Form Attachment D Attachment D Attachment D: COVID-19 Monthly Outcome Survey – Question

ASPA COVID-19 Public Education Campaign Evaluation Surveys

Part A_Attachment D_COVID-19 Monthly Outcome Survey_Questionnaire

Monthly Outcome Survey (MOS)

OMB: 0990-0475

Document [docx]
Download: docx | pdf

Attachment D: COVID-19 Monthly Outcome Survey – Questionnaire


U.S. Department of Health and Human Services (HHS) COVID-19 Public Education Campaign


We would like to ask you about some COVID-19 content that may or may not have appeared in the media in the past month. This section will also ask you about your opinions on COVID-19 testing and vaccination.


// Page Break //


Item #: Q1

Question type: Single punch

// Soft Prompt: “We would like your response to this question.” //

CAM1_Aw: In the past month, that is since October 13, 2020, how frequently have you seen or heard any media content from the U.S. Department of Health and Human Services (HHS) COVID-19 Public Education Campaign? Campaign content would have included the statement [TAGLINE] and the images below.



[Campaign image collage]



Variable Label: Q1: Campaign awareness

Value

Value Label

1

Never

2

Rarely

3

Sometimes

4

Often

5

Very often

-99

Refused


// Page Break //



Item #: Q2

Question Type: Single punch

// Ask if Q1 = 2|3|4|5 //

CAM2_Bel. How believable do you find the information from the HHS COVID-19 Public Education Campaign?

Variable Label: Q2: Believability of campaign

Value

Value Label

1

Very unbelievable

2

Unbelievable

3

Neither believable nor unbelievable

4

Believable

5

Very believable

-99

Refused

-100

Valid skip


// Page Break //


Item #: Q3

Question type: Single punch

// Ask if Q1 = 2|3|4|5 //

CAM3_Rel: Do you agree or disagree with the following statement? The HHS COVID-19 Public Education Campaign media content is for everyone, including me.

Variable Label: Q3: Relevance of campaign

Value

Value Label

1

Strongly disagree

2

Disagree

3

Neither agree nor disagree

4

Agree

5

Strongly agree

-99

Refused

-100

Valid skip


// Page Break //


Item #: Q4

Question Type: Single punch

// Ask if Q1 = 2|3|4|5 //

CAM4_Atn: Do you agree or disagree with following statement? The HHS COVID-19 Public Education Campaign media content grabbed my attention.

Variable Label: Q4: Attention grabbing of campaign

Value

Value Label

1

Strongly disagree

2

Disagree

3

Neither agree nor disagree

4

Agree

5

Strongly agree

-99

Refused

-100

Valid skip



// Page Break //


Item #: Q5

Question type: Single punch

CAM5_Test: If you were given the opportunity to take a free COVID-19 test within the next 3 days, would you take the test?

Variable Label: Q5: Would take test

Value

Value Label

0

No, I would not take the test.

1

Yes, I would take the test.

-99

Refused


// Page Break //


Item #: Q6

Question type: Single punch

CAM6_VaccWait: A Food and Drug Administration (FDA)-authorized vaccine to prevent COVID-19 is now available at no cost. How soon will you get vaccinated? For this question, assume there is enough vaccine so that everyone who wants it can get it.

Variable Label: Q6: Wait to get vaccinated

Value

Value Label

1

I would get a vaccine as soon as I could

2

I would wait to get a vaccine for one or more reasons

60

I would never get a vaccine

-99

Refused


// Page Break //


Item #: Q7

Question Type: Grid

// Soft Prompt: “We would like your response to this question.” //

CAM7_VaccBel: How much do you agree or disagree with the following statements about COVID-19? Select one response for each item.

Variable Label: Q7: Vaccine Beliefs

Variable Name

Variable Text

Variable Label

CAM7_VaccBel_1

I would accept a COVID-19 vaccine offered during a regularly scheduled appointment with my healthcare provider.

CAM7_VaccBel_1: COVID vaccine likelihood

CAM7_VaccBel_2

I am worried that a COVID-19 vaccine could give me COVID-19.

CAM7_VaccBel_2: Worried COVID from vaccine

CAM7_VaccBel_3

I would rather build immunity by exposure to an infected individual than receive a COVID-19 vaccine.

CAM7_VaccBel_3: Immunity from exposure

CAM7_VaccBel_4

I would get a COVID-19 vaccine if it would help life return to normal more quickly.

CAM7_VaccBel_4; Life return normal

CAM7_VaccBel_5

I am worried about side effects of a COVID-19 vaccine for myself.

CAM7_VaccBel_5: Worried side effects

CAM7_VaccBel_6

I am worried that side effects of a COVID-19 vaccine could be worse than COVID-19 itself.

CAM7_VaccBel_6: Worse side effects



Value

Value Label

1

Strongly disagree

2

Disagree

3

Neither agree nor disagree

4

Agree

5

Strongly agree

-99

Refused


// Page Break //


Item #: Q8

Question Type: Single-Punch

// Soft Prompt: “We would like your response to this question.” //

CAM8_SiteAw: Before today, have you heard of the website cdc.gov/coronavirus?

Variable Label: Q8: HHS site awareness

Value

Value Label

0

No

1

Yes

-99

Refused


// Page Break //


Item #: Q9

Question Type: Single-Punch

CAM9_SiteVis: Before today, have you visited the website cdc.gov/coronavirus?

Variable Label: Q9: HHS site visit

// Ask if Q8 (HHS site heard) = “Yes” //

Value

Value Label

0

No

1

Yes

-99

Refused

-100

Valid skip


// Page Break //


Item #: Q10

Question Type: Grid

CAM10_SiteRec: How much do you agree or disagree with the following statements about the website cdc.gov/coronavirus? Select one response for each item.

Variable Label: CAM10_SiteRec: HHS website receptivity

// Ask if Q9 (HHS site visit) = “Yes” //

Variable Name

Variable Text

Variable Label

CAM10_SiteRec_1

The information on the website is believable.

CAM10_SiteRec_1: Believable HHS website

CAM10_SiteRec_2

The information on the website is helpful.

CAM10_SiteRec_2: Helpful HHS website

CAM10_SiteRec_3

The website allows me to take action to protect myself from COVID-19.

CAM10_SiteRec_3: Actionable HHS website

CAM10_SiteRec_4

The website grabbed my attention.

CAM10_SiteRec_4: Attention-grabbing HHS website

CAM10_SiteRec_5

I like the website.

CAM10_SiteRec_5: Likeable HHS website


Value 

Value Label 

Strongly Disagree

Disagree

Neither Agree/Disagree

Agree

Strongly Agree

-99 

Refused 

-100

Valid skip


// Page Break //

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorColin Macfarlane
File Modified0000-00-00
File Created2021-01-11

© 2024 OMB.report | Privacy Policy