
Anegada
Virgin Gorda (The Valley)
Virgin Gorda (North Sound)
Mosquito Island
Mosquito Rock
Prickly Pear Island
Eustatia Island
Saba Rock
Necker Island
West Seal Dog
East Seal Dog
Biras Creek
Bitter End
Round Rock
Fallen Jerusalem
Broken Jerusalem
Ginger Island
The Carval
Great Dog
West Dog
George Dog
Cockroach Islands
Other:
Please select your faith-based association?* must provide value
Anglican
Baptist
Buddhism
Hindu
Jehovah Witness
Methodist
Mormon
Muslim
Pentecostal
Presbyterian
Protestant
Roman Catholic
Seventh -day Adventist
Rastafarian
Agnostic or Atheist
Other, please specify
What is the highest degree or level of education you have completed? No schooling
Primary school
Secondary/High School
Tertiary (Bachelor's Degree, Masters, PHD or higher)
Trade School
What is your current occupation?* must provide value
Agricultural or Fisherman
Business Professional
Business Owner/Self Employed
Medical/Health-care Professional
Government/Civil Services
Clerical/ Secretary Support
Educator
Manager/ Supervisor
Customer Service
Homemaker
Sales
Full-time Student
Laborer
Technology/Enginerring
Social Service
Transportation
Hospitality
Retired
Other: please specify
Do you have any chronic diseases or underlying health conditions?* must provide value
Yes
No
Have you received the influenza vaccine before?* must provide value
Yes
No
What are your main sources of information regarding the COVID-19 vaccines and the vaccination programme? (Check all that apply)* must provide value
World Health Organization (WHO)
Center for Disease Control and Prevention (CDC)
Religious leaders
Political leaders
Social media (videos or messages sent via WhatsApp, Facebook, instagram)
National/local news broadcasts (E.g. radio, lives)
Health-care professional
Word of mouth (Discussion amongst family, friends or colleagues).
News sites
Other, please specify
How often do you verify information presented to you through social media or discussions?* must provide value
Very often
Often
Seldom
Not at all.
How exactly do you verify this information?* must provide value
World Health Organization (WHO)
Center for Disease Control and Prevention (CDC)
Religious leaders
Political leaders
Social media (videos or messages sent via WhatsApp, Facebook, instagram)
National/local news broadcasts (E.g. radio, lives)
Health-care professional
Word of mouth (Discussion amongst family, friends or colleagues).
News sites
Other, please specify
Has your experience with the Covid-19 global pandemic affected your opinion on vaccinations in general?* must provide value
Yes
No
How has your experience with the pandemic affected your opinion on vaccinations?
* must provide value
I am much more likely to vaccinate myself/ my children
I am more likely to vaccinate myself/my children
I am less likely to vaccinate myself/my children
I am much less likely to vaccinate myself/my children
Vaccinated persons cannot become infected or transmit the Covid-19 virus. * must provide value
True
False
AstraZeneca is an mRNA vaccine, with a high efficacy rate. * must provide value
True
False
There are 3 main variants of concern circulating globally at present.* must provide value
True
False
To date, reported vaccine-related side effects in the BVI have been mild. * must provide value
True
False
Vaccinations aside, what other procedures do you believe will help prevent you from contracting Covid-19?* must provide value
Physical distancing >3ft
Using detergents
Wearing face masks properly (above the nose)
Washing hands for 20 seconds with soap
Avoid touching face.mouth/nose/eyes
Consuming Zinc
Consuming vitamin C
Avoid eating meat
Herbal remedies (e.g. facial steaming, saline nasal rinses, bush tea)
Vaccination in the BVI is legally mandatory.* must provide value
Yes
No
Persons NOT eligible for vaccination include: (please check all that apply)
* must provide value
Persons < 5yrs of age
Immunocompromised patients
Patients with chronic diseases like diabetes, hypertension and heart diseases
Persons having active COVID-19 infection
Persons recovered from COVID-19 infection
Persons with food allergies
Pregnant ladies and lactating mothers
Persons >18 years
In your opinion, is Covid-19 a mild disease that poses no serious health risk?* must provide value
Yes
No
In your opinion, has mask wearing, hand washing and physical distancing declined in the BVI?* must provide value
Yes
No
In your opinion, should vaccinated persons still adhere to the public health measures like mask wearing, physical distancing and hand washing? Yes
No
Have you ever been infected with Covid-19?* must provide value
Yes
No
Did you tell your family and friends you had been infected?* must provide value
Yes
No
In the event that you are diagnosed with Covid-19, are you willing to tell your friends and family?* must provide value
Yes
No
Why not?* must provide value
Fear of discrimination and stigma
Fear of Judgement
Sense of shame
To protect myself from mental and emotional stress
Other, please specify
In the last 12 months , have you ever experienced any symptoms of Covid-19? For example: dry cough, headaches, nasal congestion, diarrhea, muscle aches, joint pains, fever?
Yes
No
Did you contact Public Health or your local Health-care provider to schedule a test? Yes
No
Please indicate why. For economic reasons- I could not take the risk of testing positive and being isolated from work.
I did not want for my family and/or I to be quarantined.
Close contacts would also need to be quarantined, which may negatively impact their finances and possibly our relationship.
I could not mentally cope with testing positive.
I have concerns surrounding the accuracy of the test.
I did not know where or who to call to get a test done.
Other, please specify
In your opinion, should partially or fully vaccinated close contacts of a case be subject to the same 10-14 day quarantine period as an unvaccinated close contact?
Yes
No
In your opinion, do you think that the best way to avoid health complications is by getting the vaccine?* must provide value
Yes
No
If you had to choose, which Covid-19 vaccine would you prefer to be administered in the BVI?* must provide value
Pfizer
Moderna
Johnson & Johnson's Janssen
Sputnik (Russian Vaccine)
Novavax (American Vaccine)
Sinopharm (Chinese Vaccine)
Sinovac (Chinese Vaccine)
Soberana 02 (Cuban Vaccine)
Abdala (Cuban Vaccine)
None of the above- I prefer AstraZeneca.
None. No Covid-19 vaccines should be administered in the BVI.
In your opinion, what is the likelihood that you will contract Covid-19 in the next 6 months?* must provide value
I think I will be infected and my symptoms will be severe
I think I will be infected and my symptoms will be mild
I do not think that I will be infected.
Do you think more education and awareness around the vaccines are needed?* must provide value
Yes
No
Are you fully or partially vaccinated?* must provide value
Yes
No
Do you intend to get vaccinated for Covid-19?* must provide value
Yes
No
I am still undecided
Are you likely to get a Covid-19 booster? Yes
No
Undecided
Give a brief reason why.
No more than 1-2 sentences. * must provide value
Why? Please select all appropriate answers.* must provide value
I prefer natural immunity than immunity stimulated from vaccines.
I am still concerned about vaccine efficacy
I am concerned about vaccine safety and their side effects.
These vaccines give people Covid-19.
I don't want to be a guinea pig.
I am concerned about the rigor of testing.
I am concerned about what the vaccines are made up of.
These vaccines cause other diseases, like autism.
I am concerned about these rare health impacts, like blood clots.
I can still contract Covid, so what's the sense?
The vaccines they give black people are different from those they give other races.
I would prefer to be given another vaccine like Pfizer or Moderna over AstraZeneca.
The vaccine may affect my fertility.
The vaccine may not be effective against variants.
I don't want to take multiple shots of the vaccine.
It depends on what my doctors recommends.
It depends on the scale of the outbreak in the BVI. If it is low, I may not do it.
I don't feel I'm at risk.
I am religious and God will protect me.
I don't take vaccines at all.
I am scared to put foreign objects in my body.
The vaccines should go to those who are most at risk of severe symptoms and premature death.
If the government endorses it, I will not take it.
I do not trust Big Pharma.
These vaccines are a way to depopulate the earth.
The vaccines contain tracking devices and/or chips.
I am afraid of needles.
Other, please specify:
What are some factors that may prompt you to get vaccinated?* must provide value
If I was convinced that the vaccine has be tested rigourously.
If I saw that enough people were safely vaccinated without negative side effects.
If I saw that enough people who got the vaccine didn't get severely ill with Covid-19.
Enough of my family and friends took the vaccine without negative side effects.
My job mandated that I had to get vaccinated.
If I thought the health authorities were trustworthy.
If I was convinced that getting vaccinated helped protect vulnerable members of my community.
If getting vaccinated was required by Government.
If a trusted health-care professional told me to get vaccinated.
If I knew for a fact Big Pharma was not trying to exploit me.
If getting vaccinated was required for me to attend social or sporting events.
If getting vaccinated was required for travel.
If I personally knew someone who died from Covid-19.
If I received a financial incentive.
If I received some other incentive (e.g. discount on food supplies or gas).
If I knew someone who got sick from Covid-19.
If I knew someone who was hospitalised from Covid-19.
If religious leaders in my community promoted the vaccine.
If the Premiere or the Minister of Health promoted the vaccine
If vaccination was positively promoted in my peer group or social media network.
Other, please specify:
Differential Quarantine periods?* must provide value
* must provide value
Ten (10%) discount at various stores and retailers. * must provide value
Bimonthly swabbing at your organization.* must provide value
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