APPENDIX 3
Questionnaire for GP Divisional Immunisation Coordinators
National Centre for Immunisation Research and
Surveillance of Vaccine Preventable Diseases (NCIRS)
University of Sydney
Royal Alexandra Hospital for Children
(NCIRS is a collaborating unit of the Australian Institute of Health and Welfare)
To Immunisation Coordinators in Divisions of General Practice
The National Centre for Immunisation Research and Surveillance of Vaccine
Preventable Diseases (NCIRS) is presently conducting an evaluation of the
National Indigenous Pneumococcal and Influenza Immunisation Program
(NIPII) on behalf of the Office for Aboriginal and Torres Strait Islander Health,
Australian Government Department of Health and Ageing. (OATSIH). Included
in the evaluation will be the GP contribution to the NIPII program.
Your Division has been identified as having a relatively large proportion of the
population as Aboriginal or Torres Strait Islander (more than 4.5%) and
therefore selected for inclusion in our survey.
We are very interested in the present level of awareness and utilisation of the
NIPII program in your Division and at the GP practice level. We would also
like to hear about successful initiatives or activities involving adult Aboriginal
and Torres Strait Islander pneumococcal and influenza vaccination which may
have potential for wider use.
Could you please answer the following questions and return your responses
as an attachment to me by email at TomN@chw.edu.au or by fax to (02) 9845
3082 or by post to “NCIRS The Children’s Hospital Westmead Locked Bag
4001 “.
If you have any queries regarding the survey please contact me as per my
contact details below.
In appreciation of your time we will send you a $20 gift voucher on receipt of
your survey.
Statistical Clearing House Approval Number XXXX
1
Dr Tom Norris
National Centre for Immunisation Research and Surveillance
The Children’s Hospital, Westmead
Ph: (02)9845 1319 Fax: (02)9845 3082
Mobile: 0403 846421
Email: TomN@chw.edu.au
DRAFT ONLY
PLEASE NOTE
THIS SURVEY IS DESIGNED TO BE COMPLETED IN MS WORD AND
RETURNED BY EMAIL. However it can also be printed out or completed by
hand and returned by fax if desired. Please see further instructions at end of
survey.
Please use the Tab key to move between questions. To change a
response click on it again.
1. (a) Please rate your level of awareness of the recommendations on free
influenza and pneumococcal vaccine for Aboriginal and Torres Strait
Islander adults.
Please select one answer by clicking in the appropriate box.
a) Very aware
b) Somewhat aware
c) Not aware
Comments:
(b) Now please rate your level of awareness of how to obtain free influenza
and pneumococcal vaccine for Aboriginal and Torres Strait Islander adults.
Please select one answer by clicking in the appropriate box.
d) Very aware
e) Somewhat aware
f) Not aware
Comments:
Statistical Clearing House Approval Number XXXX
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2. (a) Please estimate the percentage of GPs in your Division who are aware
of the recommendations about free influenza and pneumococcal vaccine
for Aboriginal and Torres Strait Islander adults.
Please select one answer by clicking in the appropriate box.
a)
b)
c)
d)
>80%
50-80%
10-50%
<10%
Comments:
(b) Now please estimate the percentage of GPs in your Division who are
aware of how to obtain free influenza and pneumococcal vaccine for
Aboriginal and Torres Strait Islander adults.
Please select one answer by clicking in the appropriate box.
e)
f)
g)
h)
>80%
50-80%
10-50%
<10%
Comments:
3. Do you see yourself or your Division as having a role in the immunisation
of Aboriginal and Torres Strait Islander adults for influenza and
pneumococcal vaccine?
Please select one answer only by clicking in the appropriate box.
Statistical Clearing House Approval Number XXXX
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a) Yes
b) No
If so, how would you briefly describe that role?
4. How active is your Division in the immunisation of Aboriginal and Torres
Strait Islander adults for influenza and pneumococcal vaccine?
Please select one answer only by clicking in the appropriate box.
a) Very active
b) Somewhat active
c) Not active
Comments:
5. How involved are the GPs in your Division in the immunisation of
Aboriginal and Torres Strait Islander adults for influenza and
pneumococcal vaccine?
Please select one answer only by clicking in the appropriate box.
a) Very involved
b) Somewhat involved
c) Not involved
Comments:
6. What is/are the main settings in your Division where GP involvement in the
influenza and pneumococcal immunisation of Aboriginal and Torres Strait
Islander adults occurs?
Please select one answer from each row by clicking in the appropriate box.
Statistical Clearing House Approval Number XXXX
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Practice Setting
Private Practice
Government
Controlled
ATSI Controlled
Other
>80%
50-80%
10-50%
<10%
If other please specify:
7. Do you remember receiving any posters or information sheets for influenza
and pneumococcal immunisation of Aboriginal and Torres Strait Islander
adults this year?
Please select one answer only by clicking in the appropriate box.
a) Yes
b) No
If yes, did you find this material useful?
Please select one answer only by clicking in the appropriate box.
a) Very Useful
b) Somewhat Useful
c) Not Useful
How did make use of this material?
8. Do you remember any other promotional activities for influenza and
pneumococcal immunisation of Aboriginal and Torres Strait Islander adults
that were conducted this year?
Please select one answer only by clicking in the appropriate box.
a) Yes
b) No
If yes, please describe the activities.
Statistical Clearing House Approval Number XXXX
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Overall how would you rate the effectiveness in your Division of the
promotional activities in promoting awareness or vaccine uptake for influenza
and pneumococcal immunisation of Aboriginal and Torres Strait Islander
adults?
Please select one answer only by clicking in the appropriate box.
a) Very effective
b) Somewhat effective
c) Not effective
Comments;
9. Does your Division actively promote influenza and pneumococcal
immunisation of Aboriginal and Torres Strait Islander adults to GPs?
Please select one answer only by clicking in the appropriate box.
a) Yes
b) No
If yes, please describe how?
10. Does your Division conduct any other programs that enhance the uptake
of for influenza and pneumococcal immunisations of Aboriginal and Torres
Strait Islander adults?
Statistical Clearing House Approval Number XXXX
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Please select one answer only by clicking in the appropriate box.
a) Yes
b) No
If yes please specify.
11. Please describe any successful initiatives or examples of collaboration
with other providers or sectors in your Division, related to the influenza and
pneumococcal immunisation of Aboriginal and Torres Strait Islander
adults.
12. Does your Division collect data from GPs in your Division that would allow
us to estimate the current status of Aboriginal and Torres Strait Islander
adults or the numbers of Aboriginal and Torres Strait Islander adults being
immunised for influenza and pneumococcal vaccine in your Division?
Please select one answer only by clicking in the appropriate box.
a) Yes
b) No
If yes please specify.
13. Does your Division keep data that that would allow us to obtain an
estimate of the level of chronic diseases among Aboriginal and Torres
Strait Islander adults in your Division? (For example a chronic diseases or
diabetes register or other sources of information on the level of HIV
Statistical Clearing House Approval Number XXXX
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infection, chronic cardiac or pulmonary disease, diabetes or cancer and
high alcohol consumption among Aboriginal and Torres Strait Islander
adults.)
a) Yes
b) No
If yes please specify.
14. Has the supply of free influenza and pneumococcal vaccine been
adequate in your Division?
Please select one answer only by clicking in the appropriate box.
a) Yes
b) No
Please add any comments you have on the supply of free influenza and
pneumococcal vaccine.
15. Do you believe there are any obstacles to influenza and pneumococcal
immunisation of Aboriginal and Torres Strait Islander adults in the GP
setting or at Divisional level not already mentioned?
Please select one answer only by clicking in the appropriate box.
a) Yes
b) No
If yes, please describe them.
Statistical Clearing House Approval Number XXXX
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16. Do you personally administer pneumococcal and influenza immunisations
to Aboriginal and Torres Strait Islander adults in your Division?
Please select one answer only by clicking in the appropriate box.
a) Yes
b) No
If yes, please specify
17. Does your Division have in place any quality assurance programs that
include the immunisation of Aboriginal and Torres Strait Islander adults?
Please select one answer only by clicking in the appropriate box.
a) Yes
b) No
If yes please describe.
16. Please estimate the overall contribution of the GPs in private practice in
your Division to the influenza and pneumococcal immunisation of Aboriginal
and Torres Strait Islander adults in your Division?
Statistical Clearing House Approval Number XXXX
9
Please select one answer by clicking in the appropriate box.
i)
j)
k)
l)
>80%
50-80%
10-50%
<10%
Comments:
17. Do you have any other comments or suggestions regarding the
immunisation of Aboriginal and Torres Strait Islander adults in your Division?
Please provide a postal address to where we can send your gift voucher.
Finally please provide an estimate of the time taken to complete this form
Include:
 The time actually spent reading the instructions, working on the question
and obtaining the information
 The time spent by all employees in collecting and providing this information
Thank you for taking the time to complete this survey.
Hours
Minutes
Please save this document to a folder on your computer and return saved
copy with your responses to me by email at TomN@chw.edu.au or by fax to
(02) 9845 3082.
Dr Tom Norris
Statistical Clearing House Approval Number XXXX
10
Statistical Clearing House Approval Number XXXX
11