Attachment B - R75 PVQ (JAN 2016)

Preventive Care (PVQ)
Variable Name MR Screen Name
BOX PVBEG

PVINTRO

PVINT

FLUSHOT

PVF1

Question text/description
Code list
IF RESPONDENT IS DECEASED, GO TO BOX PVEND.
ELSE IF (SEASON=SUMMER) AND (WINTER ROUND RESONSE TO PVF1-FLUSHOT=1/YES) GO TO BOX PVEND PV4.
ELSE GO TO PVINT-PVINTRO.
IF SEASON=WINTER FILL "Now I’d like to ask you some questions about the seasonal flu vaccine."
ELSE IF SEASON=SUMMER, FILL "Last time we interviewed you, you told us that you had not gotten a flu
vaccination for the [CURRENT YEAR MINUS 1] - [CURRENT YEAR] flu season."
Since [July 1st, (CURRENT YEAR MINUS 1)/[MREFDATE]], [have you/has (SP)] had a seasonal flu vaccination?
IF THE RESPONDENT MENTIONS A SHORT NEEDLE OR NEEDLELESS INJECTOR, CODE AS “YES”.

BOX PV1
FLUCODE

PVF2

IF SEASON=WINTER GO TO PVF2-FLUCODE.
ELSE GO TO BOX PVEND PV4.
For what reason didn't [you/(SP)] get a seasonal flu vaccination since July 1st?
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.

FLUOTHOS

PVF2
BOX PV2

OTHER (SPECIFY)
IF MORE THAN ONE RESPONSE SELECTED AS YES AT PVF2-FLUCODE, GO TO PVF3-PVFLU3, ELSE GO TO BOX PV3

PVFLU3

PVF3

Of the reasons you listed, what is the main reason [you/(SP)] did not get a flu vaccination this flu season?
READ LIST TO RESPONDENT. IF RESPONDENT SELECTS MORE THAN ONE REASON PROBE FOR MAIN REASON.

(01) YES
(02) NO
(-8) DON’T KNOW
(-9) REFUSED

(01) DIDN’T KNOW IT WAS NEEDED
(02) SHOT COULD CAUSE FLU
(03) SHOT COULD HAVE SIDE EFFECTS OR CAUSE DISEASE
(04) DIDN’T THINK IT WOULD PREVENT THE FLU/COULD GET THE
FLU ANYWAY
(05) FLU NOT SERIOUS/WOULD NOT GET FLU ANYWAY/NOT AT
RISK/NEVER GET THE FLU
(06) DOCTOR DID NOT RECOMMEND THE SHOT
(07) DOCTOR RECOMMENDED AGAINST GETTING VACCINE
(08) DON'T LIKE SHOTS OR NEEDLES/CONCERNS ABOUT SORENESS
OR RASH/LOCAL REACTIONS
(09) INCONVENIENT TO GET SHOT/UNABLE TO GET TO LOCATION
(10) DIDN’T THINK ABOUT IT/FORGOT/MISSED IT
(11) COST OF VACCINE
(12) HAD VACCINE BEFORE/DIDN’T NEED IT AGAIN
(13) VACCINE UNAVAILABLE/VACCINE SHORTAGE
(14) NOT WORTH THE MONEY
(15) DIDN'T HAVE TIME
(16) NOT IN HIGH RISK/PRIORITY GROUP
(17) ONGOING HEALTH CONDITION PREVENTING
VACCINE/ALLERGIC TO SHOT/MEDICAL REASONS
(18) DON'T TRUST WHAT GOVERNMENT SAYS ABOUT VACCINE
(91) OTHER
(-8) DON'T KNOW
(-9) REFUSED

[LIST ALL RESPONSES SELECTED AT PVF2-FLUCODE]
_ _ [ENTER MAIN REASON]
(-8) DON’T KNOW
(-9) REFUSED

Variable Name

MR Screen Name
BOX PV3

NOVACINE

PVF4

VACSUPLY

PVF5

Did [you/(SP)] have any trouble getting a seasonal flu shot when (you/he/she) wanted to because the vaccine
was in short supply or unavailable?

BOX PV4

IF THIS IS A SUMMER ROUND AND RESPONDENT HAS NOT REPORTED RECEIVING THE SHINGLES VACCINE
(P_SHINGVAC^=1) AND RESPONDENT IS AGE 60 OR ABOVE (AGECALC ≥ 60), GO TO PV6-SHINGVAC.
ELSE GO TO BOX PV5.
Shingles is an outbreak of a rash or blisters on the skin that may be associated with severe pain. The pain is
(01) YES
generally on one side of the body or face. Shingles is caused by the chicken pox virus. A vaccine for shingles has (02) NO
been available since May 2006.
(-8) DON'T KNOW
(-9) REFUSED
[Have you/Has SP] ever had the Zoster (ZOSS-ter) or Shingles vaccine, also called Zostavax®?
IF THIS IS A SUMMER ROUND AND RESPONDENT HAS NOT REPORTED RECEIVING THE PNEUMONIA VACCINE
(PNEUSHOT^=1), GO TO PV7-PNEUSHOT.
ELSE GO TO BOX PVEND.
[Have you/Has SP] EVER had a pneumonia shot?
(01) YES
(02) NO
This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also
(-8) DON'T KNOW
called the pneumococcal vaccine.
(-9) REFUSED

SHINGVAC

PV6

BOX PV5

PNEUSHOT

PV7

Question text/description
IF RESPONSE TO PVF2-FLUCODE DOES NOT INCLUDE 13, GO TO PVF4-NOVACINE.
ELSE GO TO BOX PVEND PV4.
Was one reason that [you/(SP)] did not get a seasonal flu vaccination since July 1st, [CURRENT YEAR MINUS 1]
because the vaccine was in short supply or unavailable?

Code list

(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED