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

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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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
1	Strongly Disagree
2	Disagree
3	Neither Agree/Disagree
4	Agree
5	Strongly Agree
-99	Refused
-100	Valid skip

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