MEC Interview and Exam (with Covid mods)

Attachment 2a - MEC INTERVIEW VERSION

CoVID-19 – COQ

Target Group: SPs Birth +

CAPI DISPLAY INSTRUCTIONS FOR ALL QUESTIONS IN COQ MEC SECTION:

• DISPLAY DATE ENCODED IN SIA085 IN “MONTH, DD, YYYY” FORMAT FOR PRE-FILLS SPECIFIED AS “SP INTERVIEW DATE”.

COQ.210 {Have you/Has SP} had COVID-19, or the illness caused by the Coronavirus Disease 2019 since we interviewed you at home on {SP INTERVIEW DATE}?

INTERVIEWER INSTRUCTIONS:

CODE ‘MAYBE’ IF THE SP THINKS S/HE MAY HAVE HAD COVID-19 DUE TO EXPERIENCING CERTAIN SYMPTOMS BUT DID NOT GET TESTED OR IS UNSURE OF THE RESULTS. CODE ‘DON’T KNOW’ IF THE SP DOES NOT KNOW IF S/HE HAS HAD COVID-19.

YES 1

NO 2 (COQ.230)

MAYBE 3

REFUSED 7 (COQ.230)

DON’T KNOW 9 (COQ.230)

COQ.220 How would {you/SP’s} describe {your/his/her} symptoms when they were at their worst? Would you say…

No symptoms 1

Mild symptoms 2

Moderate symptoms 3

Severe symptoms 4

REFUSED 7

DON’T KNOW 9

COQ.230 Now I’m going to ask you about testing for active COVID infections, which is done through a nasal or throat swab or a saliva test. This does not include blood tests for COVID-19.

{Have you/Has SP} ever been tested for coronavirus or COVID-19 since we interviewed you at home on {SP INTERVIEW DATE}?

YES 1

NO 2 (COQ.260)

REFUSED 7 (COQ.260)

DON’T KNOW 9 (COQ.260)

COQ.240 Did the swab or saliva test find that {you/SP} had coronavirus or COVID-19?

INTERVIEWER INSTRUCTION: IF TESTED MULTIPLE TIMES, CODE ANY POSITIVE RESULT RECEIVED AS YES.

YES 1

NO 2 (COQ.260)

DID NOT RECEIVE RESULTS 3 (COQ.260)

REFUSED 7 (COQ.260)

DON’T KNOW 9 (COQ.260

COQ.250m/y What was the date of {your/SP’s} positive COVID-19 test? Please tell me the month and year of {your/his/her} most recent positive test since {SP INTERVIEW DATE}. This does not include the blood test.

INTERVIEWER INSTRUCTION: PROBE FOR ANY MISSING PORTIONS OF DATE.

|___|___|

ENTER MONTH

REFUSED 77

DON'T KNOW 99

|___|___|___|___|

ENTER YEAR

REFUSED 7777

DON'T KNOW 9999

CAPI INSTRUCTIONS:

HARD EDIT VALUE FOR MONTH: 01-12

HARD EDIT: DATE MUST BE BETWEEN CURRENT MONTH AND YEAR AND MONTH AND YEAR OF THE SP INTERVIEW IN SIA085.

COQ.260 Since {SP INTERVIEW DATE}, {Have you/Has SP} ever had an antibody blood test to determine if {you/s/he} had coronavirus or COVID-19 in the past?

INTERVIEWER INSTRUCTION: IF TESTED MULTIPLE TIMES, CODE ANY POSITIVE RESULT RECEIVED AS YES.

YES 1

NO 2 (COQ.280)

REFUSED 7 (COQ.280)

DON’T KNOW 9 (COQ.280)

COQ.270 Did the blood test find that {you/SP} had antibodies for coronavirus or COVID-19?

YES 1

NO 2 (COQ.280)

DID NOT RECEIVE RESULTS 3 (COQ.280)

REFUSED 7 (COQ.280)

DON’T KNOW 9 (COQ.280)

COQ.275m/y What was the date of this blood test? Please tell me the month and year of the most recent date that the blood test found {you/SP} had antibodies for COVID-19 since {SP INTERVIEW DATE}?

INTERVIEWER INSTRUCTION: PROBE FOR ANY MISSING PORTIONS OF DATE.

|___|___|

ENTER MONTH

REFUSED 77

DON'T KNOW 99

|___|___|___|___|

ENTER YEAR

REFUSED 7777

DON'T KNOW 9999

CAPI INSTRUCTIONS:

HARD EDIT VALUE FOR MONTH: 01-12

HARD EDIT: DATE MUST BE BETWEEN CURRENT MONTH AND YEAR AND MONTH AND YEAR OF THE SP INTERVIEW IN SIA085.

COQ.280 {Our records shown that {you/SP} had received vaccine for COVID-19 on….

LIST OF VACCINE BRAND(S) AND VACCINATION DATE(S) REPORTED IN SP INTERVIEW, SORT BY DOSE.}

{Have you/Has SP} ever received {another dose of/a} vaccine for COVID-19 {since {SP INTERVIEW DATE}}?

YES 1

NO 2 (COQ.200)

REFUSED 7 (COQ.200)

DON’T KNOW 9 (COQ.200)

CAPI INSTRUCTIONS:

IF COQ080 = 1 IN THE SP COQ SECTION, DISPLAY THE FOLLOWING:

• “Our records shown that {you/SP} had received vaccine for COVID-19 on….”

• “LIST OF VACCINE BRAND(S) AND VACCINATION DATE(S) REPORTED”

• “another dose of”, AND

• “Since {SP INTERVIEW DATE}”

IF COQ080 ≠ 1 IN THE SP COQ SECTION, DISPLAY “a”

COQ.286 How many doses of COVID-19 vaccine {have you/has he/has she} received since {SP INTERVIEW DATE}? Please include booster shots and any additional doses.

INTERVIEWER INSTRUCTION:

IF THE RESPONDENT WAS HESITATING OR NOT SURE ABOUT THE ANSWER, ENCOURAGE THE RESPONDENT TO GET THE VACCINE CARD OR CHECK THE VACCINATION RECORD TO HELP ANSWERING THE QUESTION.

|___|___|

ENTER THE NUMBER OF DOSES

REFUSED 77

DON'T KNOW 99

BOX 1

LOOP 1:

ASK COQ.287 FOR EACH VACCINE

COQ.287/288 Which COVID-19 vaccine did {you/SP} receive {for your first/second/third/fourth/… dose} since {SP INTERVIEW DATE}? Is it Johnson & Johnson, Moderna, Pfizer-BioNTech, or something else?

INTERVIEWER INSTRUCTION:

IF THE RESPONDENT WAS HESITATING OR NOT SURE ABOUT THE ANSWER, ENCOURAGE THE RESPONDENT TO GET THE VACCINE CARD OR CHECK THE VACCINATION RECORD TO HELP ANSWERING THE QUESTION.

VACCINE	BRAND	DATE
		MONTH	YEAR
Original reported vaccine
1st Dose	Brand reported in COQ.087	M in COQ.095m	Y in COQ.095y
2nd Dose	Brand reported in COQ.087	M in COQ.095m	Y in COQ.095y
3rd Dose	Brand reported in COQ.087	M in COQ.095m	Y in COQ.095y
Newly reported vaccine
1st Dose
2nd Dose
…

JOHNSON & JOHNSON (JANSSEN) 1

MODERNA 2

PFIZER-BIONTECH 3

OTHER (SPECIFIED_________) 4

REFUSED 7

DON’T KNOW 9

CAPI INSTRUCTION:

DISPLAY A VACCINE ROSTER WITH VACCINES ORIGINALLY REPORTED IN SP INTERVIEW AND ADDED ROW(S) PER NUMBER OF VACCINES INDICATED IN COQ.286 (SEE EXAMPLE GRID ABOVE).

IF COQ.286 = (77 OR 99), DISPLAY ONE ADDITIONAL ROW (1^ST DOSE) IN THE GRID.

DISPLAY “for your first/second/third/fourth/… dose” BASED ON THE DOSE NUMBER, IF 1 < COQ.286 AND COQ.286 ≠ (77 OR 99).

ALLOW ENTRY OF VACCINE TYPE USING DROP-DOWN LIST FOR EACH DOSE.

ALLOW INTERVIEWER TO ADD ROW(S) IF ADDITIONAL DOSE(S) REPORTED.

IF CODE 4 (OTHER) IS SELECTED, ACTIVATE A TEXT FIELD (COQ.088) TO ALLOW SPECIFYING OTHER VACCINE BRAND USING A DROP-DOWN LIST WITH TYPING IN “NOT LISTED” OPTION AVAILABLE.

BOX 2

END LOOP 1:

ASK COQ.287 FOR THE NEXT VACCINE.

IF INFORMATION COLLECTED FOR ALL VACCINES, GO TO BOX 3

BOX 3

LOOP 2:

ASK COQ.295M/Y FOR EACH VACCINE.

COQ.295m/y In what month and year did {you/he/she} receive the {first/second/third/fourth/… dose of} vaccine } since {SP INTERVIEW DATE} for COVID-19?

INTERVIEWER INSTRUCTION:

IF THE RESPONDENT WAS HESITATING OR NOT SURE ABOUT THE ANSWER, ENCOURAGE THE RESPONDENT TO GET THE VACCINE CARD OR CHECK THE VACCINATION RECORD TO HELP ANSWERING THE QUESTION.

PROBE FOR ANY MISSING PORTIONS OF DATE.

REVIEW THE ENTRIES WITH THE RESPONDENT ONCE THE ENTIRE GRID IS COMPLETED.

VACCINE	BRAND	DATE
		MONTH	YEAR
Original reported vaccine
1st Dose	Brand reported in COQ.087	M in COQ.095m	Y in COQ.095y
2nd Dose	Brand reported in COQ.087	M in COQ.095m	Y in COQ.095y
3rd Dose	Brand reported in COQ.087	M in COQ.095m	Y in COQ.095y
Newly reported vaccine
1st Dose	Brand reported in COQ.287
2nd Dose	Brand reported in COQ.287
…

|___|___|

ENTER MONTH

REFUSED 77

DON'T KNOW 99

|___|___|___|___|

ENTER YEAR

REFUSED 7777

DON'T KNOW 9999

CAPI INSTRUCTIONS:

DISPLAY VACCINE GRID INCLUDING BRAND(S) REPORTED IN COQ.287.

HARD EDIT VALUE FOR MONTH: 01-12

HARD EDIT: DATE MUST BE BETWEEN CURRENT MONTH AND YEAR AND MONTH AND YEAR OF THE SP INTERVIEW IN SIA085.

DISPLAY “first/second/third/fourth/… dose of” IF MORE THAN 1 ROW ENTERED IN COQ.287.

BOX 4

END LOOP 1:

ASK COQ.295M/Y FOR THE NEXT VACCINE.

IF INFORMATION COLLECTED FOR ALL VACCINES, CONTINUE TO COQ.200.

COQ.200 {Have you/Has SP} ever had an overnight stay in a hospital for suspected or confirmed COVID-19 since {SP INTERVIEW DATE}?

YES 1

NO 2

REFUSED 7

DON’T KNOW 9

COQ.210 Has anyone else in {your/SP’s} household ever tested positive for coronavirus or COVID-19 since {SP INTERVIEW DATE}??

YES 1

NO 2

REFUSED 7

DON’T KNOW 9

HELP SCREEN:

Household: The entire group of persons who live in one dwelling unit. It may be several persons living together or one person living alone. It includes the household reference person and any of their relatives, as well as roomers, employees, and other non-related persons.

COQ.220 {Do you/Does SP} currently have a health condition that a doctor or other health professional told {you/him/her} weakens the immune system, making it easier for {you/him/her} to get sick?

YES 1

NO 2

REFUSED 7

DON’T KNOW 9

HELP SCREEN:

Doctor: The term refers to both doctors of medicine (M.D.s) and doctors of osteopathic medicine (D.O.s). It includes general practitioners as well as specialists. It does not include persons who do not have an M.D. or D.O. degree, but other doctoral degrees such as dentists, oral surgeons, chiropractors, podiatrists, Christian Science healers, opticians, optometrists, psychologists, etc.

Health Care Professionals (Health Professional): A person entitled by training and experience and possibly licensure to assist a doctor and who works with one or more medical doctors. Examples include: doctor’s assistants, nurse practitioners, nurses, pharmacists, lab technicians, and technicians who administer shots (e.g., allergy shots). Also include paramedics, medics and physical therapists working with or in a doctor’s office. Do not include: dentists, oral surgeons, chiropractors, chiropodists, podiatrists, naturopaths, Christian Science healers, opticians, optometrists, and psychologists or social workers.

COQ.230 Since {SP INTERVIEW DATE}, {have you/has SP} taken prescription medication or had any medical treatments that a doctor or other health professional told {you/him/her} would weaken {your/his/her} immune system?

YES 1

NO 2

REFUSED 7

DON’T KNOW 9

HELP SCREEN:

Doctor: The term refers to both doctors of medicine (M.D.s) and doctors of osteopathic medicine (D.O.s). It includes general practitioners as well as specialists. It does not include persons who do not have an M.D. or D.O. degree, but other doctoral degrees such as dentists, oral surgeons, chiropractors, podiatrists, Christian Science healers, opticians, optometrists, psychologists, etc.

Health Care Professionals (Health Professional): A person entitled by training and experience and possibly licensure to assist a doctor and who works with one or more medical doctors. Examples include: doctor’s assistants, nurse practitioners, nurses, pharmacists, lab technicians, and technicians who administer shots (e.g., allergy shots). Also include paramedics, medics and physical therapists working with or in a doctor’s office. Do not include: dentists, oral surgeons, chiropractors, chiropodists, podiatrists, naturopaths, Christian Science healers, opticians, optometrists, and psychologists or social workers.

COQ.240 There are two types of flu vaccinations. One is a shot and the other is a spray, mist, or drop in the nose. Since {SP INTERVIEW DATE}, {have you/has SP} had a flu vaccination?

YES 1

NO 2

REFUSED 7

DON’T KNOW 9