Domain.

Item

Response format

Confidence

Efficacy

Safety

Competence of Healthcare provider

Motivating factor for introducing the vaccine.

Overall Score on Confidence

Complacence

Risk of being infected

Side effects

Knowledge of vaccine.

Overall Score on Complacence

Convenience

Time of administration^*

Place of administration

Route

Affordability^*

Comfortable^*

Overall Score on Convenience

Do you think that immunization works?

Will you still immunize you child even if he/she will suffer side effects?

When introduced will you vaccinate your child with IPV?

Do you have any fear about the proposed use of IPV?

How confident are you on the competence of the vaccinators?

Which one is the main reason for introducing IPV: (a) to prevent diseases or (b) government means to embezzle funds?

How confident are you that your child will not suffer from Poliomyelitis even if not immunized?

How convinced are you that vaccines can cause adverse event?

How knowledgeable are you on the major content of vaccine?

Do you believe the rumours you heard about vaccines?

Do you accept to the timing of the vaccine doses?

Will you go to health facility to vaccinate your child with IPV?

Will you agree to your child receiving OPV during house-to-house campaign?

Will you hesitate to go for an injectable vaccine when there is an oral alternative?

How much are you willing to pay to receive IPV?

Are you comfortable with the number of vaccines in the immunization programme.

SA/A/D/SD

NAH/NTH/SH/VH

NAH/NTH/SH/VH

NAA/NTA/SA/AF

VC/SC/NTC/NAC

A/B

NAC/NTC/SC/VC

VC/SC/NTC/NACVK/SK/NTK/NAK

SA/A/D/SD

SA/A/D/SD^**

SA/A/D/SD

SA/A/D/SD

NAH/NTH/SH/VH

…………

NAC/NTC/SC/VC