ASPA
COVID-19 PUBLIC EDUCATION CAMPAIGN A
campaign to increase vaccine acceptance and reinforce basic
prevention measures
CET – Annotated Questionnaire (Wave 5)
Note: The questions below are the proposed questions for the fifth 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 5 only. This week we have added questions that examine opinion changes on HHS, trusted vaccine messengers, and challenges to getting vaccinated.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 |
// Page Break //
//PROGRAMMING NOTE: IF Q1=1, SKIP TO Q5//
Item #: Q2
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
hhs_op. How favorable is your opinion of the U.S. Department of Health and Human Services (HHS)?
Variable Label: hhs_op: Opinion of HHS
Value |
Value Label |
1 |
Very unfavorable |
2 |
Mostly unfavorable |
3 |
Mostly favorable |
4 |
Very favorable |
-99 |
Refused |
-100 |
Valid skip |
// Page Break //
Item #: Q3
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
hhs_op_change. In the past few weeks, how has your opinion of the U.S. Department of Health and Human Services (HHS) changed, if at all?
Variable Label: hhs_op_change: Change in Opinion of HHS
Value |
Value Label |
1 |
Much more negative |
2 |
Slightly more negative |
3 |
Stayed the same |
4 |
Slightly more positive |
5 |
Much more positive |
-99 |
Refused |
-100 |
Valid skip |
// Page Break //
//PROGRAMMING NOTE: Randomize order of Q4 & Q5, i.e., 50% see Q4 first, 50% see Q5 first.//
Item #: Q4
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 #: Q5
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
cdc_trust. How much trust do you have in the Centers for Disease Control and Prevention (CDC) to provide you with accurate information about the coronavirus or COVID-19?
Variable Label: hhs_trust: Trust in CDC
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 #: Q6
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 #: Q7
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
BEH1_CET. Food and Drug Administration (FDA)-authorized vaccines to prevent COVID-19 are 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 Q6=0 OR -99//
Item #: Q8
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 |
-100 |
Valid Skip |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q6=1//
Item #: Q9
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 |
-100 |
Valid Skip |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q6=0 OR -99//
Item #: Q10
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
BEH3a_CET. Food and Drug Administration (FDA)-authorized vaccines to prevent COVID-19 are 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 Q6=1//
Item #: Q11
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
BEH3b_CET. Food and Drug Administration (FDA)-authorized vaccines to prevent COVID-19 are 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 Q9=2//
Item #: Q12-Q14
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 BEH4_1_CET-BEH4_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 Q9≠3 OR -100//
Item #: Q15-Q17
Question Type: Grid
// Soft Prompt: “We would like your response to this question.” //
vacc_source. How likely would you be to get the COVID-19 vaccine if each of the following recommended it?
//PROGRAMMING NOTE: RANDOMIZE vacc_source1-vacc_source11.//
Variable Name |
Variable Text |
Variable Label |
vacc_source1 |
Your State Government |
vacc_source1: Source of Vaccine: Your State Government |
vacc_source2 |
The U.S. Department of Health and Human Services (HHS) |
vacc_source2: Source of Vaccine: HHS |
vacc_source3 |
The Centers for Disease Control and Prevention (CDC) |
vacc_source3: Source of Vaccine: CDC |
vacc_source4 |
U.S. Federal public health officials |
vacc_source4: Source of Vaccine: Federal public health officials |
vacc_source7 |
The U.S. Food and Drug Administration (FDA) |
vacc_source7: Source of Vaccine: FDA |
vacc_source8 |
Pharmaceutical companies |
vacc_source8: Source of Vaccine: Pharmaceutical companies |
vacc_source9 |
Local public health officials (e.g. state, county, city, or town) |
vacc_source9: Source of Vaccine: Local public health officials |
vacc_source10 |
The American Medical Association |
vacc_source10: Source of Vaccine: The American Medical Association |
vacc_source11 |
Medical websites, like WebMD or the Mayo Clinic |
vacc_source11: Source of Vaccine: Medical websites like WebMD or the Mayo Clinic |
vacc_source12 |
Your local hospital leadership (e.g., Chief Medical Officer) |
vacc_source12: Local hospital leadership |
vacc_source13 |
President Biden |
vacc_source13: President Biden |
vacc_source14 |
Vice President Harris |
vacc_source14: Vice President Harris |
Value |
Value Label |
1 |
Not at all likely |
2 |
Not very likely |
3 |
Somewhat likely |
4 |
Very likely |
-99 |
Refused |
// Page Break //
Item #: Q18-Q19
Question Type: Grid
// Soft Prompt: “We would like your response to this question.” //
vacc_source. How likely would you be to get the COVID-19 vaccine if each of the following recommended it?
//PROGRAMMING NOTE: RANDOMIZE vacc_source1-vacc_source10.//
Variable Name |
Variable Text |
Variable Label |
fam_vacc_source1 |
My family physician |
fam_vacc_source1: Source of Vaccine: My family physician |
fam_vacc_source2 |
Friends |
fam_vacc_source2: Source of Vaccine: Friends |
fam_vacc_source3 |
Immediate family members |
fam_vacc_source3: Source of Vaccine: Immediate family members |
fam_vacc_source4 |
Extended family members |
fam_vacc_source4: Source of Vaccine: Extended family members |
fam_vacc_source5 |
Neighbors in my community |
fam_vacc_source5: Source of Vaccine: Neighbors in my community |
fam_vacc_source6 |
Local schools |
fam_vacc_source6: Source of Vaccine: Local schools |
fam_vacc_source7 |
My employer |
fam_vacc_source7: Source of Vaccine: My employer |
fam_vacc_source8 |
My local government |
fam_vacc_source8: Source of Vaccine: My local government |
fam_vacc_source9 |
My place of worship |
fam_vacc_source9: Source of Vaccine: My place of worship |
fam_vacc_source10 |
My pharmacist/pharmacy |
fam_vacc_source10: Source of Vaccine: My pharmacist/pharmacy |
Value |
Value Label |
1 |
Not at all likely |
2 |
Not very likely |
3 |
Somewhat likely |
4 |
Very likely |
99 |
Not applicable |
-99 |
Refused |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q9≠3 OR -100//
Item #: Q20
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
vacc_distance. How far would you need to travel to get to the COVID-19 vaccination site located nearest to your home?
Variable Label: vacc_distance: Distance to vaccine site
Value |
Value Label |
1 |
Less than 15 minutes |
2 |
15 minutes – 30 minutes |
3 |
30 minutes – 1 hour |
4 |
More than 1 hour |
5 |
I don’t know where my nearest site is |
-99 |
Refused |
-100 |
Valid skip |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q9≠3 OR -100//
Item #: Q21-Q22
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
vacc_barrier. When it comes to getting a COVID-19 vaccine, how difficult do you expect the following to be?
Variable Label: vacc_barrier: Barriers to getting vaccine
//PROGRAMMING NOTE: RANDOMIZE vacc_1_barrier-vacc_7_barrier
Variable Name |
Variable Text |
Variable Label |
vacc_1_barrier |
Getting to and/or from the vaccination site |
vacc_1_barrier: Travel
|
vacc_2_barrier
|
Finding appointment times that work with my schedule |
vacc_2_barrier: Appointment times
|
vacc_3_barrier
|
Having access to the technology needed to schedule the vaccine appointment (e.g., computer, mobile device, internet) |
vacc_3_barrier: Technology
|
vacc_4_barrier |
Cost of traveling to and from the vaccination site |
vacc_5_barrier: Travel cost |
vacc_5_barrier |
Other costs associated with getting the vaccine (e.g., childcare, time off from work) |
vacc_6_barrier: Other costs |
vacc_6_barrier
|
Getting the documentation needed to get a vaccine (e.g., driver’s license or other form of identification) |
vacc_7_barrier: Documentation
|
Value |
Value Label |
1 |
Not at all difficult |
2 |
Slightly difficult |
3 |
Moderately difficult |
4 |
Very difficult |
-99 |
Refused |
-100 |
Valid skip |
// Page Break //
//PROGRAMMING NOTE: DISPLAY IF Q9≠3 OR -100//
Item #: Q23-Q24
Question Type: Single punch
// Soft Prompt: “We would like your response to this question.” //
vacc_resource. When it comes to getting a COVID-19 vaccine, how much would each resource, if available, increase your likelihood to get vaccinated?
Variable Label: vacc_resource: Vaccine resources
//PROGRAMMING NOTE: RANDOMIZE vacc_1_resource-vacc_8_resource
Variable Name |
Variable Text |
Variable Label |
vacc_1_resource |
If transportation was provided for traveling to and from the vaccine site |
vacc_1_resource: Travel
|
vacc_2_resource
|
If more flexibility was offered in scheduling my vaccine appointments (e.g., later appointment times, more weekend availability) |
vacc_2_resource: Appointments
|
vacc_3_resource
|
If my employer offered paid time off to get the vaccine |
vacc_3_resource: Compensation
|
vacc_4_resource
|
If I received automatic notifications with updates on my vaccine eligibility status and appointment scheduling options |
vacc_4_resource: Notifications |
vacc_5_resource
|
If vaccine scheduling could be done in-person |
|
vacc_6_resource |
If vaccine registration sites were available in more languages |
vacc_7_resource: Language
|
vacc_7_resource |
If I could bring my child(ren) with me to the vaccine site |
vacc_8_resource: Child |
Value |
Value Label |
1 |
Not at all |
2 |
Not very much |
3 |
A fair amount |
4 |
A great deal |
99 |
Not applicable |
-99 |
Refused |
-100 |
Valid skip |
For
internal communications only
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Lindsey Strausser |
File Modified | 0000-00-00 |
File Created | 2023-07-29 |