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  1. 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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