ASPA
COVID-19 PUBLIC EDUCATION CAMPAIGN A
campaign to increase vaccine acceptance and reinforce basic
prevention measures
CET – Annotated Questionnaire
Note: The questions below are the proposed questions for the third wave of the Weekly Current Events Tracker (CET). Questions highlighted in yellow will be asked every week; questions highlighted in blue will be rotated into the survey on a monthly basis; and questions highlighted in green are meant to be asked in Wave 3 only. This week we have added questions that examine sources of information about getting the vaccines, additional concerns about getting the vaccines, and the change in Valentine’s Day plans due to the pandemic.ASPA will provide OMB with updates to the questionnaire for subsequent Waves. |
Standard Questions
Modular Questions
One-Time Questions
For the next section we would like to talk about current events.
// Page Break //
Item #: Q1
Question type: Single punch
// Soft Prompt: “We would like your response to this question.” //
hhs_fam: How familiar are you with the U.S. Department of Health and Human Services (HHS)?
Variable Label: hhs_fam: Familiarity with HHS
Value |
Value Label |
1 |
Not at all familiar |
2 |
Slightly familiar |
3 |
Moderately familiar |
4 |
Very familiar |
-99 |
Refused |
//PROGRAMMING NOTE: IF Q1 = 1, SKIP TO Q3//
// Page Break //
Item #: Q2
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
hhs_trust. How much trust do you have in the U.S. Department of Health and Human Services (HHS) to provide you with accurate information about the coronavirus or COVID-19?
Variable Label: hhs_trust: Trust in HHS
Value |
Value Label |
1 |
None at all |
2 |
Not very much |
3 |
A fair amount |
4 |
A great deal |
-99 |
Refused |
-100 |
Valid skip |
// Page Break //
Item #: Q3
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
BEH1_CET. A Food and Drug Administration (FDA)-authorized vaccine to prevent COVID-19 is now available at no cost. Have you received a COVID-19 vaccine?
Variable Label: BEH1: Vaccination behavior
Value |
Value Label |
0 |
No, I have not received a COVID-19 vaccine |
1 |
Yes, but I have only received one shot out of the two required shots |
2 |
Yes, I have received all of the required shots |
-99 |
Refused |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q3=0 OR -99//
Item #: Q4
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
BEH2a_CET. What is the likelihood that you will get a COVID-19 vaccine?
Variable Label: BEH2a: Intention to get vaccinated
Value |
Value Label |
1 |
Very unlikely |
2 |
Somewhat unlikely |
3 |
Neither likely nor unlikely |
4 |
Somewhat likely |
5 |
Very likely |
-99 |
Refused |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q3=1//
Item #: Q5
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
BEH2b_CET. What is the likelihood that you will complete COVID-19 vaccination?
Variable Label: BEH2b_CET: Intention to complete vaccination
Value |
Value Label |
1 |
Very unlikely |
2 |
Somewhat unlikely |
3 |
Neither likely nor unlikely |
4 |
Somewhat likely |
5 |
Very likely |
-99 |
Refused |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q3=0 OR -99//
Item #: Q6
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
BEH3a_CET. 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: BEH3a_CET: Wait to get vaccinated
Value |
Value Label |
1 |
I will get a vaccine as soon as I can |
2 |
I will wait to get a vaccine for one or more reasons |
3 |
I will never get a COVID-19 vaccine |
-99 |
Refused |
-100 |
Valid Skip |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q3=1//
Item #: Q7
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
BEH3b_CET. A Food and Drug Administration (FDA)-authorized vaccine to prevent COVID-19 is now available at no cost. How soon will you get the second required dose? For this question, assume there is enough vaccine so that everyone who wants it can get it.
Variable Label: BEH3b_CET: Wait to complete vaccination
Value |
Value Label |
1 |
I will get the second required dose as soon as I can |
2 |
I will wait to get the second required dose for one or more reasons |
3 |
I will never get the second required COVID-19 dose |
-99 |
Refused |
-100 |
Valid Skip |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q6=2//
Item #: Q8-Q10
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
BEH4_CET. You responded that you will wait to get a COVID-19 vaccine. For each of the following statements, is this a reason why you would wait to get a COVID-19 vaccine? Select yes or no for each item.
Variable Label: BEH4_CET: Reasons: Waiting to get vaccinated
//PROGRAMMING NOTE: RANDOMIZE BEH3_1_CET-BEH3_10_CET
Variable Name |
Variable Text |
Variable Label |
BEH4_1_CET |
I will wait because of my age. |
BEH4_1_CET: Age |
BEH4_2_CET |
I will wait because of my health status, allergies, or medical history. |
BEH4_2_CET: Health |
BEH4_3_CET |
I want to know if the vaccine is effective first. |
BEH4_3_CET: Confirm effectiveness |
BEH4_4_CET |
I am pregnant or expect to become pregnant. |
BEH4_4_CET: Pregnant |
BEH4_5_CET |
I want to talk to my doctor first. |
BEH4_5_CET: Talk to doctor first |
BEH4_6_CET |
I want to compare the effectiveness of the different vaccines. |
BEH4_6_CET: Compare vaccines |
BEH4_7_CET |
I want to see if my friends and family get the vaccine. |
BEH4_7_CET: Friends/family |
BEH4_8_CET |
I want to see if others who get the vaccine first develop any problems. |
BEH4_8_CET: Side effects |
BEH4_9_CET |
I want to make sure it is safe for people like me first. |
BEH4_9_CET: Confirm safety |
BEH4_10_CET |
I want to hear from leaders in my community about the vaccine first. |
BEH4_10_CET: Hear from leaders |
BEH4_11_CET |
Other |
BEH4_11_CET: Other |
Value |
Value Label |
0 |
No |
1 |
Yes |
-99 |
Refused |
-100 |
Valid skip |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q6=1//
Item #: Q11
Question Type: Grid
// Soft Prompt: “We would like your response to this question.” //
elgibility. How much do you agree or disagree with the following statements?
//PROGRAMMING NOTE: RANDOMIZE eligibility_1 – eligibility_5//
eligibility _1 |
I know where to look to find out when I am eligible to receive the COVID-19 vaccines. |
eligibility _1: Eligibility |
eligibility _2 |
I know what COVID-19 vaccination priority group/phase (e.g., 1b, 1c) I am in. |
eligibility _2: Priority group |
eligibility _3 |
I know how to schedule an appointment when it is time for me to get the COVID-19 vaccine. |
eligibility _3: How to schedule |
eligibility _4 |
I know where to schedule an appointment when it is time for me to get the COVID-19 vaccine. |
eligibility _4: Where to schedule |
eligibility _5 |
I know how to prepare for my eventual COVID-19 vaccine appointments (e.g., what to bring). |
eligibility _5: How to prepare |
Value |
Value Label |
1 |
Strongly disagree |
2 |
Disagree |
3 |
Neither agree nor disagree |
4 |
Agree |
5 |
Strongly agree |
-99 |
Refused |
-100 |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q6=1//
Item #: Q12-Q14
Question Type: Grid
// Soft Prompt: “We would like your response to this question.” //
eligible_sources. Which of the following sources have you used to find out about COVID-19 vaccine eligibility and distribution? Select all that apply.
//PROGRAMMING NOTE: RANDOMIZE eligible_sources_1-eligible_sources_10//
eligible_sources_1 |
Your state health department |
eligible_sources_1: State |
eligible_sources_2 |
Your county/city health department |
eligible_sources _2: County/city |
eligible_sources_3 |
National public health departments (e.g., CDC, HHS) |
eligible_sources _3: National public health departments |
eligible_sources_4 |
Local or national chain pharmacies |
eligible_sources _4: Pharmacies |
eligible_sources_5 |
Health care provider |
eligible_sources _5: Health care provider |
eligible_sources_6 |
Advertising campaigns |
eligible_sources _6: Ad campaigns |
eligible_sources_7 |
Family members |
eligible_sources _7: Family |
eligible_sources_8 |
Friends |
eligible_sources _8: Friends |
eligible_sources_9 |
Coworkers |
eligible_sources _9: Coworkers |
eligible_sources_10 |
Your employer |
eligible_sources _10: Employer |
eligible_sources_11 |
Other |
eligible_sources _11: Other |
eligible_sources_12 |
None of the above, I have not looked for information on vaccine eligibility or distribution |
eligible_sources _12: None |
Value |
Value Label |
0 |
No |
1 |
Yes |
-99 |
Refused |
-100 |
Valid skip |
// Page Break //
//PROGRAMMING NOTE: SHOW IF AT LEAST ONE FROM eligible_sources_1-eligible_sources_10= 1. PIPE “YES” RESPONSES ////
Item #: Q15
Question Type: Multi-Punch Grid
// Soft Prompt: “We would like your response to this question.” //
eligible_sources. From which of the following sources did you see or hear about vaccine eligibility and distribution? Select all that apply.
//PROGRAMMING NOTE: MATCH ORDER OF eligible_sources_1-eligible_sources_5. //
source_1 |
Your state health department |
eligible_sources_1: State |
source_2 |
Your county/city health department |
eligible_sources _2: County/city |
source_3 |
National public health departments (e.g., CDC, HHS) |
eligible_sources _3: National public health departments |
source_4 |
Local or national chain pharmacies |
eligible_sources _4: Pharmacies |
source_5 |
Advertising campaigns |
eligible_sources _5: Ad campaigns |
Value |
Value Label |
1 |
Website |
2 |
Newspaper (online or print) |
3 |
Social media |
4 |
Television |
5 |
Radio |
6 |
Other |
Value |
Value Label |
0 |
No |
1 |
Yes |
-99 |
Refused |
-100 |
Valid skip |
// Page Break //
//PROGRAMMING NOTE: SHOW IF AT LEAST ONE FROM eligible_sources_1-eligible_sources_11 = 1. //
Item #: Q16
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
eligible_others. Have you looked into vaccine eligibility only for yourself, for yourself and others (e.g., family members/friends), or only for others?
Variable Label: eligible_others: Vaccine eligibility for others?
Value |
Value Label |
1 |
Only for myself |
2 |
|
3 |
Only for others (e.g., family members/friends) |
-99 |
Refused |
//PROGRAMMING NOTE: DISPLAY IF Q6=1//
Item #: Q17-Q19
Question Type: Grid
// Soft Prompt: “We would like your response to this question.” //
vacc_concerns. How concerned are you about the following aspects of getting a COVID-19 vaccine?
//PROGRAMMING NOTE: RANDOMIZE vacc_concerns_1 – vacc_concerns_15. Split grid across three pages (every 5 questions). //
vacc_concerns_1 |
Difficulty signing up for COVID-19 vaccine appointment(s) |
vacc_concerns_1: Difficulty signing up |
vacc_concerns_2 |
Having my COVID-19 vaccine appointment(s) cancelled |
vacc_concerns_2: Cancelled appointments |
vacc_concerns_3 |
My state will run out of COVID-19 vaccine before I get my second dose |
vacc_concerns_3: Run out |
vacc_concerns_4 |
Whether the COVID-19 vaccine will be free and/or if it will be covered by my insurance |
vacc_concerns_4: Free |
vacc_concerns_5 |
Finding out where to go to get a COVID-19 vaccine |
vacc_concerns_5: Where to get |
vacc_concerns_6 |
Getting reliable information, or information I trust, about the COVID-19 vaccines |
vacc_concerns_6: Reliable information |
vacc_concerns_7 |
Contracting COVID-19 before both doses of the vaccine become effective |
vacc_concerns_7: Contracting COVID-19 first |
vacc_concerns_8 |
The side effects of getting a COVID-19 vaccine |
vacc_concerns_8: Side effects |
vacc_concerns_9 |
Whether the vaccines will work against new or emerging variants of COVID-19 |
vacc_concerns_9: Work against variants |
vacc_concerns_10 |
How long the vaccines will protect me from contracting COVID-19 |
vacc_concerns_10: Length of protection |
vacc_concerns_11 |
What I should or shouldn’t do do after getting a COVID-19 vaccine (e.g., wear a mask, socially distance) |
vacc_concerns_11: Behave after vaccine |
vacc_concerns_12 |
Proving that I’m eligible to receive a COVID-19 vaccine |
vacc_concerns_12: Proving eligibility |
vacc_concerns_13 |
How I will know whether or not the COVID-19 vaccine is working |
vacc_concerns_13: Vaccine working |
vacc_concerns_14 |
Where to go to sign up for vaccine appointment(s) |
vacc_concerns_14: Where to sign up |
Value |
Value Label |
1 |
Not at all concerned |
2 |
Slightly concerned |
3 |
Moderately concerned |
4 |
Very concerned |
-99 |
Refused |
// Page Break //
Item #: Q20
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
vday. How much, if at all, have you changed your Valentine’s Day plans this year as a result of the COVID-19 pandemic?
Variable Label: vday: Vday plans changed
Value |
Value Label |
1 |
Not at all |
2 |
Not too much |
3 |
Some |
4 |
A great deal |
99 |
Not applicable, do not celebrate Valentine’s Day |
-99 |
Refused |
// Page Break //
Item #: Q21
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
vacc_trust. How much trust do you have that an FDA-authorized COVID-19 vaccine may be safe and effective for you to get?
Variable Label: vacc_trust: Trust in Safety of Vaccine
Value |
Value Label |
1 |
None at all |
2 |
Not very much |
3 |
A fair amount |
4 |
A great deal |
-99 |
Refused |
// Page Break //
Item #: Q22
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
vacc_off. How much do you trust U.S. federal public health officials to provide reliable information on COVID-19?
Variable Label: vacc_off: Confidence in U.S. public health officials
Value |
Value Label |
1 |
None at all |
2 |
Not very much |
3 |
A fair amount |
4 |
A great deal |
-99 |
Refused |
For
internal communications only
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |