Vaccination Champion Pre-Pilot Questionnaire - Page 1 of 3 - City of Wolverhampton Council

Page 1 of 3

Please complete all of the below questions:

1. How confident do you feel discussing vaccinations with care home staff?

Not confident Somewhat confident Confident Very confident

2. How confident do you feel discussing vaccinations with care home residents?

Not confident Somewhat confident Confident Very confident

3. How confident do you feel discussing vaccinations with residents’ family members?

Not confident Somewhat confident Confident Very confident

4. How would you rate your current knowledge of the following vaccines?

5. How confident are you in identifying and correcting common myths or misinformation about vaccines?

Not confident Somewhat confident Confident Very confident

6. Have you previously received any training related to vaccines or infection prevention and control (IPC)?

Yes No

If yes, please briefly describe:

7. How confident are you in having sensitive or challenging conversations about vaccine hesitancy?

Not confident Somewhat confident Confident Very confident

8. How comfortable are you using culturally sensitive approaches when discussing vaccines with diverse staff or residents?

Not comfortable Somewhat comfortable Comfortable Very comfortable

9. Do you feel you have the tools or resources needed to support vaccine conversations in your care home?

Yes No Not sure

If you answered no or not sure, what would help?

10. What do you hope to gain from being a Vaccination Champion?

11. Please state your job role: