Supplemental document 2: Self-administered questionnaire for primary caretakers

1. First, we would like you to answer some questions about yourself (i.e. the person compiling the questionnaire) and about your child that is being treated in our department
Your gender □ male / □female
Your age ______
Your school education
(highest degree) ______
Your child’s age ______
Why is your child being treated for in our department? / □Solid
Tumor / □ Leukemia / □ Lymphoma / □ other
Has your child received bone marrow transplantation? / □ yes / □ no
Current treatment phase of your child / □ Intensive therapy / □ Maintenance therapy
□ Therapy completed / □ Follow-up care

2. Now we have a few questions regarding Influenza. Please choose the answer that is most

likely correct (only one answer per question)

1. Influenza is caused by / □ Bacteria / □ Viruses / □ Fungi
2. Usually Influenza is transmitted / □ via the air or indirect contact
(coughing/sneezing; door handles etc.)
□ by smear- or direct contact infection
( direct contact with sick person)
□ by blood
3. Most people who die due to Influenza are / □ children below the age of 10 years
□ people older than 65 years and people with underlying
diseases
□ otherwise healthy men between 30 and 40 years
4. What is the rate of protection from Influenza
associated with the vaccine? / □ 100% / □ 70-90% / □ <50%
3. In the following questions we would like to ask if you or a household member and your
sick child have ever had Influenza in the past
Myself or a household member have had Influenza in the past / □ yes / □ no / □ don’t know
My sick child has had Influenza in the past / □ yes / □ no / □ don’t know
4. The following questions refer to the vaccination against Influenza
I have received vaccination against Influenza / □ yes / □ no
If your answer is “yes”, how often have you received vaccination? / □ 1x / □ 2x / □ 3x / □ more often than 3x
My sick child has received vaccination against Influenza / □ yes / □ no
If your answer is “yes”, how often has your child received vaccination? / □ 1x / □ 2x / □ 3x / □ more often than 3x
correct / not correct
I have received vaccination against Influenza in the fall of 2009 / □ / □
I had my sick child vaccinated against Influenza in the fall of 2009 / □ / □
I had my sick child’s siblings vaccinated againstInfluenza in the fall of 2009
(no siblings: please omit) / □ / □
My husband/partner has received vaccination against Influenza in the fall of 2009
(no partner: please omit) / □ / □
5.Now we have a few questions about your personal reasons for receiving or not receiving
vaccination and about the reasons for having or not having vaccinated your sick child
against Influenza; please provide answers according to what applies to you
I have received vaccination in the fall of 2009 because … / correct / not correct
I don’t want to become sick with influenza / □ / □
I don’t want to infect anyone else with Influenza / □ / □
I work in the healthcare setting / □ / □
I have contact to people for whom influenza can be dangerous / □ / □
Influenza can be dangerous for me / □ / □
The vaccination can’t do any harm / □ / □
Vaccination was for free / □ / □
Vaccination was recommended in media and TV / □ / □
Vaccination was recommended to me by my general practitioner / □ / □
Vaccination was recommended by the doctors of my sick child in Münster / □ / □
I have not received vaccination in the fall of 2009 because … / correct / not correct
Influenza is not dangerous to me / □ / □
I will likely not become sick with influenza / □ / □
I generally disapprove of vaccinations / □ / □
I don’t want to weaken my immune system / □ / □
Influenza vaccination has many adverse effects / □ / □
I am afraid of needles and injections / □ / □
Influenza vaccination can cause Influenza / □ / □
The vaccine provides insufficient protection / □ / □
I protect myself by other measures (e.g. healthy food, sports, homeopathy) / □ / □
Influenza vaccination has not been tested sufficiently in clinical studies / □ / □
I have not been informed sufficiently about the vaccination / □ / □
Influenza Vaccination was not recommended to me / □ / □
The recommendations regarding influenza vaccination were contradictory / □ / □
I was too busy and didn’t make it in time / □ / □
I have had my sick child vaccinated in the fall of 2009 because… / correct / not correct
My child should not become sick with Influenza / □ / □
Influenza can be dangerous for my child / □ / □
My child should not infect other patients with Influenza / □ / □
It can’t do any harm to my child / □ / □
It was recommended to me by my pediatrician/general practitioner / □ / □
It was recommended by doctors of my sick child in Münster / □ / □
Vaccination was recommended in media and TV / □ / □
Vaccination was for free / □ / □
I have not had my sick child vaccinated in the fall of 2009 because… / correct / not correct
Influenza is not dangerous to my child / □ / □
My child probably won’t become sick with influenza / □ / □
I generally disapprove of vaccinations / □ / □
I don’t want to weaken the child’s immune system / □ / □
Influenza vaccination has many adverse effects / □ / □
My child is afraid of needles and injections / □ / □
Influenza vaccination can cause Influenza / □ / □
The vaccine provides insufficient protection / □ / □
My child protects itself by other measures (e.g. healthy food, sports, homeopathy) / □ / □
Influenza vaccination has not been tested sufficiently in clinical studies / □ / □
No one recommended vaccination for my child / □ / □
The recommendations regarding influenza vaccination were contradictory / □ / □
I was too busy didn’t make it in time / □ / □
My child was too sick for vaccination and the doctors in Münster advised against it / □ / □

6. Finally, we would like to ask some questions about Influenza vaccination in the

upcoming Influenza season.

correct / not correct
My general practitioner or my sick child’s pediatrician has informed me about Influenza vaccination and recommended it to me and all household members / □ / □
My sick child’s doctors at Münster have informed me about Influenza vaccination and recommended it to me and all household members / □ / □
My sick child’s pediatrician has informed me about Influenza vaccination for my child and recommended it to me for my child. / □ / □
My sick child’s doctors at Münster l have informed me about Influenza vaccination for my child and recommended it to me for my child. / □ / □
I will receive/have received vaccination against Influenza
this fall / □ yes / □ no / □ don’t know
I already have had my sick child vaccinated against/will
have it vaccinated against Influenza this fall / □ yes / □ no / □ don’t know
I have had my sick child’s siblings/ will have them vaccinated against Influenza this fall (no siblings: please omit) / □ yes / □ no / □ don’t know
My husband/partner received/ will receive vaccination against Influenza this fall (no partner: please omit) / □ yes / □ no / □ don’t know

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