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. 2021 Jun 23;105(2):310–322. doi: 10.4269/ajtmh.20-1618

Table 3.

Modules included in the ARISE Network COVID-19 survey adult, adolescent, and healthcare provider questionnaires

Adult general population survey
Domain Subtopic Items
Socio-demographics Demographics Age
Sex
Role in household
Household composition
Educational attainment
Occupation
COVID-19 knowledge, attitudes, practices Knowledge Belief in COVID-19
Identification of symptoms
Identification of transmission methods
Identification of prevention measures
Knowledge of someone with COVID-19
Sources of information about the pandemic
Attitudes Maximum time could comply with a lockdown
Practices Factors preventing self-quarantine
Preparation and response measures taken
Mental health and well-being Health habits Drinking habits during the past 2 weeks compared with usual habits
Sleeping habits during the past 2 weeks compared with usual habits
Anxiety and depression Patient Health Questionnaire 4 (PHQ-4)
Healthcare utilization Access to services Childhood immunization
Vitamin A supplementation for children
Child health and nutrition prevention services
Child malnutrition management
Antenatal care
Iron and folic acid for pregnant women
HIV treatment
Sexual and reproductive health
Surgeries
Reasons for disruptions in access
Nutrition and food security Child feeding Complementary feeding habits and impacts of the pandemic
Breastfeeding practices and impacts of the pandemic
Access to meals at school for children
Impacts of COVID-19 on food pricing Prices of staple foods
Prices of pulses
Prices of fruits
Prices of vegetables
Prices of animal source foods
Food security over the past month Skipping meals, going without eating for 1 day, and worrying about food running out
Assistance received Food aid
Cash transfers
School meals
Farming Impacts of the pandemic on crop production
Diet quality Prime Diet Quality Score/dietary diversity assessing number of days each food group was consumed over the past 7 days and number of days per week each food group was consumed during the time period before the coronavirus
Water, Sanitation and Hygiene (WASH) Access Access to safe and clean water for preparing food
Access to soap
Access to water for handwashing
Adolescent survey
Descriptive characteristics Demographics Age
Sex
Education
Occupation
COVID-19 knowledge, attitudes and practices Knowledge Belief in COVID-19
Identification of symptoms
Identification of transmission methods
Identification of prevention measures
Sources of information about the pandemic
Attitudes Concerns about coronavirus spread
Perceived level of risk of coronavirus exposure
Maximum time could comply with lockdown
Practices Preparation and response measures taken
Lifestyle Impacts of COVID-19 on daily activities Impacts on going to school, income, amount of time spent at home, responsibilities at home, and weight
Physical activity Level of physical activity before the pandemic and during the past 1 week
Education COVID-19 impacts on education School enrollment
School closures because of the pandemic
Methods of receiving education
Coronavirus impacts on ability to learn
Ability to catch up on education after the pandemic
Meal provision at school
Communication COVID-19 impacts on communication Frequency of communication
Main modes of communication
Media consumption Changes in media consumption
Hours spent consuming media over the past 7 days
Nutrition Diet assessment Number of days per week consuming staples, pulses, fruits, vegetables, and animal source foods before coronavirus and during the past 7 days
Mental health and well-being Sleeping habits Sleeping habits during the past 7 days compared with usual habits
Anxiety and depression Patient Health Questionnaire 4 (PHQ-4)
Healthcare provider survey
Descriptive characteristics Demographics Age
Sex
Occupation
Type of healthcare facility
COVID-19 knowledge, attitudes, practices Knowledge Identification of symptoms
Identification of transmission methods
Identification of prevention measures
Attitudes Concern about coronavirus spread
Perceived level of risk of exposure to coronavirus
Perceived severity of the virus
Practices Experience caring for COVID-19 patients
Mental health and well-being Health habits Drinking habits during the past 2 weeks compared with usual habits
Sleeping habits during the past 2 weeks compared with usual habits
Anxiety and depression Patient Health Questionnaire 4 (PHQ-4)
COVID-19 in the workplace Access to prevention measures Wearing masks
Personal protective equipment
Handwashing
Distancing
Sanitizers
Regular cleaning and decontamination
Training offered Natural course of COVID-19
Management and treatment
Workplace policies Presence of formal policies related to COVID-19
Protocol for suspected cases
Guidelines on delivering other health services to patients with COVID-19
Healthcare impacts Impact on healthcare services Childhood immunizations
Vitamin A supplementation for children
Child health and nutrition preventative services
Management of child malnutrition
Antenatal care
Iron and folic acid for pregnant women
HIV treatment services
Sexual and reproductive health
Surgeries
Impact on prescription patterns Antibiotics
Antimalarials
Multivitamins and other nutritional supplements
Stigma Experiences as a healthcare professional Social avoidance or rejection
Denial of healthcare, education, housing, etc.
Physical violence
Congratulations or acknowledgment