Assessment of Seasonal Influenza Immunization Coverage in the Canadian Population, 2016-17

Survey Report

Submitted to
Public Health Agency of Canada
POR-ROP@hc-sc.gc.ca

Prepared By
Leger

Ce rapport est aussi disponible en français.

POR 104-16

Contract Number 6D034-164442/001/CY
Awarded 2017-01-30

Project 15181-003
2017-03-31

Leger
507 Place d'Armes, Suite 700
Montréal, Quebec
H2Y 2W8
Phone: 514-982-2464
Fax: 514-987-1960
www.leger360.com

1. Executive Summary
2. Detailed Quantitative Findings
Appendix A - Detailed Research Methodology
- A.1 Quantitative Methodology
Appendix B - Survey Questionnaire

Executive Summary

Leger is pleased to present the Public Health Agency of Canada with this report on findings from a quantitative survey aimed to evaluate seasonal influenza immunization coverage within the Canadian population.

This report was prepared by Leger who was contracted by the Public Health Agency of Canada (contract number 6D034-164442/001/CY awarded January 30, 2017).

1.1 Background and Objectives

The main objective of the study is to evaluate seasonal influenza immunization coverage within the Canadian population. The following topics are covered among Canadian households participating in the survey.

Seasonal flu vaccination before September 1, 2016 and since September 1, 2016 inclusively (for the adult respondent and each minor children, if applicable)
Reasons for taking or not taking the vaccine this year (for the adult respondent and each minor children, if applicable)
Form of flu vaccine received (shot or nasal spray)
Date (month) and place of vaccination
Number, gender and age of minor children in the household
Number of doses received by children between 6 months and 9 years of age, receiving the vaccine for the first time
Reasons for not receiving two doses, if applicable
Health care and alternative care providers seen in the last year
Flu incidence among population (respondent and friend or family member)
Sources of information and most trusted resource for the flu shot
Promoters and detractors of the flu vaccine
Exposure to messages promoting the flu vaccine
Demographic profile of adult respondents and identification of any chronic health condition considered as high risk for influenza-related complications

1.2 Methodology - Quantitative Research

The quantitative research was conducted by telephone, using Computer Assisted Telephone Interviewing (CATI) technology. This approach is the most appropriate to assess seasonal influenza immunization coverage among different subgroups of the Canadian population, while ensuring a high level of representativeness. To achieve data reliability in all subgroups, a sample of 2,024 adult Canadians were surveyed. Only one adult respondent was surveyed within each household.

Fieldwork for the survey was conducted from February 14 to March 5, 2017. The national response rate for the survey was 20.3%. Complete call dispositions are presented in Appendix A. A pre-test of 30 interviews, 15 in each official language, was completed on February 14, 2017 (in English) and on February 16, 2017 (in French). Survey interviews lasted 7 minutes on average.

Telephone interviewing was conducted using Leger's Computer-Assisted Telephone Interviewing (CATI) technology. Leger's CATI system handles sampling electronically, randomly selecting and dialing the phone number to call. To ensure perfect coverage of a population, the sample consisted of residential phone numbers located in all Canadian provinces and territories, as well as cell phone numbers of Canadians who do not have a residential landline phone number (i.e. pre-validated cell-only numbers). Based on the Communications Monitoring Report 2016 published by the CRTC in 2016, which revealed that 23.7% of Canadian households were using a cell phone exclusively, Leger made sure that 23.7% of the final sample was derived from cell-only numbers.

Landline phone numbers were generated and cell-only numbers were purchased according to a stratified regional sampling approach. Regional quotas were applied to ensure that a sufficient number of interviews within each region of Canada and within each type of phone number (residential (1,527) and cell phone (497)). In addition to these regional quotas, fieldwork was conducted to ensure a good distribution of respondents in terms of gender (men and women) and language (English and French-speaking Canadians), using soft quotas.

A total of 2,024 adult Canadians were interviewed in all regions of the country. The national margin of error for the survey is +/- 2.18%, 19 times out of 20.

Based on data from Statistics Canada's 2011 national census, Leger weighted the results of this survey by age, gender, region and language (mother tongue). Results were also weighted based on the presence of minor children in the household (yes or no), since this question was asked and is important for this study. Moreover, the weight of respondents reached via the cell-only sample was also controlled to match the expected 23.7% after weighting.

As a Certified Gold-Seal MRIA Member, Leger adheres to the most stringent guidelines for quantitative research. The survey has been registered with the MRIA in accordance with Government of Canada requirements for quantitative research, including the MRIA Code of Conduct and Standards of the Conduct of Government of Canada Public Opinion Research - Series D - Quantitative Research.

Respondents were assured of the voluntary and confidentiality aspect of the approach and of the anonymity of their responses. As with all research conducted by Léger, all information that could allow for the identification of participants was removed from the data, in accordance with the Privacy Act of Canada.

The details of the methodology procedure and more information on Leger's quality control mechanisms are presented in Appendix A.

The French and English questionnaires (the same questionnaire was used for both languages of the study) are available in Appendix B.

Details regarding the weighting procedures can be found in Appendix A and detailed statistical tables of results can be found in Appendix C.

1.3 Overview of Quantitative Findings

Since September 1st, 2016, more than a third of the Canadian population (36%) received the seasonal influenza vaccine. Those 65 years of age or older (69%), respondents from the Maritimes (50%), women (39%) and those between the ages of 18 and 64 with a chronic condition (37%), are proportionally more inclined to have been vaccinated against the flu in the past year. Nearly six out of ten respondents (59%) said that they had received the seasonal flu vaccine in the past (before September 1st, 2016).
Prevention / not wanting to get sick (44%) is the most important motivation for getting the flu vaccine. On the other hand, the main reasons provided by respondents for not getting the flu vaccine are not needing it / not being a person at risk / not recommended for them (47%), skepticism in its effectiveness (19%) and lack of time (15%). For parents, the main reasons for not getting their children vaccinated is also the belief that they don't need it (36%) or skepticism in its effectiveness (24%).
Almost all Canadians (99%) were vaccinated with a flu shot and few (1%) were vaccinated by nasal spray. Most Canadians received the flu vaccine in October (38%) or in November 2016 (37%). A third of Canadians received the flu vaccine at the doctor's office or a health clinic (33%) and more than one-quarter at the pharmacy (28%).
Almost one-quarter of Canadian children (23%) received the flu vaccine this year and more than a third of them (36%) received it for the first time. Nearly six out of ten children between 6 months and 9 years of age (58%) received one dose, while 28 percent received the two recommended doses. Eighteen percent (18%) of parents did not have enough information about the second dose and 16 percent did not know there was a second dose.
Two out of ten respondents (22%) say they had the flu within the past 12 months, mostly with mild symptoms (19%), and more than half of respondents (56%) have seen their friends or family members suffer from severe (13%) or mild (47%) flu symptoms.
The vast majority of respondents (93%) have seen a health care provider in the last year. Family doctors (76%), dentists (64%) and pharmacists (58%) were the most visited professionals. Nearly one-quarter of respondents have seen an alternative care provider (23%) or another care provider (22%).
Nearly half of respondents (47%) state that when they want to know more about the flu shot, they would look for information in a public health setting, health clinic or pharmacy. To a lesser extent, the Internet is also a legitimate source of information about the flu shot; 18 percent said that they do an online search and 13 percent will refer to a government website.
The most trusted resource about the flu shot is the family doctor with two-thirds of respondents (64%) saying that they trust him/her the most on this topic.
Four out of ten respondents (40%) say that someone advised them to get the flu vaccine within the last 12 months, while 14 percent of respondents say that someone told them the opposite. Nearly four out of ten of those who were advised to get the flu vaccine were advised to do so by their family doctor (38%). Family members also play a role in getting the flu vaccine for two out of ten respondents (21%). Conversely, friends (50%) and family members (30%) also played a major role in advising respondents not to get the flu vaccine.
More than three-quarters of respondents (78%) state that they have seen, read or heard messages promoting the flu vaccine in the last 12 months. More than six out of ten of those who have seen, read or heard messages promoting the flu vaccine have seen or heard them on radio, or seen TV ads or advertisements (62%), and more than one-quarter have also seen messages about the flu vaccine when visiting the pharmacy, doctor's office or hospital (27%).

1.4 Notes on Interpretation of Research Findings

The views and observations expressed in this document do not reflect those of the Public Health Agency of Canada. This report was compiled by Leger based on the research conducted specifically for this project. This research is probabilistic; the results can be inferred to the general population of Canada. The design of the research was built with this objective in mind.

1.5 Political Neutrality Statement and Contact Information

Leger certifies that the final deliverables fully comply with the Government of Canada's political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research.

Additional information

Supplier name: Leger
PWGSC Contract Number: 6D034-164442/001/CY
Contract Award Date: January 30th, 2017

The expenditure for this project is $74,664.75 (including HST).

To obtain more information on this study, please email POR-ROP@hc-sc.gc.ca

2. Detailed Quantitative Findings

This chapter presents the detailed findings from the quantitative survey for the Public Health Agency of Canada regarding seasonal influenza immunization coverage within the Canadian population. The research was fielded between February 14 and March 5, 2017. A full set of detailed tables is also available in the appendix (under a separate cover).

Methodological note to read the tables in the report

In this report, it should be noted that the numbers presented have been rounded. On the other hand, numbers before rounding have been used to calculate the sums presented. For this reason, those sums may not match the manual summation of the numbers presented.

Differences in proportion

According to the normal distribution, a two-tailed test is always done between two proportions and based on the unweighted total columns. The test is performed by comparing the percentage of a vertical cell with the vertical percentage formed by the complement of the cells for the relevant category (e.g. the complement of men is women and the complement of the 18-24 age group is those 25 and over). The test results (if they are significant at a confidence level of 95%) are indicated with a symbol in the table.

In the tables, results presented with a "↓" characters represent statistically lower differences when compared to the complement, while results with "↑" characters indicate statistically higher differences when compared to the complement.

2.1 Seasonal Influenza Immunization Coverage Before and Since September 1, 2016 Inclusively

Nearly six out of ten Canadians (59%) said that they had received the seasonal flu vaccine before September 1, 2016. When looking at subgroups within the general population, we observe that people 65+ years old (79%), people from the Maritimes (72%), the 18-64 group with a chronic condition (68%), those with a university degree (66%), Ontarians (64%) and females (64%) are more likely to have received the seasonal flu vaccine in the past.

Table 1. Seasonal Influenza Immunization Coverage before September 1, 2016 (Q1)
Before September 1st, 2016, had you ever received the seasonal flu vaccine?
	Total	Region
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Weighted n=	2,024	141	479	777	355	266	6
Unweighted n=	2,024	160	526	640	388	280	30
Yes	59%	72%↑	48%↓	64%↑	59%	59%	58%
No	41%	28%↓	52%↑	36%↓	41%	41%	42%

Since September 1, 2016, more than a third of the Canadian population (36%) received the seasonal influenza vaccine. We can observe that those 65 years of age or older (69%) and those between the ages of 18 and 64 with a chronic condition (37%) are more likely to have received the flu vaccine this year. We also note that respondents from the Maritimes (50%) and women (39%) are more likely to have received the flu vaccine since September. The opposite trend is observed in Quebec, where one-quarter of respondents (25%) received the flu vaccine this year.

Table 2a. Seasonal Influenza Immunization Coverage since September 1, 2016 inclusively (Q2)
Since September 1st, 2016 inclusively, have you received the seasonal flu vaccine?
	Total	Subgroups
	Total	18-64	18-64 with chronic health condition	18-64 without chronic health condition	65 +	Children 13-17 years of age	Children 6-12 years of age	Children 6 months to 5 years of age	Children younger than 6 months
Table 1 footnotes Table 1 footnote 1 Because of the small sample size (n<30), results are presented for illustrative purposes only. Return to table 1 footnote * referrer
Weighted n=	2,024	1,647	412	1,235	377	213	309	254	20
Unweighted n=	2,024	1,446	407	1,039	578	185	255	199	18^{Table 1 footnote *}
Yes	36%	28%↓	37%↑	25%↓	69%↑	27%	21%↓	22%↓	20%
No	64%	72%↑	63%↓	75% ↑	31%↓	73%	79%↑	78%↑	80%

Table 2b. Seasonal Influenza Immunization Coverage since September 1, 2016 inclusively (Q2)
Since September 1st, 2016 inclusively, have you received the seasonal flu vaccine?
	Total	Region						Gender
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories	Male	Female
Weighted n=	2,024	141	479	777	355	266	6	980	1,044
Unweighted n=	2,024	160	526	640	388	280	30	801	1,223
Yes	36%	50%↑	26%↓	37%	38%	38%	39%	32%↓	39%↑
No	64%	50%↓	74%↑	63%	62%	62%	61%	68%↑	61%↓

2.2 Reasons for Getting or Not Getting the Flu Vaccine This Year

Nearly half of Canadians who indicated that they did not receive the flu vaccine this year (47%) say that they did not get the flu vaccine because they did not need it / they are not a person at risk / it is not recommended for them. Two Canadians out of ten (19%) say that they do not believe in the effectiveness of the vaccine and 15 percent say they did not have time to do it.

Image 1. Reasons for Not Taking the Flu Vaccine in 2016-17 (Q3)

What are the reasons why you did not receive the flu vaccine this year?

Base: Among those who did not receive the flu vaccine this year (n=1,171)

Image 1. Reasons for Not Taking the Flu Vaccine in 2016-17 (Q3)

Text Description - Figure 1

Because respondents were able to give multiple answers, total mentions may exceed 100%.

Conversely, Table 3 shows that 44 percent of those who received the flu vaccine this year did so because they want to prevent infection / do not want to get sick. This reason is especially prevalent among the 65+ group (51%). To a lesser extent, 16 percent of those who received the vaccine did so because it is required in their workplace and 13 percent did so because they are at risk because of their health condition or because they receive it every year.

The 18-64 group without a chronic condition is more likely to have received the flu vaccine because it is required in their workplace (25%) while those in the 18-64 group with a chronic condition are more likely to say that they got the flu vaccine because of their risky health condition (31%). Finally, respondents in the 65+ group are showing a higher proportion of getting the flu vaccine because they receive it every year (22%) or because it was recommended by a health care professional (12%).

Table 3. Reasons for Taking the Flu Vaccine in 2016-17 (Q6)
What are the reasons you decided to receive the flu vaccine this year?
Base: Among those who received the flu vaccine this year (n=853)	Total	Subgroups
	Total	18-64	18-64 with chronic health condition	18-64 without chronic health condition	65 +
Weighted n=	724	462	152	310	262
Unweighted n=	853	450	166	284	403
I want to prevent infection / I do not want to get sick	44%	41%	35%	44%	51%↑
It is required in my workplace	16%	23%	18%	25%↑	4%↓
I am at risk because of my health condition	13%	13%	31%↑	5%↓	12%
I receive it every year (no specific reason)	13%	8%↓	11%	7%↓	22%↑
I was recommended by a health care professional	9%	7%	9%	6%	12%↑
If not vaccinated, I can transmit the disease to at-risk people (children, elderly or sick people/patients)	7%	8%	7%	9%	4%↓
I am at risk because of my age	6%	2%	4%	2%↓	11%↑
If not vaccinated, I can transmit the disease to family members, colleagues or friends (without mention of at-risk people)	5%	7%	5%	9%	1%↓
I was encouraged by family members, colleagues or friends	3%	4%	2%	4%	1%↓
It was offered / free (by employer or other)	2%	2%	1%	2%	2%
I would be required to wear a mask at work if not vaccinated	0%	0%	0%	0%	0%
Other reason	0%	0%	0%	0%	0%
Refusal	1%	1%	0%	1%	0%

Because respondents were able to give multiple answers, total mentions may exceed 100%.

2.3 Form of Flu Vaccine Received

Nearly all Canadians who received the flu vaccine this year (99%) were vaccinated with a flu shot (with a needle), whereas one percent received it by nasal spray (Flumist).

Image 2. Form of Flu Vaccine Received (Q4)

Was the flu vaccine you received this year given by a shot (with a needle) or a spray in the nose?

Base: Among those who received the flu vaccine this year (n=853)

Image 2. Form of Flu Vaccine Received (Q4)

Text Description - Figure 2

2.4 Date and Place of Vaccination

Most Canadians who received the flu vaccine this year received it in October 2016 (38%) or in November 2016 (37%). Table 4 shows that two-thirds of Quebecers (67%) received the vaccine in November and half of residents of Manitoba, Saskatchewan or Alberta (51%) received it in October. The analysis of the results shows that there are no significant differences between the subgroups studied by Public Health Agency of Canada (PHAC).

Table 4. Date (month) of Vaccination (Q5)
In which month did you receive the flu vaccine this year?
Base: Among those who received the flu vaccine this year (n=853)	Total	Region
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Table 4 footnotes Table 4 footnote 1 Because of the small sample size (n<30), results are presented for illustrative purposes only. Return to table 4 footnote * referrer
Weighted n=	724	71	127	290	134	101	2
Unweighted n=	853	86	166	288	176	125	12^{Table 4 footnote *}
September 2016	4%	5%	3%	5%	5%	2%	7%
October 2016	38%	40%	15%↓	40%	51%↑	39%	8%
November 2016	37%	28%	67%↑	32%↓	26%↓	35%	46%
December 2016	9%	9%	10%	9%	5%↓	10%	18%
January 2017	4%	5%	3%	4%	5%	4%	0%
February 2017	1%	0%	0%	1%	2%	1%	0%
Don't remember	8%	13%↑	3%↓	8%	6%	9%	21%

One-third of Canadians who got the flu vaccine (33%) received it at a doctor's office or health clinic. This proportion is higher among respondents from the Maritimes (43%) and Ontario (45%).

More than one-quarter of respondents (28%) received the flu vaccine at their pharmacy. This was especially prominent in British Columbia (36%).

Finally, Quebec has the highest proportion of respondents who received the flu vaccine at a temporary vaccine clinic (22%) or at a CLSC or community health centre (26%).

Table 5. Place of Vaccination (Q7)
Where did you receive the flu vaccine this year?
Base: Among those who received the flu vaccine this year (n=853)	Total	Region
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Table 5 footnotes Table 5 footnote 1 Because of the small sample size (n<30), results are presented for illustrative purposes only. Return to table 5 footnote * referrer
Weighted n=	724	71	127	290	134	101	2
Unweighted n=	853	86	166	288	176	125	12^{Table 5 footnote *}
Doctor's office or health clinic	33%	43%↑	14%↓	45%↑	21%↓	29%	27%
Pharmacy	28%	28%	9%↓	31%	34%	36%↑	0%
Temporary vaccine clinic (i.e. at the mall)	11%	10%	22%↑	7%↓	17%↑	4%↓	7%
CLSC or Community health centre	10%	3%↓	26%↑	5%↓	13%	6%	51%
Workplace	9%	11%	12%	4%↓	8%	19%↑	16%
Hospital	7%	3%	9%	8%	5%	4%	0%
Retirement residence or eldercare centre	1%	0%	3%↑	0%	1%	2%	0%
Other	1%	0%	5%↑	0%	0%	1%	0%
Don't remember	0%	0%	1%↑	0%	0%	0%	0%

2.5 Seasonal Influenza Immunization Coverage among Children

Of the households with children, nearly one-quarter of Canadian children (23%) received the flu vaccine this year. Interestingly, influenza immunization coverage seems to decrease when there are more children in the household.

Table 6. Seasonal Influenza Immunization Coverage among Children (Q11)
Since September 1st, 2016 inclusively, have your ***<Q9A1> <Q9A2>***-old child received the seasonal flu vaccine?
Base: Among all children (n=894)
	Total	Number of children
	Total	1 child	2 children	3 children	4+ children
Weighted n=	1.081	233	468	225	154
Unweighted n=	894	204	380	174	136
Yes	23%	31%	23%	19%	16%
No	77%	69%	77%	81%	84%

For more than a third of the children (36%), it was the first time they received the flu vaccine.

Image 3. First Time Receiving the Flu Vaccine (Q12)

Was it the first time your ***<Q9A1> <Q9A2>***-old child received the flu vaccine?

Base: Among all children who received the flu vaccine (n=124)

Image 3. First Time Receiving the Flu Vaccine (Q12)

Text Description - Figure 3

Nearly six out of ten of all children between 6 months and 9 years of age who received the flu vaccine (58%) received only one dose, while 28 percent received the two recommended doses.

Image 4. Number of doses received by children between 6 months and 9 years of age, receiving the vaccine for the first time (Q13)

Since September 1st, 2016 inclusively, has your ***<Q9A1> <Q9A2>***-old child received one or two doses of the flu vaccine?

Base: Among all children between 6 months and 9 years of age who received the flu vaccine for the first time (n=40)

Image 4. Number of doses received by children between 6 months and 9 years of age, receiving the vaccine for the first time (Q13)

Text Description - Figure 4

Nearly two in ten parents indicated that their child(ren) did not receive a second dose of the flu vaccine because they did not have this information (18%) and they did not know there was a second dose (16%).

Image 5. Reasons for Children Not Receiving a Second Dose (Q14)

Children between the ages of 6 months and 9 years who are receiving the flu vaccine for the first time are sometimes given two doses. What are the reasons why your ***<Q9A1> <Q9A2>***-old child did not receive a second vaccine?

Base: Among children between 6 months and 9 years of age who did not receive a second dose (n=26^{Image 5 footnote *})

Image 5. Reasons for Children Not Receiving a Second Dose (Q14)

Text Description - Figure 5

Image 5 footnotes

Image 5 footnote 1

Because of the small sample size (n<30), results are presented for illustrative purposes only.

Return to image 5 footnote * referrer

Note: Only answers with at least 1% of total mentions are presented.
Because respondents were able to give multiple answers, total mentions may exceed 100%.

Of those who have children under 18 years of age, the main reasons provided for not getting their children vaccinated are the belief that they don't need it (36%) or not believing in its effectiveness (24%).

Image 6. Reasons for Children Not Receiving the Vaccine This Year (Q15)

What is(are) the reason(s) your ***<Q9A1> <Q9A2>***-old child did not receive the flu vaccine this year?

Base: Among all children who did not receive the flu vaccine (n=739)

Image 6. Reasons for Children Not Receiving the Vaccine This Year (Q15)

Text Description - Figure 6

Note to reader: Only answers with at least 1% of total mentions are presented.
Because respondents were able to give multiple answers, total mentions may exceed 100%.

2.6 Flu Incidence among Population (Respondent and Friend or Family Member)

Two out of ten respondents (22%) say that they had the flu within the past 12 months, mostly with mild symptoms (19%). It seems that respondents from Manitoba, Saskatchewan and Alberta (17%) are slightly less likely to suffer from flu symptoms.

Table 7a. Flu Incidence among Respondents within the Past 12 Months (Q19C)
Within the past 12 months, have you had the flu?
PERSONALLY, WITHIN THE PAST 12 MONTHS	Total	Region
PERSONALLY, WITHIN THE PAST 12 MONTHS	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Weighted n=	2,024	141	479	777	355	266	6
Unweighted n=	2,024	160	526	640	388	280	30
NET YES	22%	28%	25%	21%	17%↓	25%	46%↑
Yes, with severe symptoms (e.g. hospitalization, pneumonia)	3%	4%	2%↓	3%	4%	5%	5%
Yes, with mild symptoms (e.g. sudden onset of high fever, chills, sore throat, cough, muscle pain)	19%	24%	23%↑	18%	14%↓	20%	41%↑
No, did not have the flu	77%	72%	74%	78%	82%↑	73%	54%↓
Don't know / Don't remember	1%	0%	1%	1%	1%	2%	0%

Conversely, as shown in Table 7b, the 18-64 group with a chronic health condition and children 6 months to 5 years of age are more likely to have shown flu symptoms in the past year (29% and 32%, respectively). Regardless of whether they were vaccinated or not, the same proportion of Canadians was affected by flu symptoms within the last months.

Table 7b. Flu Incidence among Respondents within the Past 12 Months (Q19C)
Within the past 12 months, have you had the flu?
PERSONALLY, WITHIN THE PAST 12 MONTHS	Total	Subgroups								Flu vaccine 2016-2017
PERSONALLY, WITHIN THE PAST 12 MONTHS	Total	18-64	18-64 with chronic health condition	18-64 without chronic health condition	65 +	Children 13-17 years of age	Children 6-12 years of age	Children 6 months to 5 years of age	Children younger than 6 months	Yes	No
Table 7 footnotes Table 7 footnote 1 Because of the small sample size (n<30), results are presented for illustrative purposes only. Return to table 7 footnote * referrer
Weighted n=	2,024	1,647	412	1,235	377	213	309	254	20	724	1,300
Unweighted n=	2,024	1,446	407	1,039	578	185	255	199	18^{Table 7b footnote *}	853	1,171
NET YES	22%	24%	29%↑	22%	16%↓	22%	22%	32%↑	19%	22%	23%
Yes, with severe symptoms (e.g. hospitalization, pneumonia)	3%	3%	7%↑	2%↓	3%	3%	1%	5%	6%	4%	3%
Yes, with mild symptoms (e.g. sudden onset of high fever, chills, sore throat, cough, muscle pain)	19%	20%	22%	20%	13%↓	19%	21%	27%↑	13%	18%	20%
No, did not have the flu	77%	75%	71%↓	77%	83%↑	76%	77%	65%↓	81%	77%	76%
Don't know / Don't remember	1%	1%	1%	1%	1%	2%	1%	3%↑	0%	1%	1%

It seems that respondents have seen more than half (56%) of their friends or family members suffer from severe (13%) and/or mild (47%) flu symptoms. Friends or family members from the Maritimes (20%) and British Columbia (18%) are more likely to have more severe flu symptoms.

Table 8. Flu Incidence among Respondents' Friends and Family Members within the Past 12 Months (Q19E)
Within the past 12 months, do you know a friend or family member who had the flu?
FRIEND OR FAMILY MEMBER, WITHIN THE PAST 12 MONTHS	Total	Region
FRIEND OR FAMILY MEMBER, WITHIN THE PAST 12 MONTHS	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Weighted n=	2,024	141	479	777	355	266	6
Unweighted n=	2,024	160	526	640	388	280	30
NET YES	56%	59%	54%	56%	56%	61%	53%
Yes, with severe symptoms (e.g. hospitalization, pneumonia)	13%	20%↑	9%↓	13%	14%	18%↑	8%
Yes, with mild symptoms (e.g. sudden onset of high fever, chills, sore throat, cough, muscle pain)	47%	49%	46%	47%	46%	49%	50%
No, did not have the flu	40%	36%	42%	41%	41%	37%	38%
Don't know / Don't remember	3%	5%	4%	3%	3%	2%	9%

Because respondents were able to give multiple answers, total mentions may exceed 100%.

More than half of respondents (55%) mentioned having severe (7%) or mild (48%) flu symptoms in the past. Respondents from the Maritimes (14%) and British Columbia (11%) are slightly more likely to have experienced severe flu symptoms in the past.

Table 9a. Flu Incidence among Respondents before the Past 12 Months (Q19D)
Before the last 12 months, have you ever had the flu?
PERSONALLY, BEFORE THE PAST 12 MONTHS	Total	Region
PERSONALLY, BEFORE THE PAST 12 MONTHS	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Weighted n=	2,024	141	479	777	355	266	6
Unweighted n=	2,024	160	526	640	388	280	30
NET YES	55%	62%	53%	55%	57%	57%	45%
Yes, with severe symptoms (e.g. hospitalization, pneumonia)	7%	14%↑	3%↓	6%	9%	11%↑	13%
Yes, with mild symptoms (e.g. sudden onset of high fever, chills, sore throat, cough, muscle pain)	48%	49%	49%	48%	48%	45%	33%
No, did not have the flu	41%	35%	45%↑	42%	41%	37%	47%
Don't know / Don't remember	3%	3%	2%	3%	2%	6%↑	7%

Because respondents were able to give multiple answers, total mentions may exceed 100%.

Table 9b shows that children between 13-17 years of age (12%) and those who received the vaccine this year (11%) are slightly more likely to have experienced severe flu symptoms in the past.

Table 9b. Flu Incidence among Respondents before the Past 12 Months (Q19D)
Before the last 12 months, have you ever had the flu?
PERSONALLY, BEFORE THE PAST 12 MONTHS	Total	Subgroups								Flu vaccine 2016-2017
PERSONALLY, BEFORE THE PAST 12 MONTHS	Total	18-64	18-64 with chronic health condition	18-64 without chronic health condition	65 +	Children 13-17 years of age	Children 6-12 years of age	Children 6 months to 5 years of age	Children younger than 6 months	Yes	No
Table 9b footnotes Table 9b footnote 1 Because of the small sample size (n<30), results are presented for illustrative purposes only. Return to table 9b footnote * referrer
Weighted n=	2,024	1,647	412	1,235	377	213	309	254	20	724	1,300
Unweighted n=	2,024	1,446	407	1,039	578	185	255	199	18^{Table 9b footnote *}	853	1,171
NET YES	55%	57%	60%	56%	49%↓	58%	60%	67%↑	52%	56%	55%
Yes, with severe symptoms (e.g. hospitalization, pneumonia)	7%	7%	9%	6%↓	8%	12%↑	8%	10%	5%	11%↑	5% ↓
Yes, with mild symptoms (e.g. sudden onset of high fever, chills, sore throat, cough, muscle pain)	48%	50%	51%	50%	41%↓	46%	52%	56%↑	47%	45%↓	50%↑
No, did not have the flu	41%	40%	36%	41%	48%↑	41%	37%	29%↓	48%	42%	41%
Don't know / Don't remember	3%	3%	3%	3%	3%	1%	3%	4%	0%	3%	4%

More than six out of ten respondents (63%) are aware of friends or family members who have suffered from severe (16%) and/or mild (55%) flu symptoms in the past.

Respondents' friends or family members in the Maritimes (73%) are more likely to have suffered flu symptoms.

Table 10. Flu Incidence among Respondents' Friends and Family Members before the Past 12 Months (Q19F)
Before the last 12 months do you know a friend or family member who has ever had the flu?
FRIEND OR FAMILY MEMBER, BEFORE THE PAST 12 MONTHS	Total	Region
FRIEND OR FAMILY MEMBER, BEFORE THE PAST 12 MONTHS	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Weighted n=	2,024	141	479	777	355	266	6
Unweighted n=	2,024	160	526	640	388	280	30
NET YES	63%	73%↑	55%↓	66%	64%	66%	65%
Yes, with severe symptoms (e.g. hospitalization, pneumonia)	16%	24%↑	8%↓	17%	15%	22%↑	25%
Yes, with mild symptoms (e.g. sudden onset of high fever, chills, sore throat, cough, muscle pain)	55%	63%↑	47%↓	56%	57%	57%	59%
No, did not have the flu	30%	22%↓	39%↑	27%	29%	28%	26%
Don't know / Don't remember	6%	5%	6%	7%	7%	6%	10%

Because respondents were able to give multiple answers, total mentions may exceed 100%.

2.7 Health Care and Alternative Care Providers Seen in the Last Year

The vast majority of respondents (93%) have seen a health care provider in the last year. Three-quarters of Canadians (76%) have seen their family doctor. This proportion is slightly higher among respondents from Manitoba, Saskatchewan and Alberta (81%).

Nearly two-thirds of respondents (64%) visited their dentist (orthodontist) in the last 12 months. This is especially prominent in Ontario (69%).

Close to six out of ten Canadians (58%) have seen their pharmacist in the last year, a proportion that is higher in the Maritimes (66%). Finally, more than a third of respondents (37%) visited a medical specialist within the last 12 months and 22 percent have seen a nurse.

Table 11. Health Care Providers Seen in the Last 12 Months (Q19A)
Within the last 12 months, have you seen any of the following health care providers?
	Total	Region
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Weighted n=	2,024	141	479	777	355	266	6
Unweighted n=	2,024	160	526	640	388	280	30
NET seen a health care provider	93%	95%	92%	93%	92%	94%	82%↓
Family doctor	76%	81%	68%↓	77%	81% ↑	78%	63%
Dentist / orthodontist	64%	71%	56%↓	69%↑	60%	62%	52%
Pharmacist	58%	66%↑	54%	59%	56%	57%	47%
Medical specialist (e.g. gynecologist, cardiologist, ophthalmologist, allergist, orthopedist, psychiatrist)	37%	33%	37%	41%↑	34%	30%↓	33%
Nurse practitioner	22%	21%	28%↑	23%	15%↓	15%↓	38%↑
Midwife	1%	1%	1%	1%	1%	1%	3%
Did not see a health care provider	7%	5%	8%	7%	8%	6%	18%↑
Refusal	0%	0%	0%	0%	0%	0%	0%

Because respondents were able to give multiple answers, total mentions may exceed 100%.

In the last year, nearly one-quarter of respondents (23%) have seen an alternative care provider from the list provided, chiropractors (17%) being the most popular.

Table 12 shows that Quebecers (84%) are more likely not to have seen any alternative care providers in the last 12 months.

Table 12. Alternative Care Providers Seen in the Last 12 Months (Q19B)
Within the last 12 months, have you seen any of the following alternative care providers?
	Total	Region
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Weighted n=	2,024	141	479	777	355	266	6
Unweighted n=	2,024	160	526	640	388	280	30
NET seen an alternative care provider	23%	18%	16%↓	27%↑	23%	27%	12%
Chiropractor	17%	11%↓	12%↓	19%	18%	19%	6%
Acupuncturist	5%	2%	2%↓	7%↑	6%	6%	3%
Homeopath or naturopath	4%	5%	4%	5%↑	3%	3%	0%
Spiritual or religious healer	2%	1%	0%↓	3%↑	1%	2%	3%
Herbalist	1%	0%	1%	1%	1%	1%	6%↑
Reflexologist	1%	1%	1%	2%	0%	2%	0%
Did not see an alternative care provider	76%	82%	84%↑	72%↓	77%	73%	88%
Refusal	0%	0%	0%	1%↑	0%	1%	0%

Because respondents were able to give several answers, total mentions may exceed 100%.

Lastly, two out of ten respondents (22%) have seen other care providers in the last 12 months; including massage therapists (7%) and physiotherapists (6%).

Image 7. Other Care Providers Seen in the Last 12 Months (Q19OP)

Have you seen another health care provider in the past 12 months?

Image 7. Other Care Providers Seen in the Last 12 Months (Q19OP)

Text Description - Figure 7

Because respondents were able to give multiple answers, total mentions may exceed 100%.

2.8 Sources of Information and Most Trusted Resource about the Flu Vaccine

Nearly half of respondents (47%) state that when they want to know more about the flu shot, they look for information in a public health setting, health clinic or pharmacy. This proportion is higher among respondents from the Maritimes (60%) and among those 55 years of age or older (53%).

The Internet is also a source of information about the flu shot; 18 percent would do an online search and 13 percent would consult a government website. Quebecers (28%) are more likely to refer a government website to get information about the flu shot.

Those 18 to 34 years old are slightly more likely to seek information on a government website (18%) or by trusting word of mouth (11%) when looking for information about the flu shot.

Table 13. Sources of Information about the Flu Shot (Q21)
Where do you get information, when you want to know more about the flu shot?
	Total	Region						Age
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories	18-34	35-54	55+
Weighted n=	2,024	141	479	777	355	266	6	564	748	711
Unweighted n=	2,024	160	526	640	388	280	30	355	655	1,014
A public health setting, health clinic or pharmacy	47%	60%↑	41%↓	48%	47%	44%	62%	40%↓	45%	53%↑
Online search	18%	12%↓	15%↓	21%↑	17%	22%	22%	20%	20%	14%↓
A government website (e.g. Public Health Agency of Canada)	13%	4%↓	28%↑	10%	8%↓	10%↓	14%	18%↑	15%	8%↓
The media (e.g. newspaper, radio)	11%	9%	7%↓	15%↑	11%	11%	6%	6%↓	11%	16%↑
Word of mouth	8%	8%	4%↓	11%↑	5%↓	11%	0%	11%↑	9%	5%↓
Social media (e.g. Twitter, Facebook)	6%	4%	2%↓	8%	8%	9% ↑	0%	8%	8%	4%↓
Printed materials (e.g. pamphlets, books, medical journals)	1%	1%	0%↓	2%↑	1%	2%	0%	1%	1%	2%
An app (e.g. ImmunizeCA)	0%	1%	0%	0%	0%	0%	0%	1%↑	0%	0%↓
Other	2%	1%	2%	2%	5%↑	1%	3%	3%	2%	2%
None of the above	4%	0%↓	5%	5%	3%	2%↓	7%	3%	3%	5%↑
Does not apply to me	11%	14%	11%	9%↓	13%	12%	5%	10%	11%	10%
Refusal	0%	0%	0%	0%	1%↑	0%	0%	0%	1%	0%

Because respondents were able to give multiple answers, total mentions may exceed 100%.

The most trusted resource about the flu shot out of the options provided is the family doctor. Nearly two-thirds of respondents (64%) say that they trust their family doctor the most for information about the flu shot. This proportion is higher in the Maritimes (72%) and Ontario (70%).

Table 14. Most Trusted Resource about the Flu Shot (Q22)
For information about the flu shot, who do you trust the most?
	Total	Region						Age
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories	18-34	35-54	55+
Weighted n=	2,024	141	479	777	355	266	6	564	748	711
Unweighted n=	2,024	160	526	640	388	280	30	355	655	1,014
Family doctor	64%	72%↑	57%↓	70%↑	58%↓	68%	44%↓	58%↓	66%	69%↑
Pharmacist	22%	30%↑	24%	21%	20%	21%	8%	19%	22%	24%↑
Nurse practitioner	14%	16%	18%↑	12%	12%	11%	36%↑	15%	13%	13%
Medical specialist (e.g. gynecologist, cardiologist, ophthalmologist, allergist, orthopedist, psychiatrist)	8%	8%	6%↓	10%↑	7%	10%	8%	7%	9%	9%
Family	6%	3%	5%	9%↑	4%↓	6%	0%	11%↑	4%↓	5%
Friends	4%	4%	3%	5%	4%	1%↓	0%	4%	4%	3%↓
The government / Health Canada	4%	7%	2%↓	4%	7%↑	4%	2%	4%	6%↑	3%↓
Other health care provider (e.g. nurse, pharmacist, medical specialist)	2%	1%	2%	2%	3%	3%	24%↑	3%	2%	2%
An alternative care provider (e.g. naturopath, homeopath)	2%	4%	2%	3%	2%	0%	6%	2%	2%	2%
I trust my own judgement	2%	3%	2%	2%	3%	2%	3%	2%	3%	3%
Government website	1%	0%	0%	1%	2%↑	0%	0%	2%↑	1%	0%↓
Scientists	1%	1%	0%	1%	1%	1%	0%	1%	1%	0%
Online research	1%	0%	1%	1%	2%↑	1%	0%	2%↑	1%	1%
The media (e.g. television, radio, newspapers)	1%	1%	1%	2%	1%	1%	3%	1%	1%	2%
Other	3%	0%	2%	2%	4%	5%↑	6%	3%	3%	2%
Does not apply to me	5%	4%	6%	3%↓	6%	5%	0%	4%	5%	5%
None of the above	6%	5%	6%	6%	6%	4%	15%↑	5%	5%	6%
Refusal	1%	0%	0%↓	0%↓	2%↑	1%	0%	1%	0%	1%

Because respondents were able to give multiple answers, total mentions may exceed 100%.

2.9 Flu Vaccine Promoters

Four out of ten respondents (40%) say that someone advised them to get the flu vaccine within the last 12 months (Image 8).

Image 8. Flu Vaccine Promoters (Q23A)
Within the last 12 months, did anyone advise you to get the flu vaccine?

Image 8. Flu Vaccine Promoters (Q23A)

Text Description - Figure 8

2.10 Flu Vaccine Detractors

Fourteen percent of respondents (14%) say that someone advised them NOT to get the flu vaccine within the last 12 months (Image 9).

Image 9. Flu Vaccine Detractors (Q24A)
Within the last 12 months, did anyone advise you NOT to get the flu vaccine?

Image 9. Flu Vaccine Detractors (Q24A)

Text Description - Figure 9

Nearly four out of ten of those who were advised to get the flu vaccine within the past year (38%) were advised by their family doctor. This proportion is higher in Ontario (44%).

Family members also play a role in advising two out of ten respondents (21%) to get the flu vaccine. To a slightly lesser extent, respondents also received this advice from their coworkers (17%) and friends (11%).

Table 15a. Promoters of the Flu Vaccine (Q23)
Who advised you to get the flu vaccine?
Base: Among those who were advised to get the flu vaccine (n=787)	Total	Region
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Table 15a footnotes Table 15a footnote 1 Because of the small sample size (n<30), results are presented for illustrative purposes only. Return to table 15a footnote * referrer
Weighted n=	814	65	158	321	152	114	3
Unweighted n=	787	76	173	251	155	117	15^{Table 15a footnote *}
Family doctor	38%	45%	31%	44%↑	36%	27%↓	32%
Family	21%	18%	19%	21%	23%	21%	26%
Coworkers / employer	17%	16%	21%	15%	10%↓	28%↑	12%
Friends	11%	3%↓	12%	12%	10%	11%	21%
Nurse practitioner	6%	11%	9%	3%↓	10%↑	6%	18%
Pharmacist	5%	7%	4%	4%	9%↑	3%	10%
Medical specialist (e.g. gynecologist, cardiologist, ophthalmologist, allergist, orthopedist, psychiatrist)	5%	5%	5%	6%	4%	3%	6%
Advertisement (e.g. media, billboards)	4%	2%	3%	4%	5%	2%	8%
At school	3%	0%	3%	4%	5%	0%↓	0%
Other	3%	2%	2%	2%	5%	9%↑	14%
None of the above	1%	1%	0%	1%	0%	0%	0%
Refusal	0%	1%	0%	0%	1%	1%	0%

Note: Only answers with at least 1% of total mentions are presented.
Because respondents were able to give multiple answers, total mentions may exceed 100%.

The family doctor (48%) played an important role in advising those who received the flu vaccine this year. This is consistent with the results among vulnerable groups of those ages 65+ (66%), children 6 months to 5 years (46%) and those ages 18-64 with a chronic health condition (43%).

Table 15b. Promoters of the Flu Vaccine (Q23)
Who advised you to get the flu vaccine?
	Total	Subgroups								Flu vaccine 2016-2017
	Total	18-64	18-64 with chronic health condition	18-64 without chronic health condition	65 +	Children 13-17 years of age	Children 6-12 years of age	Children 6 months to 5 years of age	Children younger than 6 months	Yes	No
Table 15b footnotes Table 15b footnote 1 Because of the small sample size (n<30), results are presented for illustrative purposes only. Return to table 15b footnote * referrer
Weighted n=	814	678	195	482	136	89	128	107	9	352	462
Unweighted n=	787	581	182	399	206	79	106	83	9^{Table 15b footnote *}	379	408
Family doctor	38%	32%↓	43%↑	28%↓	66%↑	29%	31%	46%↑	44%	48%↑	30%↓
Family	21%	22%	13%↓	25%↑	17%	19%	21%	22%	47%	13%↓	27%↑
Coworkers / employer	17%	20%	18%	21%	1%↓	26%	25%	14%	0%	22%↑	13%↓
Friends	11%	11%	13%	10%	10%	8%	6%	4%	0%	4%↓	16%↑
Nurse practitioner	6%	7%	8%	6%	5%	5%	7%	13%↑	0%	7%	6%
Pharmacist	5%	6%	8%	5%	3%	3%	8%	4%	0%	4%	6%
Medical specialist (e.g. gynecologist, cardiologist, ophthalmologist, allergist, orthopedist, psychiatrist)	5%	5%	10%↑	3%	4%	3%	4%	5%	7%	7%↑	3%↓
Advertisement (e.g. media, billboards)	4%	4%	3%	5%	1%↓	10%↑	8%	4%	3%	1%↓	5%↑
At school	3%	3%	0%↓	5%↑	0%↓	0%	2%	0%	0%	2%	3%
Other	3%	3%	3%	4%	3%	5%	1%	1%	0%	3%	4%
None of the above	1%	0%	0%	1%	1%	2%	2%	1%	0%	1%	1%
Refusal	0%	1%	0%	1%	0%	1%	1%	0%	0%	0%	1%

Note: Only answers with at least 1% of total mentions are presented.
Because respondents were able to give multiple answers, total mentions may exceed 100%.

Conversely, friends (50%) and family members (30%) played a major role in advising respondents not to get the flu vaccine.

Image 10. Flu Vaccine Detractors (Q24)

Who advised you NOT to get the flu vaccine?

Base: Among those who were advised NOT to get the flu vaccine (n=266)

Image 10. Flu Vaccine Detractors (Q24)

Text Description - Figure 10

Note: Only answers with at least 1% of total mentions are presented.
Because respondents were able to give multiple answers, total mentions may exceed 100%.

2.11 Exposure to Messages Promoting the Flu Vaccine

More than three-quarters of respondents (78%) say that they have seen, read or heard messages promoting the flu vaccine in the last 12 months. Respondents from Manitoba, Saskatchewan and Alberta (84%) and Ontario (80%) are proportionally more likely to have seen, read or heard messages about the flu vaccine. The analysis of the results shows that there are no significant differences between the subgroups studied by Public Health Agency of Canada (PHAC).

Table 16. Exposure to Messages Promoting the Flu Vaccine (Q25A)
Within the last 12 months, have you seen, read or heard any messages promoting the flu vaccine?
	Total	Region
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories
Weighted n=	2,024	141	479	777	355	266	6
Unweighted n=	2,024	160	526	640	388	280	30
Yes	78%	80%	70%↓	80%↑	84%↑	74%	74%
No	21%	18%	29%↑	18%↓	16%↓	23%	26%
Don't know / Don't remember	2%	3%	1%	1%	1%	3%↑	0%

More than six out of ten of those who have seen, read or heard messages promoting the flu vaccine (62%) have heard them on the radio, or seen TV ads. More than one-quarter of respondents have seen messages about the flu vaccine when visiting the pharmacy, doctor's office or hospital (27%) and 16 percent have seen them on printed posters. Finally, 15 percent of respondents have seen advertisements in newspapers and 13 percent on the Internet.

The older generation has the highest proportion of those who heard messages about the flu shot on the radio or TV ads (73% of those ages 55+) and in newspapers (25%). Those 18 to 34 years of age are more likely to have seen, read or heard messages on printed posters (22%), the Internet (19%), in public transportation (6%), on Twitter or other social media (6%) and through word of mouth (5%).

Respondents from the Maritimes (37%), British Columbia (34%) and Ontario (32%) are slightly more likely to have seen, read or heard messages about the flu vaccine when visiting the pharmacy, doctor's office or hospital. On the other hand, respondents from Manitoba, Saskatchewan and Alberta (22%) are proportionally more likely to have seen messages about the flu shot on printed posters.

Table 17. Locations of Exposure to Messages Promoting the Flu Vaccine (Q25)
Where did you see, read or heard those messages promoting the flu vaccine?
Base: Among those who have seen, read or heard messages promoting the flu vaccine (n=1,569)	Total	Region						Age
	Total	Maritimes	Quebec	Ontario	MB/SK/AB	BC	Territories	18-34	35-54	55+
Weighted n=	1,57	112	337	624	297	196	4	416	608	546
Unweighted n=	1,569	125	375	514	320	212	23*	255	532	782
Radio / TV ads / advertisements	62%	58%	63%	65%↑	64%	50%↓	56%	43%↓	66%↑	73%↑
When visiting the pharmacy, doctor's office, hospital	27%	37%↑	12%↓	32%↑	28%	34%↑	17%	31%	29%	23%↓
On printed posters	16%	16%	5%↓	18%	22%↑	18%	31%	22%↑	16%	10%↓
In newspapers (articles, public health announcements or advertisements)	15%	13%	17%	13%↓	19%↑	14%	31%	4%↓	14%	25%↑
On the Internet (e.g. Facebook, PHAC website)	13%	13%	14%	13%	14%	12%	15%	19%↑	14%	8%↓
At workplace	5%	6%	6%	3%↓	5%	9%↑	4%	6%	7%↑	2%↓
Advertisements in public transport	4%	0%↓	0%↓	5%↑	4%	5%	9%	6%↑	4%	1%↓
In brochures	3%	4%	3%	3%	5%	3%	16%	3%	3%	4%
Twitter or other social media	3%	4%	1%↓	2%	4%	5%↑	4%	6%↑	2%	1%↓
In magazines	2%	4%	2%	3%	3%	1%	5%	1%	2%	4%↑
Word of mouth	2%	2%	4%↑	2%	3%	1%	6%	5%↑	2%	0%↓
Other	1%	3%↑	1%	1%	1%	1%	4%	3%↑	1%	1%↓
I did not see, read or heard any messaging about the flu vaccine	1%	1%	1%	1%	1%	1%	0%	1%	1%	1%
Refusal	0%	1%	0%	0%↓	1%	2%↑	0%	0%	1%	0%

Because respondents were able to give multiple answers, total mentions may exceed 100%.

Appendix A - Detailed Research Methodology

A.1 Quantitative Methodology

A total of 2,024 adult Canadians were interviewed in all regions of the country. The national margin of error for the survey is +/- 2.18%, 19 times out of 20.

Computer Aided Telephone Interviewing (CATI)

Telephone interviewing was conducted using Leger's CATI technology. Highly trained data analysts program each survey in CATI then perform thorough testing to ensure accuracy in set-up and data collection.

Leger's CATI system handles sampling and questionnaire completion electronically, removing the possibility of misdials and imposing control over skip patterns, branching, and valid ranges. The system can be used to automate many calculations that would slow unaided interviewers.

CATI also removes the need for separate coding and data entry cycles, further reducing the opportunity for error. CATI also ensures correct timing of call-backs. To keep complaints to a minimum, no number is called twice in a two-hour period and each number is called on different days of the week and at different times of the day (i.e. late afternoon, evening, daytime). This system ensures all scheduled appointments are kept, maximizing the response rate and sample representativeness.

Field and Quality-Control

Leger's call centre is located in Montreal and has a total of 100 stations. All interviews for this research were conducted out of our Montreal call centre. This call centre is divided into three distinct divisions: One consisting of English only interviewers, one of French only interviewers and one of bilingual interviewers. This ensures that all telephone surveys can easily be conducted in either official language. If at any time, a potential respondent wished to conduct the survey in French (or vice-versa), they were quickly transferred to a French or bilingual interviewer, no matter when or where the call was made.

Leger integrates all projects to a Virtual Call Centre™ (VCC) platform. The Virtual Call Centre™ is a system enabling interviewers in our call centre to conduct telephone surveys supported by questionnaire and sample management provided over the Internet. The efficiency of the VCC greatly benefits the success of any project.
The VCC allows both the bilingual and English (or French) interviewers to have access to the same survey as well as the same sample data base. This is particularly important for a telephone survey that demands tight fielding timeline. We utilized all languages seamlessly to ensure that data collection was finished in the prescribed timeline. Additionally, having the VCC system allowed us to manage provincial and other quotas simultaneously.

Once the questionnaire was installed, a close validation of the programmed questionnaire was carried out to avoid any potential data error. This validation ensured that the data entry process conformed to the survey's basic logic.

The VCC system allowed for questionnaire changes to be completed quickly and accurately. By allowing the Research Manager access from anywhere in the world, Leger's research staff can receive changes and update the survey program within a very short time. This procedure allowed for the nimble management process required for the project.

Interview Monitoring

Leger's call centre enables data collection supervisors to monitor interviews as they are being conducted. Monitoring is essential to ensure the proper administration of a questionnaire. Through ongoing monitoring, supervisors ensured the questionnaire was administered properly and provided timely feedback to interviewers regarding potential issues with coding or wording.

Leger's monitoring and recording system allows project managers and clients to monitor interviews as they happen. Upon request, interview recordings could be available through a secure FTP site so that clients could listen to the quality of our interviews.

Senior supervisors monitored interviews throughout field to ensure flow, clarity, consistency and comprehension of the survey. The Project Authority would have been notified immediately of any issue. If a serious issue had been found, fielding would have ceased until the problem was rectified.

With Centralus, our proprietary software, project managers could check on frequencies, the number of completes, quotas (if any), and the response rate at any time during field. This "real-time" management tool allowed for any issues to be quickly flagged and corrected.

Field Supervision and Quality Control

All interviewers used by Leger during this project received customized training with respect to interview techniques, and in-depth training on our call centre CATI software. Once they have completed their probationary period, Leger's interviewers are evaluated every six months based on the following:

reading integrity (never suggesting or interpreting respondent answers);
appropriate follow-up to open-ended questions; and
quality control (good pronunciation, zero tolerance for bias).

For each project, our field staff members go through a practice session before fielding. During these practice sessions, interviewers will work with one other to role-play a simulated interviewer/respondent survey. The field supervisor will allow interviewing to commence only when satisfied that each interviewer is able to conduct a proper, professional interview. Intensive monitoring, editing, and verification are conducted throughout the fielding process.

Phone interviews were monitored throughout the data collection period, with a minimum of 10% of each interviewer's phone calls being monitored. By insisting on ongoing monitoring, we are able to ensure the quality of the data collected.

Data Cleaning

Upon completion of data collection, Leger's data analysts and data processing department cleaned the data thoroughly, ensuring that:

all closed-ended questions were within the allowable or logical range (allowable ranges would be confirmed with the client in any circumstance where it is not obvious from the questionnaire);
outliers were verified and, if necessary, excluded from the data;
all skip patterns had been followed correctly;
the data was complete (except where it is intentional and within client expectations); and
information was consistent and logical across questions, with no contradictions in the data.

The data was checked and cleaned after the first night of field and at project completion. During analysis, all numbers were double-checked and any outliers are double-checked to ensure the data has been entered accurately in the first place. If necessary, the original phone call could be reviewed to check the answer.

Maximizing the response rate

Low response rate threatens a survey's reliability and validity. Through Leger's experience surveying various populations, we have established the following methods to maximize response rates:

including a toll free number for call backs if necessary;
patience and rapport development in speaking with respondents, which helps to keep participants engaged in the survey and limits mid survey drop offs;
prepared arguments to be used by interviewers to inform respondents of the importance of their participation: usefulness of the study for them and their family, etc.
use of experienced field personnel in contacting households and identify the appropriate respondent;
making a minimum of 8 call-backs to each number and setting appointments for call-backs (even for the initial contact); and
included contact information for a senior researcher so respondents can verify the validity of the research.
calls are made to cell phone only (CPO) users in order to maximise the representativeness of the sampling frame and ensure that a sufficient number of younger, and often highly mobile, individuals are included in the final sample.

Call Dispositions

The overall response rate for this study is 20.3%.

The response rate is calculated using the following formula: (Completed interviews + Out of Sample) / (Total sample - Invalid sample). This is the Market Research and Intelligence Association's standard calculation method for the response rate of a telephone survey. The table below presents the calculation details.

Table 18. Call Disposition and Response Rate
TOTAL SAMPLE	18,545
Invalid sample	3,545
No service	3,361
Non-residential	65
Fax / Modem / Pager	119
Numbers outside of sample	1,023
Language Barrier	233
Unqualified (deaf-mute, etc.)	228
Quota attained	562
EFFECTIVE SAMPLE	13,977
Non-completed interviews	11,953
Refusal	4,236
No answer	2,726
Answering machine	4,159
Line busy	108
Incomplete	120
Appointment	604
COMPLETED INTERVIEWS	2,024
Response rate:	20.3%

Non Response Bias and Additional Socio-Demographic Analysis

An effective response rate of 20.3% is average for a national telephone survey of 2,024 respondents conducted in about three weeks, matching typical rates for similar studies. This response rate minimizes the risks of an important non-response bias in the survey as it decreases the likelihood of an unrepresentative sample.

Nevertheless, a basic comparison of the unweighted and weighted sample sizes was conducted to identify potential non-response bias that could be introduced by lower response rates among specific demographic subgroups (see table below). As is typically the case for a telephone survey mainly targeting homes with a fixed telephone line, younger individuals are more difficult to reach. To compensate for this fact, Leger conducted over 497 interviews who are wireless only households (reached on their cellular phone). Using this procedure, we see that our unweighted sample closely matches the weighted numbers, devised using Statistics Canada updated data.

Weighted and Unweighted Samples

The table below presents the geographic distribution of respondents, before and after weighting. There were almost no imbalances in geographical distribution in the unweighted sample. The weighting process has mainly adjusted the weight of Ontario which had been slightly under-represented in the sample in order to allow more respondents in small provinces and territories.

Table 19. Unweighted and Weighted Sample Distribution by Province
	Unweighted	Weighted
Newfoundland and Labrador	1%	1%
Prince-Edward-Island	1%	0%
Nova Scotia	4%	3%
New Brunswick	3%	2%
Quebec	26%	24%
Ontario	32%	38%
Manitoba	4%	4%
Saskatchewan	4%	3%
Alberta	11%	11%
British Columbia	14%	13%
Nunavut	0%	0%
Northwest Territories	0%	0%
Yukon	0%	0%

The following tables present the demographic distribution of respondents, according to gender, age, language (mother tongue), education and household income.

First, regarding gender, we can see that weighting has adjusted the proportion of female respondents vs. male respondents, women always being slightly overrepresented in telephone surveys.

Table 20. Unweighted and Weighted Sample Distribution by Gender
GENDER	Unweighted	Weighted
Male	40%	48%
Female	60%	52%

Regarding age distribution, the unweighted sample greatly exceeded the expectations of the Public Health Agency of Canada, requiring at least 50% of the sample to be 18 to 64 years of age. In fact, 72% of our unweighted sample was under 65 years of age, and 50% of the unweighted sample was under 55 years of age.

Table 21. Unweighted and Weighted Sample Distribution by Age Group
AGE	Unweighted	Weighted
Between 18 and 24	4%	9%
Between 25 and 34	13%	18%
Between 35 and 44	15%	17%
Between 45 and 54	18%	20%
Between 55 and 64	22%	17%
Between 65 and 74	18%	12%
75 or older	11%	7%

Minor imbalances on language distribution were corrected with weighting, as presented below.

Table 22. Unweighted and Weighted Sample Distribution by First Language
LANGUAGE (MOTHER TONGUE)	Unweighted	Weighted
French	25%	21%
English	59%	57%
Other	13%	18%
French and English	1%	1%
French and other	0%	0%
English and other	0%	1%
Other and other	1%	2%

The last tables present distribution based on education and household income, although those variables were not included in the weighting procedures.

Table 23. Unweighted and Weighted Sample Distribution by Education Level
EDUCATION	Unweighted	Weighted
Grade 8 or less	2%	2%
Some high school	8%	6%
High School diploma or equivalent	22%	21%
Registered Apprenticeship or other trades certificate or diploma	6%	6%
College, CEGEP or other non-university certificate or diploma	26%	27%
University certificate or diploma below bachelor's level	6%	5%
Bachelor's degree	17%	19%
Post graduate degree above bachelor's level	12%	13%
Refusal	1%	1%

Table 24. Unweighted and Weighted Sample Distribution by Household Income
HOUSEHOLD INCOME	Unweighted	Weighted
$19,999 or less	7%	6%
between $20,000 and $39,999	13%	12%
between $40,000 and $59,999	16%	15%
between $60,000 and $79,999	12%	13%
between $80,000 and $99,999	10%	11%
between $100,000 to $149,999	12%	14%
$150,000 and above	10%	12%
Refusal	20%	19%

However, there is no evidence from the data that having achieved a different age or gender distribution prior to weighting would have significantly changed the results for this study. The relatively small sizes of weights and of the differences in responses between various subgroups suggest that data quality was not affected. The weight that was applied corrected the initial imbalance for data analysis purposes and no further manipulations were necessary.

As with all research conducted by Leger, contact information was kept entirely confidential and all information that could allow for the identification of participants was removed from the data, in accordance with the Privacy Act of Canada.

Appendix B - Survey Questionnaire

English Questionnaire

Section info
Page info
[ASK ALL]

QINF#

Good morning (afternoon, evening), my name is XX and I'm calling from LEGER research.

We are currently conducting a study on flu vaccine. This survey is led by the Public Health Agency of Canada. Your answers will help improve services that impact Canadians like you. We would therefore greatly appreciate your cooperation.

Your participation is voluntary and completely confidential. Your answers will remain anonymous and cannot affect in any way your dealings with the government of Canada.

Can I ask you a few questions? It will take no more than 10 minutes.

IF ASKED: Your opinion counts. Leger research is a renowned company throughout Canada. Today's study is about various current events and trends in society. There are no wrong answers. When may I contact you again? When would be a good time to contact you? Whom should I ask to speak with when I call back? Is there another person in your household with whom we could talk?

NOTE: If a respondent requests to speak with a study leader at Health Canada, please take his / her name and phone number and mention that a supervisor will call back to establish the link with Health Canada.

Contact:
Shelley Shackleton
Health Canada / Government of Canada
Phone number: 613-866-4093

Note to the interviewer: If a respondent asks you about the legitimacy of this project or if the respondent wants to make a complaint or a comment about this project, you must invite him/her to visit the MRIA Website: www.surveyverification.ca (English) or www.verificationsondage.ca (French), and you must give him the MRIA Project Registration Number: 20170208-382F

Section info
[ASK ALL]

QSCTDEMO1

To begin, I have a few questions about you.

Simple mention question

[ASK IF ECHA=CELL]
[SIMPLE MENTION]
QFLT1

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Do you currently have a residential land-line telephone service at home?
Response	Value	Attribute	Termination
Yes	1	n/a	RECODE LANDLINE
No	2	n/a	n/a
(DO NOT READ) Refusal	9	n/a	TERMINATE

Question NUMERIC

[ASK ALL]
[NUMERIC: Min=18, Max=150]
[DECIMAL: 0]
[PROGRAMMER NOTES: Under 18 = terminate]
[VALIDATION: AGE]
AGE

INTERVIEWER INSTRUCTION: (ENTER THE NUMBER.)

How old were you as of September 1, 2016?
Response	Value	Attribute	Termination
Enter number	XXX	n/a	n/a
(DO NOT READ) Refusal	999	n/a	n/a

CALCULATION AGEX

[PROGRAMMER NOTES: CALCULATION FROM AGE]
[VALIDATION:]

AGEX


Response	Value	Attribute	Termination
Under 18	0	n/a	TERMINATION
...Between 18 and 24	1	n/a	n/a
...Between 25 and 34	2	n/a	n/a
...Between 35 and 44	3	n/a	n/a
...Between 45 and 54	4	n/a	n/a
...Between 55 and 64	5	n/a	n/a
...Between 65 and 74	6	n/a	n/a
...75 or older	7	n/a	n/a
Refusal	999	n/a	TERMINATION

Simple mention question

[ASK ALL]
[SIMPLE MENTION]

LANGU

INTERVIEWER INSTRUCTION: (READ LIST. ONLY ONE MENTION)

What is the language you first learned at home in your childhood and that you still understand?
Response	Value	Attribute	Termination
French	1	n/a	n/a
English	2	n/a	n/a
Other	3	n/a	n/a
French and English	7	n/a	n/a
French and other	4	n/a	n/a
English and other	5	n/a	n/a
Other and other	6	n/a	n/a
(DO NOT READ) Dnk/Refusal	9	F	n/a

Simple mention question

[ASK ALL]
[SIMPLE MENTION]

SEX

Enter respondent's gender - DO NOT READ.

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)


Response	Value	Attribute	Termination
Male	1	n/a	n/a
Female	2	n/a	n/a

Simple mention question

[ASK ALL]
[SIMPLE MENTION]

Note: The flu vaccine can be received by a shot (needle) or nasal spray.

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q1 Before September 1st, 2016, had you ever received the seasonal flu vaccine?
Response	Value	Attribute	Termination
Yes	1	n/a	n/a
No	2	n/a	n/a

Simple mention question

[ASK ALL]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q2 Since September 1st, 2016 inclusively , have you received the seasonal flu vaccine? Note: The flu vaccine can be received by a shot (needle) or nasal spray.
Response	Value	Attribute	Termination
Yes	1	n/a	n/a
No	2	n/a	n/a

Multiple question - open

[ASK IF Q2=2]
[MENTIONS MULTIPLES: Max=13]
[PROGRAMMER NOTES: Make sure to create a column by choice of code answers 0,1]

INTERVIEWER INSTRUCTION: DO NOT READ - MULTIPLE ANSWERS ALLOWED
Please select all that apply.

Q3 What are the reasons why you did not receive the flu vaccine this year?
Response	Value	Attribute	Termination
I am allergic	01	n/a	n/a
I do not like needles / I am scared of needles	02	n/a	n/a
I do not need it / I am not a person at high risk / It is not recommended for me	03	n/a	n/a
I did not have enough information	04	n/a	n/a
I did not get the time to do it	05	n/a	n/a
I had difficulty making an appointment	06	n/a	n/a
I had difficulty getting to clinic / doctor's office	07	n/a	n/a
I did not want to pay for a vaccine / too expensive	08	n/a	n/a
I did not know it existed	09	n/a	n/a
I do not believe in its effectiveness	10	n/a	n/a
I believe vaccines are unsafe (risks associated to vaccine)	11	n/a	n/a
I fear side effects	12	n/a	n/a
Other reason, please specify:	96	FO	n/a
(DO NOT READ) Refusal	99	XF	n/a
*** I was sick / I was in the hospital	13	N	n/a

Simple mention question

[ASK IF Q2=1]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: READ. ONLY ONE MENTION

Q4 Was the flu vaccine you received this year given by a shot (with a needle) or a spray in the nose?
Response	Value	Attribute	Termination
Flu shot	1	n/a	n/a
Nasal spray (Flumist)	2	n/a	n/a
(DO NOT READ) Does not remember	8	n/a	n/a

Simple mention question

[ASK IF Q2=1]
[SIMPLE MENTION]
[ORDER OF THE LIST: In order]

INTERVIEWER INSTRUCTION: READ. ONLY ONE MENTION

Q5 In which month did you receive the flu vaccine this year?
Response	Value	Attribute	Termination
September 2016	0	n/a	n/a
October 2016	1	n/a	n/a
November 2016	2	n/a	n/a
December 2016	3	n/a	n/a
January 2017	4	n/a	n/a
February 2017	5	n/a	n/a
(DO NOT READ) Does not remember	8	n/a	n/a

Multiple mentions question

[ASK if Q2=1]
[MENTIONS MULTIPLES: Max=10]
[PROGRAMMER NOTES: Make sure to create a column by choice of code answers 0,1]

INTERVIEWER INSTRUCTION: DO NOT READ - MULTIPLE ANSWERS ALLOWED
Please select all that apply.

Q6 What are the reasons you decided to receive the flu vaccine this year?
Response	Value	Attribute	Termination
I want to prevent infection / I do not want to get sick	01	n/a	n/a
I am at risk because of my health condition	02	n/a	n/a
I am at risk because of my age	03	n/a	n/a
I was recommended by a health care professional	04	n/a	n/a
I was encouraged by family members, colleagues or friends	05	n/a	n/a
It is required in my workplace	06	n/a	n/a
I would be required to wear a mask at work if not vaccinated	07	n/a	n/a
It was offered / free (by employer or other)	08	n/a	n/a
If not vaccinated, I can transmit the disease to at-risk people (children, elderly or sick people/patients)	09	n/a	n/a
If not vaccinated, I can transmit the disease to family members, colleagues or friends (without mention of at-risk people)	10	n/a	n/a
Other reason, please specify:	96	FO	n/a
(DO NOT READ) Refusal	99	XF	n/a
*** I receive it every year (no specific reason)	11	N	n/a

Question simple - open

[ASK IF Q2=1]

INTERVIEWER INSTRUCTION: (READ IF NEEDED - ONE ANSWER ALLOWED)

Q7 Where did you receive the flu vaccine this year?
Response	Value	Attribute	Termination
Temporary vaccine clinic (i.e. at the mall)	01	n/a	n/a
Doctor's office / health clinic	02	n/a	n/a
CLSC / Community health centre	03	n/a	n/a
Hospital	04	n/a	n/a
Pharmacy	05	n/a	n/a
Workplace	06	n/a	n/a
Other, please specify:	96	FO	n/a
(DO NOT READ) Does not remember	98	XF	n/a
*** Retirement residence / eldercare centre	07	N	n/a

Question NUMERIC

[ASK ALL]
[NUMERIC: Min=0, Max=15]
[DECIMAL: 0]
[PROGRAMMER NOTES: ALLOW UP TO 15 CHILDREN]

INTERVIEWER INSTRUCTION: We do not want the respondent to provide information about children of which he or she is not the parent or guardian, such as younger siblings. If a respondent asks if they can answer for their spouse's children, the answer would be "yes, if you are aware of the vaccines they received and their state of health"

(Record number of children: VALIDATE THAT THEY ARE LESS THAN 18 YEARS.
IF MORE THAN 15 CHILDREN - PROVIDE A REMINDER WITH THE RESPONDENTS

Q8 How many children under 18 years of age, of whom you are the parent or guardian, were living in your household on September 1, 2016?
Response	Value	Attribute	Termination
None	000	n/a	n/a
(DO NOT READ) Prefer not to answer	999	n/a	n/a

Numerical question

[ASK IF Q8 BIGGER THAN 0]
[NUMERIC Min=1, Max=17]
[DECIMAL: 0]
[NOTE FOR PROGRAMMING: PROGRAM FOR THE NUMBER OF CHILDREN UNDER 18 IN Q8]
[ENABLE SEIZURE IN MONTH OR YEARS]
[CAN NOT BE MORE THAN 17 YEARS]

Q9 How old were your children as of September 1, 2016?
Response	Value	Attribute	Termination
Enter child age # 1	Q9_1	n/a	n/a
Enter child age # 2	Q9_2	n/a	n/a
Enter child age # 3	Q9_3	n/a	n/a
Enter child age # 4	Q9_4	n/a	n/a
Enter child age # 5	Q9_5	n/a	n/a
Enter child age # 6	Q9_6	n/a	n/a
Enter child age # 7	Q9_7	n/a	n/a
Enter child age # 8	Q9_8	n/a	n/a
Enter child age # 9	Q9_9	n/a	n/a
Enter child age # 10	Q9_10	n/a	n/a
Enter child age # 11	Q9_11	n/a	n/a
Enter child age # 12	Q9_12	n/a	n/a
Enter child age # 13	Q9_13	n/a	n/a
Enter child age # 14	Q9_14	n/a	n/a
Enter child age # 15	Q9_15	n/a	n/a


Response	Value	Attribute	Termination
Month(s)	1	n/a	n/a
Year(s)	2	n/a	n/a
(DO NOT READ) Refusal	9	n/a	n/a

Section info
[SI Q8 = AT LEAST ONE CHILDREN]
[TO BE INCLUDED AT THE BEGINNING OF THE SECTION FOR EACH CHILD:]
[NOTES TO THE PROGRAMMER: CREATE A LOOP FOR THE NEXT SECTION FOR THE NUMBER OF CHILDREN UNDER 18 IN Q8]
LOOP ON Q10 TO Q15 * NUMBER OF CHILDREN UNDER 18 YEARS.

INFO SECTION

Let's start with your first child.
... Q10A to Q15A
Let's talk about your second child / third / child. [...]

Simple mention question

[SI Q8 = GREATER THAN 0]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: READ. ONLY ONE MENTION

Q10A What is the gender of your (Q9_1) month(s)/year(s)-old child?
Response	Value	Attribute	Termination
A boy	1	n/a	n/a
A girl	2	n/a	n/a
(DO NOT READ) Refusal	9	n/a	n/a

Simple mention question

[ASK IF Q8 = GREATER THAN 0]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q11A Since September 1st, 2016 inclusively, have your ***<Q9A1> <Q9A2>***-old child received the seasonal flu vaccine?
Response	Value	Attribute	Termination
Yes	1	n/a	n/a
No	2	n/a	n/a

Simple mention question

[ASK IF Q9>5 MONTHS AND <10 YEARS AND Q11=1]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q12A Was it the first time your ***<Q9A1> <Q9A2>***-old child received the flu vaccine?
Response	Value	Attribute	Termination
Yes	1	n/a	n/a
No	2	n/a	n/a
(DO NOT READ) Does not know / Does not remember	8	n/a	n/a

Simple mention question

[ASK IF Q9>5 MONTHS AND <10 YEARS AND Q11=1 AND Q12=1]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q13A Since September 1st, 2016 inclusively, has your ***<Q9A1> <Q9A2>***-old child received one or two doses of the flu vaccine?
Response	Value	Attribute	Termination
One dose	1	n/a	n/a
Two doses	2	n/a	n/a
(DO NOT READ) Does not know / Does not remember	8	n/a	n/a

Multiple mentions question

[ASK IF Q13=1]
[MENTIONS MULTIPLES: Max=12]
[PROGRAMMER NOTES: Make sure to create a column by choice of code answers 0,1]

INTERVIEWER INSTRUCTION: DO NOT READ - MULTIPLE ANSWERS ALLOWED
Please select all that apply

Q14A Children between the ages of 6 months and 9 years who are receiving the flu vaccine for the first time are sometimes given two doses. What are the reasons why your ***<Q9A1> <Q9A2>***-old child did not receive a second vaccine?
Response	Value	Attribute	Termination
He/she had an allergic reaction to the first dose	01	n/a	n/a
He/she does not like needles / is scared of needles	02	n/a	n/a
He/she does not need it / It is not recommended for him/her	03	n/a	n/a
We did not have enough information	04	n/a	n/a
We did not get the time to do it	05	n/a	n/a
We had difficulty making an appointment	06	n/a	n/a
We had difficulty getting to clinic / doctor's office	07	n/a	n/a
We I did not want to pay for a second dose / too expensive	08	n/a	n/a
We did not know there was a second dose	09	n/a	n/a
I do not believe in the second dose's effectiveness	10	n/a	n/a
He/she had side effects after the first dose	12	n/a	n/a
Other reason, please specify:	96	FO	n/a
(DO NOT READ) Refusal	99	XF	n/a

Multiple mentions question

[ASK IF Q11=2]
[MENTIONS MULTIPLES: Max=13]
[PROGRAMMER NOTES: Make sure to create a column by choice of code answers 0,1]

INTERVIEWER INSTRUCTION: DO NOT READ - MULTIPLE ANSWERS ALLOWED
Please select all that apply.

Q15A What is(are) the reason(s) your ***<Q9A1> <Q9A2>***-old child did not receive the flu vaccine this year?
Response	Value	Attribute	Termination
He/she is allergic	01	n/a	n/a
He/she does not like needles / is scared of needles	02	n/a	n/a
He/she does not need it / is not at high risk / It is not recommended for him/her	03	n/a	n/a
I did not have enough information	04	n/a	n/a
I did not get the time to do it	05	n/a	n/a
I had difficulty making an appointment	06	n/a	n/a
I had difficulty getting to clinic / doctor's office	07	n/a	n/a
I did not want to pay for a vaccine / too expensive	08	n/a	n/a
I did not know it existed	09	n/a	n/a
I do not believe in its effectiveness	10	n/a	n/a
I believe vaccines are unsafe (risks associated to vaccine)	11	n/a	n/a
I or he/she fear(s) side effects	12	n/a	n/a
Other reason, please specify:	96	FO	n/a
(DO NOT READ) Refusal	99	XF	n/a

END OF LOOP - GO TO SECTION info

Now, regarding your second child / third / child.
Q10B - Q15B...
Q10C - Q15C...
FOR THE 15 CHILDREN...

Section info

HEALTH STATUS

Multiple mentions question

[ASK ALL]
[MENTIONS MULTIPLES: Max=12]
[ORDER OF THE LIST: In order]

INTERVIEWER INSTRUCTION: (READ LIST - MULTIPLE ANSWERS ALLOWED)
Please select all that apply.
Check the problem only if the respondent is currently suffering or is still being treated.

Q19 Have you been diagnosed with the following conditions?
Response	Value	Attribute	Termination
Asthma	01	n/a	n/a
Another chronic lung disease such as emphysema, chronic bronchitis or cystic fibrosis	02	n/a	n/a
A heart condition such as angina, high blood pressure, heart failure, heart attack	03	n/a	n/a
Cancer	04	n/a	n/a
Diabetes or other metabolic diseases	05	n/a	n/a
Chronic liver disease	06	n/a	n/a
Chronic kidney disease	07	n/a	n/a
Immune disorder or immune suppression such as chemotherapy, radiation, steroid use or an organ transplant	08	n/a	n/a
Spleen problems or removal	09	n/a	n/a
Anemia / thalassemia/ hemoglobinpathy	10	n/a	n/a
Morbid obesity (BMI > 40)	11	n/a	n/a
Conditions that compromises management of respiratory secretions, with increased risk of aspiration	12	n/a	n/a
(DO NOT READ) None of the above	97	X	n/a
(DO NOT READ) Refusal	99	X	n/a

Multiple mentions question

[ASK ALL]
[MENTIONS MULTIPLES: Max=7]
[Order of the List: Random 1 TO 6]

INTERVIEWER INSTRUCTION: (READ LIST - MULTIPLE ANSWERS ALLOWED)
Please select all that apply.

Q19A Within the last 12 months, have you seen any of the following health care providers?
Response	Value	Attribute	Termination
Family doctor	01	n/a	n/a
Nurse practitioner	02	n/a	n/a
Pharmacist	03	n/a	n/a
Dentist / orthodontist	04	n/a	n/a
Medical specialist (e.g. gynecologist, cardiologist, ophthalmologist, allergist, orthopedist, psychiatrist)	05	n/a	n/a
Midwife	06	n/a	n/a
Did not see a health care provider	97	X	n/a
(DO NOT READ) Refusal	99	X	n/a

Multiple mentions question

[ASK ALL]
[MENTIONS MULTIPLES: Max=7]
[ORDER OF THE LIST: Random 1 to 6]

INTERVIEWER INSTRUCTION: (READ LIST. MULTIPLE ANSWERS ALLOWED)
Please select all that apply.

Q19B Within the last 12 months, have you seen any of the following alternative care providers?
Response	Value	Attribute	Termination
Chiropractor	01	n/a	n/a
Acupuncturist	02	n/a	n/a
Homeopath or naturopath	03	n/a	n/a
Herbalist	04	n/a	n/a
Reflexologist	05	n/a	n/a
Spiritual or religious healer	06	n/a	n/a
Did not see an alternative care provider	97	X	n/a
(DO NOT READ) Refusal	99	X	n/a

Simple mention question

[ASK ALL]

INTERVIEWER INSTRUCTION: DO NOT READ - MULTIPLE ANSWERS ALLOWED
Please select all that apply.

Q19OP Have you seen another health care provider in the past 12 months?
Response	Value	Attribute	Termination
Yes, please specify:	96	O	n/a
No or doesn't remember	02	n/a	n/a

[ASK ALL]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: READ. MULTIPLE ANSWERS ALLOWED

Q19C Within the past 12 months, have you had the flu?
Response	Value	Attribute	Termination
Yes, with severe symptoms (e.g. hospitalization, pneumonia)	1	n/a	n/a
Yes, with mild symptoms (e.g. sudden onset of high fever, chills, sore throat, cough, muscle pain)	2	n/a	n/a
No, did not have the flu	3	n/a	n/a
(DO NOT READ) Does not know / Does not remember	8	n/a	n/a

[ASK ALL]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: READ. MULTIPLE ANSWERS ALLOWED

Q19D Before the last 12 months, have you ever had the flu?
Response	Value	Attribute	Termination
Yes, with severe symptoms (e.g. hospitalization, pneumonia)	1	n/a	n/a
Yes, with mild symptoms (e.g. sudden onset of high fever, chills, sore throat, cough, muscle pain)	2	n/a	n/a
No, did not have the flu	3	n/a	n/a
(DO NOT READ) Does not know / Does not remember	8	n/a	n/a

Multiple mention question

[ASK ALL]
[MENTIONS MULTIPLES]

INTERVIEWER INSTRUCTION: READ. MULTIPLE ANSWERS ALLOWED

Q19E >Within the past 12 months, do you know a friend or family member who had the flu?
Response	Value	Attribute	Termination
Yes, with severe symptoms (e.g. hospitalization, pneumonia)	1	n/a	n/a
Yes, with mild symptoms (e.g. sudden onset of high fever, chills, sore throat, cough, muscle pain)	2	n/a	n/a
No, don't know anyone who had the flu	3	n/a	n/a
(DO NOT READ) Does not know / Does not remember	8	n/a	n/a

Multiple mention question

[ASK ALL]
[MENTIONS MULTIPLES]

INTERVIEWER INSTRUCTION: READ. MULTIPLE ANSWERS ALLOWED

Q19F Before the last 12 months do you know a friend or family member who has ever had the flu?
Response	Value	Attribute	Termination
Yes, with severe symptoms (e.g. hospitalization, pneumonia)	1	n/a	n/a
Yes, with mild symptoms (e.g. sudden onset of high fever, chills, sore throat, cough, muscle pain)	2	n/a	n/a
No, don't know anyone who had the flu	3	n/a	n/a
(DO NOT READ) Does not know / Does not remember	8	n/a	n/a

Section info

HEALTH PROMOTION AND MESSAGING

Multiple mentions question

[ASK ALL]
[MENTIONS MULTIPLES: Max=6]

[ORDER OF THE LIST: Random 1 to 5]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. MULTIPLE ANSWERS ALLOWED)
Please select all that apply.

Q21 Where do you get information, when you want to know more about the flu shot?
Response	Value	Attribute	Termination
A public health setting, health clinic or pharmacy	01	n/a	n/a
A government website (e.g. Public Health Agency of Canada)	02	n/a	n/a
The media (e.g. newspaper, radio)	03	n/a	n/a
Social media (e.g. Twitter, Facebook)	04	n/a	n/a
An app (e.g. ImmunizeCA)	05	n/a	n/a
Other; specify	06	O	n/a
Does not apply to me	07	X	n/a
(DO NOT READ) None of the above	97	X	n/a
(DO NOT READ) Refusal	99	X	n/a

Multiple mentions question

[ASK ALL]
[MULTIPLE ANSWERS: Max=6]
[ORDER OF THE LIST: Random 1 to 5]

INTERVIEWER INSTRUCTION:(READ LIST. MULTIPLE ANSWERS ALLOWED)
Please select all that apply.

Q22 For information about the flu shot, who do you trust the most?
Response	Value	Attribute	Termination
Family doctor	01	n/a	n/a
Other health care provider (e.g. nurse, pharmacist, medical specialist)	02	N	n/a
Nurse practitioner	06	n/a	n/a
Pharmacist	08	n/a	n/a
Medical specialist (e.g. gynecologist, cardiologist, ophthalmologist, allergist, orthopedist, psychiatrist)	09	n/a	n/a
An alternative care provider (e.g. naturopath, homeopath)	03	n/a	n/a
Friends	04	n/a	n/a
Family	05	n/a	n/a
Other, specify	96	O	n/a
Does not apply to me	07	X	n/a
(DO NOT READ) None of the above	97	X	n/a
(DO NOT READ) Refusal	99	X	n/a

Simple mention question

[ASK ALL]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q23A Within the last 12 months, did anyone advise you to get the flu vaccine?
Response	Value	Attribute	Termination
Yes	1	n/a	n/a
No	2	n/a	n/a
(DO NOT READ) Does not know / Does not remember	8	n/a	n/a

Multiple mentions question

[ASK IF Q23A=1]
[MULTIPLE ANSWERS: Max=12]
[ORDER OF THE LIST: Random 1 to 5]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. MULTIPLE ANSWERS ALLOWED)
Please select all that apply.

Q23 Who advised you to get the flu vaccine?
Response	Value	Attribute	Termination
Family doctor	01	n/a	n/a
Nurse practitioner	02	n/a	n/a
Pharmacist	03	n/a	n/a
Medical specialist (e.g. gynecologist, cardiologist, ophthalmologist, allergist, orthopedist, psychiatrist)	04	n/a	n/a
Midwife	05	n/a	n/a
Chiropractor	06	n/a	n/a
Acupuncturist	07	n/a	n/a
Homeopath or naturopath	08	n/a	n/a
Herbalist	09	n/a	n/a
Reflexologist	10	n/a	n/a
Spiritual or religious healer	11	n/a	n/a
Friends	12	n/a	n/a
Family	13	n/a	n/a
Other (please specify)	96	O	n/a
(DO NOT READ OUT) None of the above	97	X	n/a
(DO NOT READ OUT) Refusal	99	X	n/a

Simple mention question

[ASK ALL]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q24A Within the last 12 months, did anyone advise you NOT to get the flu vaccine?
Response	Value	Attribute	Termination
Yes	1	n/a	n/a
No	2	n/a	n/a
(DO NOT READ) Does not know / Does not remember	8	n/a	n/a

Multiple mentions question

[ASK IF Q24A=1]
[MULTIPLE ANSWERSS: Max=14]
[ORDER OF THE LIST: Random 1 to 5]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST.)
Please select all that apply.

Q24 Who advised you NOT to get the flu vaccine?
Response	Value	Attribute	Termination
Family doctor	01	n/a	n/a
Nurse practitioner	02	n/a	n/a
Pharmacist	03	n/a	n/a
Medical specialist (e.g. gynecologist, cardiologist, ophthalmologist, allergist, orthopedist, psychiatrist)	04	n/a	n/a
Midwife	05	n/a	n/a
Chiropractor	06	n/a	n/a
Acupuncturist	07	n/a	n/a
Homeopath or naturopath	08	n/a	n/a
Herbalist	09	n/a	n/a
Reflexologist	10	n/a	n/a
Spiritual or religious healer	11	n/a	n/a
Friends	12	n/a	n/a
Family	13	n/a	n/a
Other (please specify)	96	O	n/a
(DO NOT READ OUT) None of the above	97	X	n/a
(DO NOT READ OUT) Refusal	99	X	n/a

Simple mention question

[ASK ALL]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q25A Within the last 12 months, have you seen, read or heard any messages promoting the flu vaccine?
Response	Value	Attribute	Termination
Yes	1	n/a	n/a
No	2	n/a	n/a
(DO NOT READ) Does not know / Does not remember	8	n/a	n/a

Multiple mentions question

[ASK IF Q25A=1]
[MENTIONS MULTIPLES: Max=12]
[ORDER OF THE LIST: Random 1 to 5]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. MULTIPLE ANSWERS ALLOWED)
Please select all that apply.

Q25 Where did you see, read or heard those messages promoting the flu vaccine?
Response	Value	Attribute	Termination
On printed posters	01	n/a	n/a
In brochures	02	n/a	n/a
In radio / TV ads / advertisements	03	n/a	n/a
In newspapers (articles, public health announcements or advertisements)	04	n/a	n/a
In magazines	05	n/a	n/a
Advertisements in public transport	06	n/a	n/a
On the Internet (eg Facebook, PHAC website)	07	n/a	n/a
Twitter or other social media	08	n/a	n/a
When visiting the pharmacy, doctor's office, hospital	09	n/a	n/a
Other (Please specify)	96	O	n/a
(DO NOT READ OUT) I did not see, read or heard any messaging about the flu vaccine	97	X	n/a
(DO NOT READ OUT) Refusal	99	X	n/a

Section info

QSCTDEMO

The next questions are for statistical purposes only. It will allow us to group your answers with those of other similar respondents.

Scola

[ASK ALL]
[SIMPLE MENTION]
[ORDER OF THE LIST: In order]

INTERVIEWER INSTRUCTION: (READ LIST. ONLY ONE ANSWER)

First, what is the highest level of formal education that you have completed?
Response	Value	Attribute	Termination
Grade 8 or less	1	n/a	n/a
Some high school	2	n/a	n/a
High School diploma or equivalent	3	n/a	n/a
Registered Apprenticeship or other trades certificate or diploma	4	n/a	n/a
College, CEGEP or other non-university certificate or diploma	5	n/a	n/a
University certificate or diploma below bachelor's level	6	n/a	n/a
Bachelor's degree	7	n/a	n/a
Post graduate degree above bachelor's level	8	n/a	n/a
(DO NOT READ) Prefer not to answer	9	n/a	n/a

Reven

[ASK ALL]
[SIMPLE MENTION]
[ORDER OF THE LIST: In order]

INTERVIEWER INSTRUCTION: (READ LIST. ONE MENTION POSSIBLE.)

Which of the following categories best describes your total household income? That is, the total income of all persons in your household combined, before taxes.
Response	Value	Attribute	Termination
...Under $20,000	1	n/a	n/a
... $20,000 to $39,999	2	n/a	n/a
... $40,000 to $59,999	3	n/a	n/a
... $60,000 to $79,999	4	n/a	n/a
... $80,000 to $99,999	5	n/a	n/a
... $100,000 to $149,999	6	n/a	n/a
...$150,000 and above	7	n/a	n/a
(DO NOT READ) Refusal	9	n/a	n/a

Simple mention question

[ASK ALL]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q16 Were you born in Canada?
Response	Value	Attribute	Termination
Yes	1	n/a	n/a
No	2	n/a	n/a
(DO NOT READ) Refusal	9	n/a	n/a

Simple mention - open

[ASK IF Q16=2]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q17 In which country were you born?
Response	Value	Attribute	Termination
China	01	n/a	n/a
France	02	n/a	n/a
Germany	03	n/a	n/a
Greece	04	n/a	n/a
Guyana	05	n/a	n/a
Hong Kong	06	n/a	n/a
India	07	n/a	n/a
Iran	08	n/a	n/a
Italy	09	n/a	n/a
Jamaica	10	n/a	n/a
Lebanon	11	n/a	n/a
Netherlands / Holland	12	n/a	n/a
Pakistan	13	n/a	n/a
Philippines	14	n/a	n/a
Poland	15	n/a	n/a
Portugal	16	n/a	n/a
Romania	17	n/a	n/a
South Korea	18	n/a	n/a
Sri Lanka	19	n/a	n/a
Taiwan	20	n/a	n/a
Trinidad and Tobago	21	n/a	n/a
United Kingdom	22	n/a	n/a
United States	23	n/a	n/a
Vietnam	24	n/a	n/a
Other country, please specify:	96	O	n/a
(DO NOT READ) Refusal	99	n/a	n/a
*** Algeria	25	N	n/a
*** Belgium	26	N	n/a
*** Colombia	27	N	n/a
*** Afghanistan	28	N	n/a
*** Bangladesh	29	N	n/a
*** Turkey	30	N	n/a
*** Ukraine	31	N	n/a
*** Africa	32	N	n/a

Numerical question

[ASK IF Q16=2]
[NUMERIC: BORNES Min=1, Max=100]
[DECIMAL: 0]
[VALIDATION:]

INTERVIEWER INSTRUCTION: (RECORD NUMBER OF YEARS.)

Q18 How many years have you been living in Canada?
Response	Value	Attribute	Termination
Record number of years:	000	n/a	n/a
(DO NOT READ) Refusal	999	n/a	n/a

Simple mention question

[ASK ALL]
[SIMPLE MENTION]

INTERVIEWER INSTRUCTION: (DO NOT READ LIST. ONLY ONE MENTION)

Q20 Do you currently smoke? If so, do you smoke everyday or occasionally? If not, have you smoked in the past?
Response	Value	Attribute	Termination
Yes, everyday	1	n/a	n/a
Yes, occasionally	2	n/a	n/a
No, never	3	n/a	n/a
No, past smoker	4	n/a	n/a
(DO NOT READ) Refusal	9	n/a	n/a

Thank you for your participation.

Assessment of Seasonal Influenza Immunization Coverage in the Canadian Population, 2016-17

Survey Report

Table of Contents

Executive Summary

1.1 Background and Objectives

1.2 Methodology - Quantitative Research

1.3 Overview of Quantitative Findings

1.4 Notes on Interpretation of Research Findings

1.5 Political Neutrality Statement and Contact Information

Additional information

2. Detailed Quantitative Findings

Methodological note to read the tables in the report

Differences in proportion

2.1 Seasonal Influenza Immunization Coverage Before and Since September 1, 2016 Inclusively

2.2 Reasons for Getting or Not Getting the Flu Vaccine This Year

Image 1. Reasons for Not Taking the Flu Vaccine in 2016-17 (Q3)

2.3 Form of Flu Vaccine Received

2.4 Date and Place of Vaccination

2.5 Seasonal Influenza Immunization Coverage among Children

2.6 Flu Incidence among Population (Respondent and Friend or Family Member)

2.7 Health Care and Alternative Care Providers Seen in the Last Year

2.8 Sources of Information and Most Trusted Resource about the Flu Vaccine

2.9 Flu Vaccine Promoters

2.10 Flu Vaccine Detractors

2.11 Exposure to Messages Promoting the Flu Vaccine

Appendix A - Detailed Research Methodology

A.1 Quantitative Methodology

Computer Aided Telephone Interviewing (CATI)

Field and Quality-Control

Interview Monitoring

Field Supervision and Quality Control

Data Cleaning

Maximizing the response rate

Call Dispositions

Non Response Bias and Additional Socio-Demographic Analysis

Weighted and Unweighted Samples

Appendix B - Survey Questionnaire