APPENDIX 4
Questionnaire for Aboriginal Community Controlled Health Organisations
(To be filled in by the nurse/vaccinator together with an Aboriginal Health Worker. If your service does not have both, then the person most involved with vaccination should fill it in.)
We would like to find out about the National Indigenous Pneumococcal and Influenza
Immunsation (NIPII) program in your community.
What are the jobs of the people who will be answering these questions?
___________________________________________________________________________
Q1. The posters on Pneumococcal and Influenza Immunsation for Indigenous adults have photos of well-known personalities on them. Did your service receive any this year?
(Please circle) Yes / No
If yes, please tick where these posters have been put up.
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Waiting area
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Clinic rooms
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Community building
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Other
Posters not put up please specify__________________________________ please specify__________________________________ please give reasons______________________________
______________________________________________________________________
Q2. Do you remember reading the information sheet for GP’s/Aboriginal health workers that came with these posters? (GP Flyer) Yes / No (AHW Flyer) Yes / No
(If yes, go to Q3. If no, go to Q6)
Q3. Was the information helpful to you? Very / somewhat / not very / not at all
Q4. Did you have all the information you needed on influenza and pneumococcal vaccination of Indigenous adults? Yes / No
Q5. What else would have been helpful? _________________________________________
______________________________________________________________________
(Go to Q7)
Q6. What prevented you from reading the information sheet?_________________________
______________________________________________________________________
Q7. Do you think the people from your community know the people who are on the posters?
Yes/No
Q8. Do you think it is more effective if people in your community recognise the people on the posters? Yes /No
Q9. Did you hear about the Indigenous adult pneumococcal and influenza vaccination program this year on the radio? Yes /No
Statistical Clearing House Approval number XXXX

Q10. If yes, do you think that people learnt about the Indigenous Adult pneumococcal and influenza vaccination program from the radio ads?
Yes /No
Why, or why not?
______________________________________________________________________
______________________________________________________________________
Q11. What does your organisation do to tell people about pneumococcal and influenza vaccinations? (Please describe the activities, eg. What were they, how often, how many people attended, etc.)_____________________________________________________
______________________________________________________________________
Were any of these funded by the Office for Aboriginal and Torres Strait Islander
Health? Yes / No
If yes, which one(s) ______________________________________________________
Q12. Has anyone that you know of received pneumococcal or influenza needles this year specifically because of a promotional program or activity? Yes / No
If yes, please tick which ones
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Radio
Posters
Local community promotional activity
Told by friend/relative
Told by health worker
Other. Please specify ______________________________________________
Q14. What do you think are the best ways to tell people about pneumococcal and influenza needles? _______________________________________________________________
______________________________________________________________________
Q15. Which Indigenous adults should get the vaccines? (Please tick as many as necessary)
Indigenous risk group
All aged 15+ years
All aged 65+ years
All aged 50 + years
Only with risk factors, 15 – 64 years
Only with risk factors, 15 – 49 years
Influenza Pneumococcal
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Q16. If you ticked “Only with risk factors…” above, which do you think are those risk factors? (Please tick as many as necessary)
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Diabetes
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Chronic kidney disease
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Chronic lung disease
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Smoking
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Heavy drinking
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HIV/AIDS
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Chronic heart disease
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Cancer
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Other (please specify) __________________________________________________
Statistical Clearing House Approval number XXXX

Q17. How often should these people be vaccinated?
Once only
Every year
Every 5 years
Influenza Pneumococcal
Revaccinate once only, 5 years after the first dose
Other (please specify) ______________________
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Q18. Do any other service providers in your area vaccinate Indigenous adults for influenza and pneumococcal? Eg. GP’s, community health centres?
Yes / No
If yes, what type of services are they? ________________________________________
______________________________________________________________________
Q19. Does your organisation work with other agencies or services to provide influenza and pneumococcal vaccination for Indigenous adults? Yes/No
If yes, what were the other agencies?_________________________________________
______________________________________________________________________
Q20. Does your service have any difficulty finding staff qualified to vaccinate? Yes / No
If yes, please explain _____________________________________________________
Q21. Were any Indigenous adults vaccinated by your service this year? Yes / No
If no, why not? (please tick more than one if appropriate):
 No medical services provided by your organisation

Unable to recruit / keep staff qualified to vaccinate
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Insufficient funding
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Other please specify _______________________________________________
If no, please go to Q36.
If yes, please go to Q22.
Q22. Who gives the vaccinations in your service (tick more than one if appropriate)
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Staff doctor
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Visiting doctor
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Nurse
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Aboriginal Health Worker
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Other (please specify) ______________________________________________
Statistical Clearing House Approval number XXXX

Q23. How do you get people to come in for their pneumococcal and influenza needles?
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Patient register/reminder system
Patient request
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GP/Aboriginal Health Worker recommendation during consultation
 Community outreach
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Other. Please specify ___________________________________________________
Q24. Which of these do you think work the best? ___________________________________
Q25. Does your service do adult vaccination through community outreach? Yes / No
If yes, what types of settings do they occur in? (please tick more than one of appropriate)
 Clients’ homes
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Alcohol rehabilitation centres
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Aged care homes
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Pharmacies
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Sporting venues
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Other. Please specify ______________________________________________
Q26. How important are these community outreach programs in your service’s vaccination activities? (Please circle)
Very important / somewhat important / not very important / not at all important
Q27. What are some of the things that you see that make it hard for adults to get immunised?
______________________________________________________________________
______________________________________________________________________
Could you please ask the person who orders the vaccines and/or write up the report for
OATSIH regarding the vaccine usage to fill out this section.
Q28. Did your service order influenza or pneumococcal vaccines under the NIPII program this year? Yes / No
If not, why not?__________________________________________________________
Q29. Did you get pneumococcal or influenza in other ways? Yes / No
If yes, from where? (please tick):

Pharmacy
 Other, please specify___________________________________________________
Q30. Did your organisation always have influenza and pneumococcal vaccines when they were needed this year? Yes / No
If no, could you explain the reasons? ________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Statistical Clearing House Approval number XXXX

Q31. Were there any other problems with vaccine supply not mentioned above? Yes / No
If yes, please explain the problems _________________________________________
______________________________________________________________________
______________________________________________________________________
Q32. Which information systems are used in your service for recording the vaccination of
Indigenous adults (tick as many as apply)?
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Patient medical records (paper)
Patient medical records (computer) Please specify software________________
Patient immunisation register (computer)
Patient immunisation register (paper)
Vaccine inventory
Health Department form
Other. Please specify _____________________________________________
Q33. How easy is it to provide data on vaccinations done by your organisation?(eg. by patient age, risk group): Easy / not difficult / fairly difficult / every difficult
Please give reasons ______________________________________________________
______________________________________________________________________
Q34. What measures would significantly improve your ability to provide data on each vaccine administered in your practice?
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Payment for each report
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Improved computer software
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Web-based reporting
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Feedback / information from local health authorities
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Other. Please specify _________________________________________________
Q35. If the information is available, could you please fill in the spaces below on vaccine use for 2003:
Influenza Pneumococcal
Vaccines received
Lost due to storage or transport problems
Vaccines OK but not used
_______
_______
_______
_______
_______
_______
Used for:
Indigenous, 15-49 years
Indigenous, 50+ years
Non-Indigenous
_______
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_______
_______
_______
Q36. Please provide an estimate of the time taken to complete this form
Include
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The time actually spent reading the instructions, working on the question and obtaining the information
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The time spent by all employees in collecting and providing this information
_____ Minutes
Statistical Clearing House Approval number XXXX

Thank you, you have completed the questionnaire.
Statistical Clearing House Approval number XXXX