Health & Vaccination Awareness

The questions

1. 1

   Have all eligible members of your household received their recommended vaccines?

   Single choice

   • Yes, all
   • Some of them
   • No
   • Not sure
   • Prefer not to say
2. 2

   Where do you usually get health information?

   Multiple choice

   • Doctor / nurse
   • ASHA / Anganwadi worker
   • Family and friends
   • TV / radio
   • Social media / WhatsApp
   • Newspaper
3. 3

   Do you know where your nearest government health centre is?

   Single choice

   • Yes
   • No
   • Not sure
4. 4

   Which of these vaccines have you heard of?

   Multiple choice

   • Polio
   • Measles / MR
   • Tetanus
   • Hepatitis B
   • HPV
   • Flu
   • None of these
5. 5

   How far is the nearest place to get vaccinated?

   Single choice

   • Less than 2 km
   • 2–5 km
   • 5–10 km
   • More than 10 km
   • Not sure
6. 6

   What makes it hard to get vaccinated?

   Multiple choice

   • Distance / travel
   • Loss of a day's wages
   • Worry about side effects
   • Not enough information
   • Long waiting time
   • No difficulty
7. 7

   How much do you trust the information you get about vaccines?

   Star rating · 5 stars

8. 8

   Would a reminder by SMS or phone call help you?

   Single choice

   • Yes
   • No
   • Maybe
9. 9

   Has an ASHA or health worker visited your home in the last 3 months?

   Single choice

   • Yes
   • No
   • Not sure
10. 10

    What health information would be most useful for your family?

    Text answer · Optional

Every question can be edited, removed or reordered in the survey builder, and the whole survey is translated automatically when respondents pick their language.