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Displaying records 1 - 3 of 3
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  1. Determining Economic Burden Related to COVID-19 and COVID-19-like symptoms: COVID-19 Cost Survey
    Source: University of California, San Francisco (UCSF)
    Date Published: 6/5/2020
    Format: PDF
    Annotation: This is a self-report, administered questionnaire collected via REDCap (Research Electronic Data Capture system) to assess the costs and socioeconomic consequences of having COVID-19 or COVID-19 like symptoms.

    Population: Adults Only
    Length: Approximately 30 questions
    Time to Complete: 20 minutes
    Mode of Administration: Face-to-face
    Telephone
    Administered by: Trained Lay Examiner/Interviewer
    Language(s): English, Spanish, Mandarin, Cantonese

    Determining Economic Burden related to COVID-19 and COVID-19-like symptoms: Full Questionnaire https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COST.pdf
    Costs associated with care-seeking for COVID19 related symptoms and COVID19 diagnosis: Economic Impact; Health Care https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COST_Costs.pdf
    Income Changes: Employment; Economic Insecurity https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COST_Income.pdf    ...[See more] [See less]
    URL: https://www.nlm.nih.gov/dr2/Final_COVID19COSTSURVEY_06052020.pdf
    Type: Guideline/Assessment Tool
    Access Notes: Free/Publicly Available

    Available Formats: PDF

    Contact Information:
    Neeta Thakur, MD MPH and Priya B. Shete, MD MPH
    Division of Pulmonary and Critical Care Medicine
    University of California, San Francisco, and San Francisco General Hospital
    Email: neeta.thakur@ucsf.edu or priya.shete@ucsf.edu
    Includes Research Tools: Yes.
    ID: 23631. From: Disaster Lit®a database of the U.S. National Library of Medicine.
    REDCap: Yes.
  2. Questionnaire for Assessing the Impact of the COVID-19 Pandemic and Accompanying Mitigation Efforts on Older Adults (QAICPOA)
    Source: University of California, San Francisco (UCSF)
    Date Published: 4/2/2020
    Format: Text
    Annotation: This questionnaire was developed by expert opinion. It will be used in two studies: the Study of Muscle Mobility and Aging (SOMMA), a study that is currently enrolling men and women age 70 and older to determine the biologic role of muscle in development of mobility disability, and the Osteoporotic Fractures in Men (MrOS Study), an ongoing multicenter cohort study of healthy aging of older men, with a particular focus on osteoporosis. MrOS men were initially enrolled in 2000-2002 and are all now in their mid-80s or older. In each study, organizers hope to administer the questionnaire two or three times over the coming months, along with select other repeated data from the cohorts (e.g., fall incidence, mobility function, activity level).

    Population: Adults only; High Risk/Special/Unique Populations
    Length: 17 questions
    Administered by: Self Administered/Self Report; Trained Lay Examiner/Interviewer
    Special Considerations: Can be administered via self-report or telephone interview.
    Language(s): English

    MROS/SOMMA COVID-19 Social Impact Questionnaire: Full Questionnaire https://www.phenxtoolkit.org/toolkit_content/PDF/MROS.pdf
    Symptoms and Diagnosis: Symptoms and Diagnosis https://www.phenxtoolkit.org/toolkit_content/PDF/MROS_Diagnosis.pdf
    MROS/SOMMA Social Distancing and Hygiene: Social Distancing and Hygiene https://www.phenxtoolkit.org/toolkit_content/PDF/MROS_SocialDistancing.pdf    ...[See more] [See less]
    URL: https://www.qiacpoa.com/
    Type: Guideline/Assessment Tool
    Access Notes: Citation: Peggy Cawthon, MPH, PHD, Eric Orwoll, MD, Kristine Ensrud, MD, Jane A Cauley, DrPH, Stephen B Kritchevsky, PhD, Steven R Cummings, MD, Anne Newman, MD, Assessing the impact of the covid-19 pandemic and accompanying mitigation efforts on older adults, The Journals of Gerontology: Series A, https://academic.oup.com/biomedgerontology/article/75/9/e123/5822596

    Free/Publicly Available

    Contact Information: Peggy Cawthon at pcawthon@sfcc-cpmc.net
    Includes Research Tools: Yes.
    ID: 21681. From: Disaster Lit®a database of the U.S. National Library of Medicine.
  3. COVID-19 Questionnaire on Impact of and Barriers to Stay at Home, Self-isolation, and Quarantine for Vulnerable Populations
    Source: University of California, San Francisco (UCSF)
    Date Published: 3/25/2020
    Format: PDF
    Annotation: This is a self-report, administered questionnaire collected via REDCap (Research Electronic Data Capture system) to assess experiences with non-pharmaceutical public health interventions to mitigate community transmission of COVID-19 such as stay-at-home/shelter-in-place, self-isolation, and quarantine on high-risk populations (primarily those who are low-income, non-U.S. born, or for whom English is a second language). The questionnaire covers several key domains, including 1) Demographics; 2) Health Literacy; 3) Perceived Stress for the individual and household; 4) Health Risk Belief; 5) Access to healthcare, including telehealth; 6) Barriers to self-isolation; 7) Changes in socioeconomic status; and 8) Unmet social needs. Special attention is paid to determinants rooted in education, income, safety, food security, and housing.

    Population: Adults Only
    Length: Eight sections, approximately 100 questions
    Time to Complete: 45 minutes
    Mode of Administration: Face-to-face
    Telephone
    Administered by: Trained Lay Examiner/Interviewer
    Language(s): English, Spanish, Mandarin, Cantonese

    COVID-19 Questionnaire on Impact of and Barriers to Stay at Home, Self-Isolation, and Quarantine for Vulnerable Populations: Full Questionnaire https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COVID19_Impact_and_Barriers.pdf
    Demographic: Personal Demographics https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COVID19_Questionnaire_Demographics.pdf
    Health Literacy: Health Literacy https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COVID19_Questionnaire_Health_Literacy.pdf
    Perceived Stress Scale (Adult): Stress https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COVID19_Questionnaire_Perceived_Stress_Adult.pdf
    Perceived Stress Scale (Child): Stress https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COVID19_Questionnaire_Perceived_Stress_Child.pdf
    Health Risk Belief: Knowledge; Attitudes https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COVID19_Questionnaire_Perceived_Health_Risk.pdf
    Access To Covid19 Care And Care For Chronic Conditions: Knowledge; Telehealth; Technology Use https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COVID19_Questionnaire_Access.pdf
    Covid19 Impact And Barriers To Self-Isolation: Sources of information about COVID-19; Overall Impact https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COVID19_Questionnaire_Self_Isolation.pdf
    Part II. AHCM Screening Tool https://www.phenxtoolkit.org/toolkit_content/PDF/UCSF_COVID19_Questionnaire_Screening.pdf    ...[See more] [See less]
    URL: https://www.nlm.nih.gov/dr2/Questionnaire_COVID_v9_06012020.pdf
    Type: Guideline/Assessment Tool
    Access Notes: Permission/Request required

    Available Formats: PDF

    Contact Information:
    Neeta Thakur, MD MPH and Priya B. Shete, MD MPH
    Division of Pulmonary and Critical Care Medicine
    University of California, San Francisco, and San Francisco General Hospital
    Email: neeta.thakur@ucsf.edu or priya.shete@ucsf.edu
    Includes Research Tools: Yes.
    ID: 23633. From: Disaster Lit®a database of the U.S. National Library of Medicine.
    REDCap: Yes.
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