Social Impact of COVID-19 Survey
Questionnaire
1a What is your age?
18-112
1b What is your sex?
Male/Female
1c What is your County of residence?
Text
1d How many people (including yourself) live in this household?
0-25
If 1d >1
1da How many children under 18 living in this household
0-XX
If 1d >1
1e Is there a household member currently in education
Yes
No
2 On a scale of 0 to 10, where 0 is not at all satisfied and 10 is completely
satisfied:
2a How satisfied are you with your life these days?
0-10
2b How satisfied are you with the financial situation of your household?
0-10
2c How satisfied are you with your personal relationships?
0-10
2d Do you feel that if you needed non-material help (e.g. somebody to talk to, help
with doing something or collecting something) you could receive it from
relatives, friends, neighbours or other persons that you know?
Yes
No
3a How much of the time, during the past 4 weeks, have you felt downhearted or
depressed?
All,Most
Some
Little
None …. of the time
3b How much of the time, during the past 4 weeks, have you been very nervous?
All,Most
Some
Little
None …. of the time
3c How much of the time, during the past 4 weeks, have you been feeling lonely?
All,Most
Some
Little
None …. of the time
3d How much of the time, during the past 4 weeks, have you been happy?
All,Most
Some
Little
None …. of the time
4 How concerned are you about each of the following impacts of COVID-19?
4a Your own health
Not at all
Somewhat
Very
Extremely
4b Somebody else's health (e.g. friend or relative)
Not at all
Somewhat
Very
Extremely
4c Maintaining social ties
Not at all
Somewhat
Very
Extremely
If 1e=Yes
4d Impact of interrupted education
Not at all
Somewhat
Very
Extremely
If 1d>1
4e Household stress from confinement
Not at all
Somewhat
Very
If 1d>1
4f Violence in the home
Not at all
Somewhat
Very
5 Thinking of the situation since the introduction of Covid-19 restrictions:
5a Has your consumption of alcohol changed?
Increased
Decreased
No change
I don't consume alcohol
5b Has your consumption of tobacco products changed?
Increased
Decreased
No change
I don't consume tobacco
5c Has your consumption of junk food and sweets changed?
Increased
Decreased
No change
I don't consume junk food and sweets
5d Has your consumption of fresh fruit and vegetables changed ?
Increased, Decreased, No change, I don't consume fresh fruit and vegetables
5e Has your frequency of exercising changed?
Increased
Decreased
No change
I don't exercise
5f Has your time spent watching TV changed ?
Increased
Decreased
No change
I don't watch TV
5g Has your time spent on the internet changed ?
Increased
Decreased
No change
I don't spend time on the internet
5h What is your employment status?
Employed and currently engaged in work duties
Employed, in receipt of employment income, but not carrying out work duties
Unemployed
Other
if 5h = Employed & engaged
5i Are you currently working from home?
Yes
No
if 5i = Yes
5j Did you normally work from home before introduction of Covid-19 restrictions?
Yes
No
If 5k = No
5k After Covid-19 restrictions are lifted, would you like to remain working from
home or return to your place of work?
Remain working from home
Return to place of work
Mixture of both
5l Which of the following best describes the impact of Covid-19 of on your
household's ability to meet financial obligations (loan repayments, household
bills etc)?
Major negative
Moderate negative
Minor negative
No impact
Positive impact
Too soon to tell
6.1 On a scale of 0 to 10 where 0 is 'not at all' and 10 is 'entirely', to what extent are
you following the government’s current advice and guidelines regarding
COVID-19?'
0-10
6.2 Have you been tested for COVID-19?
Yes
No
If 6.2 = Yes
6.2 Has the test returned a positive result for COVID-19
Yes
No
Don't know
Rather not say
If 6.2a ne Yes
6.3 On a scale of 0 to 10, where 0 is 'no chance' and 10 is ' a 100% chance', what
do you think are your chances of getting infected with COVID-19 within the
next 3 months?
0-10
If 6.2a ne Yes
6.4 If you were to become infected with COVID-19, do you believe that you would
have
Mild illness
Moderate illness
More severe illness
Critical illness
Don't know
6.5 How is your health in general?
Very good
Good
Fair
Bad
Very bad
6.6 Which of the following sources of information do you use to stay informed
about Covid-19? (Tick all that apply)
1. Newspapers,
2. Radio
3. Television
4. Mainstream news websites, e.g. breakingnews.ie, rte.ie
5. HSE/government agency websites
6. Social media, eg Twitter, Facebook, Whatsapp
7. Family, friends or colleagues
8. Consultations with health professionals
9. Other
If 6.6>1 option
6.7 Which of these is your main source of information to stay informed about
Covid-19?
Respondent should be presented with options selected at 6g and should only be able
to tick one as their main source
