各位先生女士:
我係香港專業教育學院(IVE) - 柴灣分校應用科學系既學生。我同我既同學做緊一份關於豬流感疫苗(Swine influenza vaccine)既問卷調查。
我地希望取得更加人既意見，所以想請各位會員花幾分鐘既時間完成呢份問卷。
你地提供既所有資料只係用作收集資料及功課用途。
為確保閣下既私隱，麻煩你地以pm/email ([email protected])既形式作答。
多謝各位!
Hong Kong Institute of Vocational Education (Chai Wan)
Survey on Swine influenza vaccine (豬流感疫苗)
We would like to collect the information about your view on the swine influenza vaccine. Please complete the questionnaire below and note that your input would only be used for data collection purpose.
Please put a ‘ü’ where appropriate unless specified.
I.Personal Information (個人資料)
1.Gender (性別):
Female(女) ¨
Male(男) ¨
2.Age(年齡): 15-24 ¨
25-34 ¨
35-44 ¨
45-54 ¨
55-64 ¨
65 or above ¨
3.Your Health condition(你的身體狀況): (Can choose one or more可選1項或以上)
Chronic disease patient(長期病患) ¨
Pregnant(懷孕) ¨
Elderly(長者) ¨
Healthy(健康) ¨
II.Survey Question
1.Have you been injected swine influenza vaccine? (你有沒有注射豬流感疫苗?)
Yes有 ¨ (請回答第2條)
No 沒有¨ (請回答第3條)
2.Do you feel sick (e.g. fever, numbness四肢無力, etc) after injecting the vaccine? (注射疫苗後，你有否感到不適? (例如:發燒，四肢無力等)
Yes有 ¨ Please clarify請註明: ________________
No沒有 ¨
(請回答第4條)
3.Will you inject the swine influenza vaccine? (你將會注射豬流感疫苗嗎?)
Yes會 ¨
No不會 ¨
4.Why did you / will you/ will you not vaccinate? (為什麼你會/不會注射疫苗?)
5.Rank the following from 1-6 in order of concerning about the vaccine, where 1 means the most important factor: (請依你的考慮因素，將下列6項以次加以排列，1為最重要，6為最不重要。)
( )Cost (費用)
( )Suspected side effect (疑似副作用e.g. fever發燒 , miscarriage流產, GBS吉巴氏綜合症, etc)
( )Complications after injection of swine influenza vaccine(注射後的併發症)
( )Pain/ Bleeding after injection (注射後的痛楚/流血)
( )Prevention of the swine influenza (預防豬流感的功效)
( )The time for producing antibodies to against virus (生產豬流感抗體的時間)
6.How much do you agree to each of the following statements? (你認同以下的句子嗎?)
(1)I think the vaccine is reliable.
我認為疫苗是可靠的。
(2)I would like to take pills rather than injecting the vaccine.
我寧願服用藥物(如特敏福)，不希望注射疫苗。
非常同意/同意/沒意見/不同意/非常不同意
7.How would you rate your confidence on the vaccine? (請選出你對於疫苗的信任程度。) (1最低，5最高)
8.If there were not any suspected side effects on the vaccine, how would you rate your confidence on the vaccine? (假如從沒有任何疑似副作用發生，你對於此疫苗的信任程度為?)
(1最低，5最高)
9.Would you recommend others to inject this vaccine? (你會建議別人注射疫苗嗎?)
Yes 會
¨
No 不會
¨
10.Please write your comments or suggestions for swine influenza vaccine.
(請填寫你對於豬流感疫苗的意見/建議。)
- Thank you for your time and cooperation -
[ 本帖最後由 elza1224 於 10-3-18 01:13 編輯 ]
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