Seasonal Influenza Vaccination Coverage Survey, 2021–2022
Final Report

Submitted to the Public Health Agency of Canada
Contract Number 6D034-214802/001/CY

Prepared By: Leger

Ce rapport est également disponible en français.
Contract value: $248,836.74
Award date: December 8, 2021
Delivery date: February 22, 2022

Registration number: POR 059-21
For more information on this report, please contact cpab_por-rop_dgcap@hc-sc.gc.ca

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

Seasonal Influenza Vaccination Coverage Survey, 2021-2022

Final Report

Prepared for the Public Health Agency of Canada
Supplier Name: Leger Marketing Inc.
February 2022

This public opinion research report presents the results of a telephone survey conducted by Leger Marketing Inc. on behalf of the Public Health Agency of Canada. The research was conducted with 3,502 Canadians between January 4 and February 11, 2022.

Cette publication est aussi disponible en français sous le titre : Enquête sur la couverture vaccinale contre la grippe saisonnière, 2021-2022.

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at cpab_por-rop_dgcap@hc-sc.gc.ca or at:

Health Canada, CPAB
200 Eglantine Driveway, Tunney's Pasture
Jeanne Mance Building, AL 1915C
Ottawa, Ontario K1A 0K9

Catalogue Number:
H14-315/2022E-PDF

International Standard Book Number (ISBN):
978-0-660-42136-0
Related publications (registration number: POR 059-21):
Catalogue Number: H14-315/2022F-PDF (Final Report, French)
978-0-660-42137-7

^©Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2022.

Table of Contents

1. Summary

1.1 Background and Objectives
1.2 Application of Results
1.3 Methodology—Quantitative Research
1.4 Notes on the Interpretation of the Findings
1.5 Declaration of Political Neutrality and Contact Information

Appendix A—Detailed Research Methodology

A.1 Quantitative Methodology

Appendix B— Questionnaire

1. Summary

Leger is pleased to submit this methodological report to the Public Health Agency of Canada (PHAC) of a quantitative survey assessing seasonal influenza vaccination coverage among the Canadian population.

This report was prepared by Leger following the awarding of a contract to PHAC (contract number 6D034-214802/001/CY, awarded December 8th, 2021. This contract has a value of $248,836.74 (including HST).

1.1 Background and Objectives

For several years now, PHAC has been conducting a study at the beginning of the year on the uptake of seasonal influenza vaccination in the Canadian population. This study has multiple research objectives. The survey covers a variety of elements and topics. This year, some secondary objectives were added to the study while other items covered in previous years were removed from the study.

The primary objective of the research was to provide national vaccination coverage estimates for the seasonal influenza vaccine. With the current pandemic context, questions about the COVID-19 vaccine were also added to the survey this year.

Secondary research objectives include:

• Measure Canadians' awareness, knowledge, attitudes and beliefs towards the seasonal influenza vaccine;
• Determine reasons for non-vaccination;
• Identify health care providers administering the influenza vaccine (i.e. nurse vs. doctor vs. pharmacist);
• Identify factors associated with vaccine uptake;
• Identify potential impact of the COVID-19 pandemic on seasonal influenza vaccine uptake; and
• Measure attitudes toward the COVID-19 vaccination.

1.2 Application of Results

The results of this study will help the Public Health Agency of Canada (PHAC) identify at-risk populations with lower immunization coverage, identify factors leading to vaccine uptake or refusal, measure the performance of vaccination programs, and design future vaccination programs in Canada. The survey results also allow PHAC to monitor and evaluate vaccination programs during the flu seasons.

1.3 Methodology—Quantitative Research

The quantitative research consisted of telephone interviews, which were conducted using a computer-assisted telephone interviewing system (CATI technology).

Data collection for this survey took place between January 4 and February 11, 2022. The national response rate for the survey was 15.43%. The comprehensive distribution of calls is presented in Appendix A. A pre-test of 43 interviews, in both official languages, was conducted on January 4, 2022. More specifically, 23 interviews were conducted in French and 20 in English. No changes were made to the questionnaire or the programming following the pre-test, data collection began as planned. The pre-test responses were included in the overall results. The interviews lasted an average of eighteen minutes. The interviews were recorded to assess the level of understanding of each question among respondents.

To obtain reliable data for each of the subgroups, we surveyed a total sample of 3,502 Canadian adults in all regions of the country. Only one adult respondent was interviewed per household. The national margin of error for this survey is +/- 1.66%, 19 times out of 20.

The main target population in this study was Canadian adults aged 18 and older who were making vaccine-related decisions for themselves. As was the case in previous years, the final analysis of the study focused on 3 different target groups:

• adults aged 18 to 64 years
• adults aged 65 and over
• adults with chronic medical conditions

A proportion of the interviews were conducted with a sample of cell-phone numbers (cell-phone-only household members), in order to provide an adequate and reliable sample of the youth cohort (18 to 34). While the cell-phone sample did not exclusively target the youth cohort, this age group was over-indexed in that target sample. The other interviews were conducted with landline users. According to 2016 national census data from Statistics Canada, Leger weighted the results of this survey by age, gender, region, language (mother tongue) and education level. Results were also weighted by households with a landline phone and household with cellphones only, according to the latest Canadian Radio-Television and Telecommunications commission (CRTC) data available.

Leger meets the strictest quantitative research guidelines. The questionnaire was prepared in accordance with the Standards for the Conduct of Government of Canada Public Opinion Research—Series B—Fieldwork and Data Tabulation for Telephone Surveys. Details on the methodology, Leger's quality control mechanisms, the questionnaire, and the weighting procedures are provided in the appendix.

1.4 Notes on the Interpretation of the Findings

The opinions 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 research conducted specifically for this project. This research is probabilistic; the results can be applied to the general population of Canada. The research was designed with this objective in mind.

1.5 Declaration of Political Neutrality and Contact Information

I hereby certify, as chief agent of Leger, that the deliverables are in full compliance with the neutrality requirements of the Policy on Communications and Federal Identity and the Directive on the Management of Communications—Appendix C (Appendix C: Mandatory Procedures for Public Opinion Research).

Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, party positions, or the assessment of the performance of a political party or its leaders.

Signed by:
Christian Bourque
Executive Vice President and Associate
Leger
507 Place d'Armes, Suite 700
Montréal, Quebec
H2Y 2W8
cbourque@leger360.com

Appendix A—Detailed Research Methodology

A.1 Quantitative Methodology

A.1.1 Methods

For tracking and comparability purposes, the methodology used for this survey was the same as that of previous waves of surveys. Leger used the same methods as those used in the 2020–2021 survey with respect to sampling methodology, data collection methods and some elements of the questionnaire.

The quantitative research consisted of telephone interviews, which were conducted using a computer-assisted telephone interviewing system (CATI technology). This approach is the most suitable for assessing seasonal influenza vaccination coverage among different subgroups of the Canadian population, while ensuring a high level of representativeness.

Leger meets the strictest quantitative research guidelines. The survey questionnaire was prepared in accordance with the Standards for the Conduct of Government of Canada Public Opinion Research—Series B—Fieldwork and Data Tabulation for Telephone Surveys.

Respondents were assured of the voluntary and confidential nature of the approach, and the anonymity of their responses. As with all research conducted by Leger, any information that could identify respondents was removed from the data, in accordance with Canada's Privacy Act.

Research interviews were conducted from the Montréal and Winnipeg virtual call centres. Montreal call centre has three separate divisions of interviewers: one made up exclusively of English-speaking interviewers, another exclusively of French-speaking interviewers, and the last of bilingual interviewers. These divisions ensure that all telephone surveys can easily be conducted in either official language. Interviews in English were also conducted from the Winnipeg call centre.

A.1.2 Data Collection

Data collection for this survey was conducted between January 4 and February 11, 2022. The national response rate for the survey was 15.43%. The comprehensive distribution of calls is presented below. A pre-test of 43 interviews, in both official languages, was conducted on January 4, 2022. More specifically, 23 interviews were conducted in French and 20 in English. The interviews lasted an average of eighteen minutes.

To obtain reliable data for each of the subgroups, we surveyed a total sample of 3,502 Canadian adults in all regions of the country. Only one adult respondent was interviewed per household. The national margin of error for this survey is +/- 1.66%, 19 times out of 20.

Representative sample of approximately 3,500 Canadians

A sample of Canadian adults was selected using a stratified regional sampling approach. Flexible regional quotas were applied to ensure that a sufficient number of interviews were conducted in each region of Canada.

The following table details the regional quotas for the 3,500 Canadian adults and the effective distribution of the 3,502 respondents:

A.1.3 Sampling Procedures

Landline telephone numbers were generated, and only cell phone numbers were purchased using a stratified regional sampling approach. Telephone interviews were conducted using Leger's computer-assisted telephone interviewing system (CATI technology). This system manages the sampling electronically, by selecting and randomly dialing the phone number to call. To ensure perfect coverage of a population, the sample included residential telephone numbers located in all of Canada's provinces and territories, as well as the cell phone numbers of Canadians who do not have a residential landline (i.e., pre-validated cell numbers only). Flexible quotas were established to ensure a sufficient number of interviews in each region of Canada. In addition to these regional quotas, data was collected to ensure proper distribution of respondents by gender (men and women) and language (English and French), using flexible quotas.

Canada-wide sampling: Households with a landline

We defined a Canada-wide sample of telephone numbers. All numbers were randomly selected to generate this basic sample. Each telephone number in this sampling frame was associated with a Canadian province. Subsequently, we used this Canada-wide sample to randomly select numbers by province or region, in proportion with the provincial or regional quotas established for the project.

Canada-wide sampling: households with a cell phone number only

For the portion of the sample composed of "cell phone only households," candidates were randomly selected for each province or region taking into account provincial or regional quotas. We set a minimum quota of 1,575 respondents from cell-phone only households to match as closely as possible the proportion of Canadian cell-phone only households estimated by the CRTC (48%). In the end, we collected data among 1,693 respondents from cell-phone only households, representing 48% of our final sample. Statistical weighting corrected the demographic differences between the sample and the actual proportion in the population.

A.1.4 Maximizing Response Rate

A low response rate compromises the reliability and validity of a survey. Based on their experience in surveying various populations, Leger has established the following methods to maximize response rates:

• Include a toll-free number that respondents can call if necessary;
• Be patient in discussions with respondents to help maintain interest in the survey and limit withdrawals during the call;
• Prepare points that interviewers can refer to in order to let respondents know that their participation is important: value of the study for them and their families, etc.
• Assign experienced interviewers to communicate with households and target the appropriate respondent;
• Make a minimum of eight call-backs at each number and schedule appointments for call-backs (even for initial contact);
• Include contact information for an experienced researcher so that respondents can confirm the validity of the research;
• Make calls to users of cell phones only to maximize sample representativeness and ensure that a sufficient number of young people, often on the move, are included in the final sample.

A.1.5 Call Distribution

The overall response rate for this study was 15.43%. The participation rate is calculated using the following formula: Participation rate / response rate = R ÷ (U + IS + R). The table below provides details of the calculation.

A.1.6 Non-response Biases and Additional Socio-Demographic Analysis

An effective response rate of 15.43% is around the average for a national telephone survey of 3,502 respondents conducted over a period of approximately five weeks. This rate is consistent with similar surveys. A response rate of more than 10% is considered typical and within industry standards for a telephone survey with the general population.

Weighting

According to Statistics Canada's 2016 national census data, Leger weighted the results of this survey by age, gender, region, language (mother tongue) and education level. In addition, the weighting of respondents in the cell phone-only sample was also controlled to match the 48% of Canadian households with landlines and to correct the difference between the sample and the actual proportion in the population, as per our estimate of CRTC's data.

A baseline comparison of weighted and unweighted samples was also conducted to identify potential non-response biases that could be introduced by lower response rates in some demographic subgroups (see tables in the next section). As is usually the case for a telephone survey targeting mainly households with a landline, it was more difficult to reach young respondents. To compensate for this, Leger conducted 1,693 interviews with individuals whose homes do not have landlines (called on their cell phones) in order to maximize the number of youth in the final sample.

A.1.7 Weighted and Unweighted Samples

The table below shows the geographical distribution of respondents, before and after weighting. There is very little geographical distribution imbalance in the unweighted sample. The weighting process mainly adjusted the weightings of Quebec and British Columbia, which were slightly underrepresented in the sample, and of Alberta, Nunavut, Northwest Territories and Yukon, which were slightly overrepresented in the sample.

The tables below illustrate the demographic distribution of respondents by gender, age, language (mother tongue), education and household income.

First, with respect to gender, we can see that the weighting adjusted the proportion of female respondents to male respondents, with women still over-represented in telephone surveys.

With respect to age distribution, the final weighting of the results corrected some imbalances regarding age groups. Respondents under 55 years old were underrepresented in the final sample, and respondents aged 55 years and older were overrepresented. The weighting corrected that discrepancy.

Some imbalances in language distribution were corrected through weighting, as shown below. The French-speaking respondents were slightly overrepresented and, as such, the respective weights of these respondents were therefore reduced.

The weighting applied corrected the original imbalance for data analysis purposes; no further manipulation was required.

As with all research conducted by Leger, contact information was kept completely confidential, and any information that could identify respondents was removed from the data, in accordance with Canada's Privacy Act.

A.1.8 Weighting Factors

Certain subgroups tend to be underrepresented or overrepresented in a sample compared to the general population. The weighting of a sample makes it possible to correct for differences in the representation of the various subgroups of that sample compared to what is usually observed in the overall study population. Weighting factors are therefore the weight given to each respondent that corresponds to a subgroup of the sample.

The following tables illustrate the proportion allocated to each target in the sample.

Appendix B — Questionnaire

Seasonal Influenza Vaccination Coverage Survey, 2021-2022

LEGEND FOR ATTRIBUTE COLUMN

X= Exclusive choice
F= Fixed Choice (not part of the rotation or permutation)
O= Open-ended

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 less than 15 minutes.

IF ASKED: Your opinion counts. Leger research is a renowned company throughout Canada. Today's study is about a topic related to public health in Canada. 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 the Public Health Agency of Canada, please provide the following contact email address.

Contact: coverage-couvertures@phac-aspc.gc.ca

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: 20171229-641F

Section info
[ASK ALL]
QSCTDEMO1
INTERVIEWER SCRIPT:
To begin, I have a few questions about you.

Single mention question
[ASK IF ECHA=CELL]
ADTADM_010
Do you currently have a residential land-line telephone service at home?
INTERVIEWER INSTRUCTIONS: (DO NOT READ LIST. ONLY ONE MENTION)

Yes 1 RECODE LANDLINE
No 0
(DO NOT READ) Valid skip / Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9 TERMINATE

Numeric question
[ASK ALL]
[NUMeric : Min=18, Max=150]
[NOTES: Under 18 = terminate]
[VALIDATION: AGE]
ADTDEM_010
How old were you as of September 1, 2021?
INTERVIEWER INSTRUCTIONS: (RECORD THE NUMBER.)

Enter number XXX
(DO NOT READ) Refusal 999 TERMINATE

Calculated variable
[NOTES: CALCULATION FROM ADTDEM_010]
ADTDEM_011

Under 18 0 TERMINATE
...Between 18 and 24 1
...Between 25 and 34 2
...Between 35 and 44 3
...Between 45 and 54 4
...Between 55 and 64 5
...Between 65 and 74 6
...75 or older 7
Refusal 9 TERMINATE

Single mention question
[ASK ALL]
PROVX
In which province do you live?

Newfoundland NL
Prince Edward Island PE
Nova Scotia NS
New Brunswick NB
Quebec QC
Ontario ON
Manitoba MB
Saskatchewan SK
Alberta AB
British Columbia BC
Northwest Territories NT
Yukon Territory YT
Nunavut NU
Atlantic AT
Prairies PR

Single mention question
[ASK ALL]
ADTDEM_020
What is the language you first learned at home in your childhood and that you still understand?
INTERVIEWER INSTRUCTIONS: (DO NOT READ LIST. ONLY ONE MENTION)

French 1
English 2
Other; specify 6
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK ALL]
ADTDEM_030
What is your gender?
INTERVIEWER INSTRUCTIONS: READ THE QUESTION EACH TIME.
Clarification, if asked: Gender is the way a person internally feels and/or publicly expresses in their daily life. A person's gender may differ from the sex they were assigned at birth (male or female). (DO NOT READ LIST. ONLY ONE MENTION)

Male 1
Female 2
Other; specify 6
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK ALL]
ADTKAB_010
As far as you know, are you up to date on your vaccines?
INTERVIEWER INSTRUCTIONS:
Clarification, if asked: Getting your flu vaccine this season is included in being up to date on your vaccines. If you missed it in a previous season, but got it this time, then you can still be considered up to date. If asked: COVID-19 vaccination should not be included in being up to date on your vaccines. READ. ONLY ONE MENTION

Yes 1
No 0
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

INTERVIEWER SCRIPT:
The next few questions I will ask you how much do you agree or disagree with a series of statements. The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree.

Single mention question
[ASK ALL]
ADTKAB_020
"In general, I consider vaccines to be important for my health." :
INTERVIEWER INSTRUCTIONS:
Clarification, if asked: "The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree".
DO NOT READ, UNLESS ASKED BY RESPONDENT.
ONLY ONE MENTION.

Strongly disagree 1
Somewhat disagree 2
Somewhat agree 3
Strongly agree 4
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) RefusaL 9

Single mention question
[ASK ALL]
ADTKAB_030
"I know enough about vaccines to make an informed decision about getting vaccinated." :
INTERVIEWER INSTRUCTIONS:
Clarification, if asked: "The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree".
DO NOT READ, UNLESS ASKED BY RESPONDENT.
ONLY ONE MENTION.

Strongly disagree 1
Somewhat disagree 2
Somewhat agree 3
Strongly agree 4
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

ADULT – Flu vaccination
INTERVIEWER SCRIPT: Now, I will ask you some questions about the flu vaccine, and your vaccination status.

Single mention question
[ASK ALL]
ADTFLU_010
Before September 1st, 2021, have you ever received the seasonal flu vaccine (also known as the flu shot)?
INTERVIEWER INSTRUCTIONS:
Note: The flu vaccine can be received by a shot (needle) or nasal spray.
(DO NOT READ LIST. ONLY ONE MENTION)

Yes 1
No 0
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK ALL]
ADTFLU_020
From September 1st 2021 to now, have you received the seasonal flu vaccine (also known as the flu shot)?
INTERVIEWER INSTRUCTIONS: (DO NOT READ LIST. ONLY ONE MENTION)

Yes 1
No 0
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK IF ADTFLU_020=0]
ADTFLU_030
How likely is it that you will get the seasonal flu vaccine between now and June 2022? Would you say you:
INTERVIEWER INSTRUCTIONS: (READ LIST. ONLY ONE MENTION)

Will definitely get one 1
Will probably get one 2
Will probably not get one 3
Will definitely not get one 4
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK IF ADTFLU_020=0]
ADTFLU_040
What was the most important reason why you did not receive the flu vaccine this time? Would you say it is because…?
INTERVIEWER INSTRUCTIONS:
If the respondents says, 'all of the above', prompt them to pick, among those, the most important reason.
If the respondent says, "Other specify" (96) – capture verbatim response. Do not back-code. (READ LIST. ONLY ONE MENTION)

The flu vaccine does not work 01
I am healthy, and/ or never get the flu 02
Getting the flu doesn't make me that sick 03
I did not get around to it (e.g. too busy, lack of time, in quarantine) 04
I have concerns about the flu vaccine, and/or its side effects 06
I have concerns about the in-person visits because of the risk of being
exposed to the COVID-19 07
I got the flu before I had the opportunity to get the flu shot 08
It was too expensive (cost of the vaccine) 09
Religious reasons or philosophical reasons 10
I was not able to get an appointment (e.g. the appointment got
cancelled, vaccine was not available when I called) 11
I am not exposed to the flu (e.g. because of telework, reduced
contacts, public health measures) 12
Because of my health condition (e.g. I was sick when the vaccine was
offered to me, allergies) 13
No specific reason, I just didn't get it 05
Something else (other; specify) 96 O
(DO NOT READ) Valid skip/ Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Single mention question
[ASK IF ADTFLU_020=1]
ADTFLU_060
In which month did you receive the flu vaccine this time?
INTERVIEWER INSTRUCTIONS: READ. ONLY ONE MENTION

September 2021 0
October 2021 1
November 2021 2
December 2021 3
January 2022 4
February 2022 5
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK IF ADTFLU_020=1]
ADTFLU_070
Where did you receive the flu vaccine this time?
INTERVIEWER INSTRUCTIONS: (READ IF NEEDED - ONE ANSWER ALLOWED)

Temporary vaccine clinic (i.e. at the mall) 01
Doctor's office / health clinic 02
CLSC / Community health centre 03
Hospital 04
Pharmacy 05
Workplace 06
Retirement residence / eldercare centre 07
Other, specify: 96 FO
(DO NOT READ) Valid skip/ Not applicable 97 F
(DO NOT READ) Don't know 98 F
(DO NOT READ) Refusal 99 F

Multiple mentions question
[ASK IF ADTFLU_020=1]
[MULTIPLE MENTIONS: Max=12]
ADTFLU_080
What are the reasons why you decided to receive the flu vaccine this time?
INTERVIEWER INSTRUCTIONS:
If the respondent says "Other specify" (96) – capture verbatim response. Do not back-code. DO NOT READ - MULTIPLE ANSWERS ALLOWED
Please select all that apply.

I want to prevent infection / I do not want to get sick 01
I am at risk because of my health condition 02
I am at risk because of my age 03
I was recommended by a health care professional 04
I was encouraged by family members, colleagues or friends 05
It is required in my workplace 06
It was offered / free (by employer or other) 08
If not vaccinated, I can transmit the disease to at-risk people
(children, elderly or sick people/patients) 09
If not vaccinated, I can transmit the disease to family members,
colleagues or friends (without mention of at-risk people) 10
I was more concerned about flu because of the COVID-19
pandemic 12
It helps to reduce stress on the healthcare system 13
I receive it every year (no specific reason) 11
Other specify: 96
(DO NOT READ) Valid skip/ Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Single mention question
[ASK ALL]
ADTCOV_010
How has the COVID-19 pandemic affected your likelihood of getting the seasonal flu shot this time?

More likely to get the seasonal flu shot 01
Less likely to get the seasonal flu shot 02
Did not affect your likelihood of getting the seasonal flu shot 03
(DO NOT READ) Valid skip/ Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Multiple mentions question
[ASK ALL]
ADTCOV_020
Did you encounter any of the following difficulties in scheduling an appointment for getting the flu shot this time due to the COVID-19 pandemic?
READ LIST

Limited appointment availability 01
Concern about being exposed to COVID-19 03
Lack of walk-in options 05
The vaccine was not offered at my usual/convenient/close
location 08
I didn't encounter any difficulties in scheduling an appointment 06
I have not taken any action to get vaccinated 07
Other, specify 96
(DO NOT READ) Valid skip/ Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

INTERVIEWER SCRIPT: For the next few questions I will ask you how much you agree or disagree with a series of statements. The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree.

Single mention question
[ASK ALL]
ADTKAB_040
"The flu vaccine does not protect you against getting the flu.":
INTERVIEWER INSTRUCTIONS:
Clarification, if asked: "The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree".
DO NOT READ, UNLESS ASKED BY RESPONDENT.
ONLY ONE MENTION.

Strongly disagree 1
Somewhat disagree 2
Somewhat agree 3
Strongly agree 4
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK ALL]
ADTKAB_050
"Sometimes, you can get the flu from the flu vaccine.":
INTERVIEWER INSTRUCTIONS:
Clarification, if asked: « The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree".
DO NOT READ, UNLESS ASKED BY RESPONDENT.
ONLY ONE MENTION.

Strongly disagree 1
Somewhat disagree 2
Somewhat agree 3
Strongly agree 4
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK ALL]
ADTKAB_060
"It's a good thing for children to get natural immunity (protection) against flu by being exposed to the virus."
INTERVIEWER INSTRUCTIONS: Clarification, if asked: ``The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree´´.
DO NOT READ, UNLESS ASKED BY RESPONDENT. ONLY ONE MENTION.

Strongly disagree 1
Somewhat disagree 2
Somewhat agree 3
Strongly agree 4
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK ALL]
ADTKAB_070
"It's a good thing for adults to get natural immunity (protection) against flu by being exposed to the virus."
INTERVIEWER INSTRUCTIONS: Clarification, if asked: ``The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree´´.
DO NOT READ, UNLESS ASKED BY RESPONDENT. ONLY ONE MENTION.

Strongly disagree 1
Somewhat disagree 2
Somewhat agree 3
Strongly agree 4
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK ALL]
ADTKAB_080
"The opinion of my family doctor, general practitioner, nurse practitioner or health nurses is an important part of my decision when it comes to getting the flu vaccine.":
INTERVIEWER INSTRUCTIONS:
Clarification, if asked: "The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree".
DO NOT READ, UNLESS ASKED BY RESPONDENT.
ONLY ONE MENTION.

Strongly disagree 1
Somewhat disagree 2
Somewhat agree 3
Strongly agree 4
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK ALL]
ADTKAB_090
"The flu vaccine is safe.":
INTERVIEWER INSTRUCTIONS:
Clarification, if asked: "The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree".
DO NOT READ, UNLESS ASKED BY RESPONDENT.
ONLY ONE MENTION.

Strongly disagree 1
Somewhat disagree 2
Somewhat agree 3
Strongly agree 4
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK ALL]
ADTKAB_100
"I understand why the flu vaccine is recommended annually.":
INTERVIEWER INSTRUCTIONS:
Clarification, if asked: "The options are: strongly disagree, somewhat disagree, somewhat agree, or strongly agree".
DO NOT READ, UNLESS ASKED BY RESPONDENT.
ONLY ONE MENTION.

Strongly disagree 1
Somewhat disagree 2
Somewhat agree 3
Strongly agree 4
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Section info
HEALTH STATUS
INTERVIEWER SCRIPT:
In this next section, I will ask you a few general questions about your health.

Single mention question
[ASK ALL]
ADTHLT_010
On a scale of one to five, with one being poor and five being excellent, how would you rate your health?
INTERVIEWER INSTRUCTIONS: READ. ONLY ONE MENTION

One (poor) 1
Two (fair) 2
Three (good) 3
Four (very good) 4
Five (excellent) 5
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Multiple mentions question
[ASK ALL]

[MENTIONS MULTIPLES: Max=12]
[LIST ORDER : IN ORDER]
ADTCMC_010
Are you currently suffering from or being treated for any of the following conditions? Indicate only conditions that have been diagnosed.
INTERVIEWER INSTRUCTIONS: (READ LIST - MULTIPLE ANSWERS ALLOWED)
Please select all that apply.

Asthma 01
Another chronic lung disease such as emphysema, chronic bronchitis or cystic fibrosis 02
A heart condition such as angina, high blood pressure, heart failure, heart attack 03
Cancer 04
Diabetes or other metabolic diseases 05
Chronic liver disease 06
Chronic kidney disease 07
Immune disorder or immune suppression such as chemotherapy, radiation, steroid
use, HIV or an organ transplant 08
Spleen problems or removal 09
Anemia / thalassemia/ hemoglobinopathy 10
Morbid obesity (BMI > 40) 11
Conditions that compromise management of respiratory secretions, with increased
risk of aspiration 12
Chronic cerebrospinal fluid (CSF) leak 13
Cochlear implant 14
(DO NOT READ) None of the above 95 X
(DO NOT READ) Valid skip/ Not applicable 97 X
(DO NOT READ) Don't know 98 X
(DO NOT READ) Refusal 99 X

Single mention question
[ASK ALL]
ADTHLT_020
Do you have a regular family doctor, general practitioner or nurse practitioner?
INTERVIEWER INSTRUCTIONS: READ LIST. ONLY ONE MENTION

Yes 1
No 0
(DO NOT READ) Valid skip/ Not applicable 7 X
(DO NOT READ) Don't know 8 X
(DO NOT READ) Refusal 9 X

Single mention question
[ASK IF ADTHLT_020=1]
ADTHLT_030
Since September 1, 2021, have you seen your family doctor, general practitioner or nurse practitioner, either in person or virtually (via phone or video)?
INTERVIEWER INSTRUCTIONS: READ LIST. ONLY ONE MENTION

Yes 1
No 0
(DO NOT READ) Valid skip/ Not applicable 7 X
(DO NOT READ) Don't know 8 X
(DO NOT READ) Refusal 9 X

Single mention question
[ASK IF ADTHLT_030=1]
ADTHLT_040
Did your family doctor, general practitioner or nurse practitioner recommend that you get the flu vaccine?
INTERVIEWER INSTRUCTIONS:
READ. ONLY ONE MENTION

Yes 1
No 0
(DO NOT READ) Valid skip/ Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention question
[ASK ALL]
ADTHLT_050
This flu season, have you had the flu?
INTERVIEWER INSTRUCTIONS:
If asked: "This flu season" means September 1, 2021 to now
If asked: flu refers to influenza, which is different from a stomach flu (i.e. gastrointestinal illness) READ LIST. ONLY ONE MENTION

Yes, I had the flu 1
I had something, but I'm not sure if it was the flu, or something else 2
No, I did not have the flu 3 X
(DO NOT READ) Valid skip/ Not applicable 7 X
(DO NOT READ) Don't know 8 X
(DO NOT READ) Refusal 9 X

Single mention question
[ASK IF ADTHLT_050=1]
ADTHLT_051
Would you say that you had a severe, moderate or mild case of the flu?
INTERVIEWER INSTRUCTIONS:
Clarifications, if asked: A severe case might include hospitalization or pneumonia. A mild case might include sudden onset of high fever, chills, sore throat, cough or muscle pain.
DO NOT READ LIST. ONLY ONE MENTION

Severe case 1
Moderate case 2
Mild case 3
Other, specify 6 X
(DO NOT READ) Valid skip/ Not applicable 7 X
(DO NOT READ) Don't know 8 X
(DO NOT READ) Refusal 9 X

Single mention question
[ASK ALL]
ADTHLT_060
Not including this flu season, have you ever had the flu?
INTERVIEWER INSTRUCTIONS:
If asked: "This flu season" means September 1, 2021 to now
If asked: flu refers to influenza, which is different from a stomach flu (i.e. gastrointestinal illness).
READ LIST. ONLY ONE MENTION

Yes, I have had the flu 1
I had something, but I'm not sure if it was the flu, or something else 2
No, I have never had the flu 3 X
(DO NOT READ) Valid skip/ Not applicable 7 X
(DO NOT READ) Don't know 8 X
(DO NOT READ) Refusal 9 X

Single mention question
[ASK IF ADTHLT_060=1]
ADTHLT_061
Thinking about the worst flu you ever had, not including this flu season, would you say you had a severe, moderate or mild case of the flu?
INTERVIEWER INSTRUCTIONS:
Clarifications, if asked: A severe case might include hospitalization or pneumonia. A mild case might include sudden onset of high fever, chills, sore throat, cough or muscle pain.
DO NOT READ LIST. ONLY ONE MENTION

Severe case 1
Moderate case 2
Mild case 3
Other, specify 6 X
(DO NOT READ) Valid skip/ Not applicable 7 X
(DO NOT READ) Don't know 8 X
(DO NOT READ) Refusal 9 X

INTERVIEWER SCRIPT:
In the context of the COVID-19 pandemic, I will now ask you some questions about the COVID-19 vaccination

Single mention question
ADTCOV_030
Have you been vaccinated against COVID-19?

Yes 01
No, but I already booked an appointment for getting vaccinated 02
No, I am not sure if I will get vaccinated 00
No, I am not getting the COVID-19 vaccine 04
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Single mention question
ADTCOV_040
[ASK IF ADTCOV_030=1]
How many doses of a COVID-19 vaccine have you received?

1 dose 01
2 doses 02
3 doses 03
4 or more doses 04
* Valid skip/not applicable 97
* Don't know 98
* Refusal 99

Single mention question
ADTCOV_050
[ASK IF ADTCOV_030=4]
What is the main reason why you are not getting the COVID-19 vaccine?

I have concerns about the safety and/or side effects of COVID-19 vaccines 01
I think COVID-19 vaccines are not effective in protecting me from the virus 02
I am not at high risk of getting COVID-19 03
I already had COVID-19 04
If I get COVID-19 I will not be very sick 05
I prefer to develop natural immunity from infection rather than from vaccination 06
There are already enough vaccinated people so I don't need to vaccinate myself 07
Philosophical or religious reasons 08
Other reasons; specify 96
* Valid skip 97
* Don't know 98
* Refusal 99

Single mention question
ADTCOV_060
[ASK IF ADTCOV_030=3]
What is the main reason why you hesitate to get vaccinated against COVID-19?

I have concerns about the safety and/or side effects of COVID-19 vaccines 01
I think COVID-19 vaccines are not effective in protecting me from the virus 02
I am not at high risk of getting COVID-19 04
I already had COVID-19 05
If I get COVID-19 I will not be very sick 06
There are already enough vaccinated people so I don't need to vaccinate myself 07
Other reasons; specify 96
(DO NOT READ) Valid skip 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Single mention question
ADTCOV_070
[ASK IF ADTCOV_040=3 or 4]
Have you received a COVID-19 vaccine booster dose?
INTERVIEWER INSTRUCTIONS:
Please provide the definition on additional doses to the respondent:
An additional dose (booster dose) may be offered to people 6 months after being fully vaccinated for continued protection against COVID-19 infections.

Yes, I have received a COVID-19 vaccine booster dose 01
No, I have not received a COVID-19 vaccine booster dose 02
* Valid skip/not applicable 97
Don't know 98
Refusal 99

Single mention question
ADTCOV_080
[ASK IF ADTCOV_070=2 and ADTCOV 040 = 1 or 2]
How likely are you to get an additional dose (booster dose) of a COVID-19 vaccine if you are eligible to receive one?

Very unlikely 01
Somewhat unlikely 02
Somewhat likely 03
Very likely 04
I already booked an appointment for my booster dose 05
* Valid skip/not applicable 97
Don't know 98
Refusal 99

Single mention question
[ASK IF ADTCOV_080 = Very likely or somewhat likely]
ADTCOV_081
What is the main reason why you would receive an additional dose (booster dose) of a COVID-19 vaccine? Would you say it is because…?
INTERVIEWER INSTRUCTIONS:
If the respondents say, 'all of the above', prompt them to pick, among those, the most important reason
(READ LIST. ONLY ONE MENTION)

To protect myself personally from COVID-19 01
To protect my family members from COVID-19 02
To prevent the spread of COVID-19 in my community 03
To put an end to the pandemic 04
Other reasons; specify 96
DO NOT READ) Valid skip/ Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Single mention question
[ASK IF ADTCOV_080 = somewhat unlikely or very unlikely]
ADTCOV_082
What is the main reason why you do not intend to get an additional dose (booster dose) of a COVID-19 vaccine? Would you say it is because…?
INTERVIEWER INSTRUCTIONS:
If the respondents say, 'all of the above', prompt them to pick, among those, the most important reason
(READ LIST. ONLY ONE MENTION)

I have concerns about the safety and/or side effects of having an additional dose of a
COVID-19 vaccine 01
I think COVID-19 vaccines are not effective in protecting me from the virus 02
I am well protected after receiving two doses/being fully vaccinated 03
I am not at high risk of getting COVID-19 04
I already had COVID-19 05
I had bad reactions to the previous doses 06
Other reasons; specify 96
(DO NOT READ) Valid skip/ Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

INTERVIEWER SCRIPT: The next few questions will ask you how much you agree or disagree with a series of statements. The options are: strongly disagree, somewhat disagree, somewhat agree or strongly agree.

Single mention question
[ASK ALL]
ADTCOV_090
"It's a good thing for children to get natural immunity (protection) against COVID-19 by being exposed to coronavirus."

Strongly disagree 01
Somewhat disagree 02
Somewhat agree 03
Strongly agree 04
(DO NOT READ) Valid skip/ Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Single mention question
[ASK ALL]
ADTCOV_100
"It's a good thing for adults to get natural immunity (protection) against COVID-19 by being exposed to coronavirus."

Strongly disagree 01
Somewhat disagree 02
Somewhat agree 03
Strongly agree 04
(DO NOT READ) Valid skip/ Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Single mention question
ADTCOV_110
"The COVID-19 vaccination passport is a good tool to motivate myself for getting vaccinated against the disease."

Strongly disagree 01
Somewhat disagree 02
Somewhat agree 03
Strongly agree 04
(DO NOT READ) Valid skip/ Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Single mention question
ADTCOV_120
"The COVID-19 vaccination passport is an effective tool to help protect myself/my family or friends/those most at-risk of dying from COVID-19."

Strongly disagree 01
Somewhat disagree 02
Somewhat agree 03
Strongly agree 04
(DO NOT READ) Valid skip/ Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Section info
QSCTDEMO
INTERVIEWER SCRIPT:
The next questions are for statistical purposes only. It will allow us to group your answers with those of other similar respondents.

Single mention question
Scola
[ASK ALL]
[LIST ORDER : IN ORDER]
ADTDEM_040
First, what is the highest level of formal education that you have completed?
INTERVIEWER INSTRUCTIONS: (DO NOT READ LIST. ONLY ONE ANSWER)

Grade 8 or less 01
Some high school 02
High School diploma or equivalent 03
Registered Apprenticeship or other trades certificate or diploma 04
College, CEGEP or other non-university certificate or diploma 05
University certificate or diploma below bachelor's level 06
Bachelor's degree 07
Post graduate degree above bachelor's level 08
(DO NOT READ) Valid skip / Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Single mention question
Reven
[ASK ALL]
[LIST ORDER : IN ORDER]
ADTDEM_050
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.
INTERVIEWER INSTRUCTIONS: (READ LIST UP TO CATEGORY THAT RESPONDENT SELECTS. ONE MENTION POSSIBLE.)

...Under $20,000 01
... $20,000 to $39,999 02
... $40,000 to $59,999 03
... $60,000 to $79,999 04
... $80,000 to $99,999 05
... $100,000 to $149,999 06
…$150,000 and above 07
(DO NOT READ) Valid skip / Not applicable 97
(DO NOT READ) Don't know 98
(DO NOT READ) Refusal 99

Single mention question
[ASK ALL]
ADTDEM_060
Were you born in Canada?
INTERVIEWER INSTRUCTIONS: (DO NOT READ LIST. ONLY ONE MENTION)

Yes 1
No 0
(DO NOT READ) Valid skip / Not applicable 7
(DO NOT READ) Don't know 8
(DO NOT READ) Refusal 9

Single mention -open
[ASK IF ADTDEM_060=0]
ADTDEM_070
In which country were you born?
INTERVIEWER INSTRUCTIONS: (DO NOT READ LIST. ONLY ONE MENTION)

China 156
France 250
Germany 276
Greece 300
Guyana 328
Hong Kong 344
India 356
Iran 364
Italy 380
Jamaica 388
Lebanon 422
Netherlands 528
Pakistan 586
Philippines 608
Poland 616
Portugal 620
Romania 642
Korea, Republic of (South Korea) 410
Sri Lanka 144
Taiwan 158
Trinidad and Tobago 780
United Kingdom 826
United States 840
Vietnam 704
Algeria 012
Belgium 056
Colombia 170
Afghanistan 004
Bangladesh 050
Turkey 792
Ukraine 804
Other; specify 996
(DO NOT READ) Valid skip/ Not applicable 997
(DO NOT READ) Don't know 998
(DO NOT READ) Refusal 999

Numerical question
[ASK IF ADTDEM_060=0]
[NUMERIC: BORNES Min=1, Max=100]
ADTDEM_080
How many years have you been living in Canada?
INTERVIEWER INSTRUCTIONS: (RECORD NUMBER OF YEARS.)

Record number of years: XXX
(DO NOT READ) Valid skip/ Not applicable 997
(DO NOT READ) Don't know 998
(DO NOT READ) Refusal 999

INTERVIEWER SCRIPT:

This concludes the questions we have for you. Your answers will help improve services that impact Canadians like you.

We greatly appreciate your cooperation and thank you for your participation.