The COVID-19 pandemic has been a stressful time that has affected everyone. The purpose of this questionnaire is for the UMass MIND Program to assess how this pandemic has affected your daily life, family, and work. This information will be used to design an education-support program for the COVID-19 pandemic. Please answer the questions below to the best of your ability. We thank you for your time and your particiaption.
Would you be interested in participating in this education/support program that focuses on issues related to the COVID-19 pandemic?
If you answered "yes" to the question above, please provide your email address and/or phone number below
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How serious of a problem do you think the coronavirus is?
How would you describe your current physical health condition?
How serious do you think it would be if someone like you got the coronavirus?
Where do you think would be the most likely place for you to contract the virus? (You may select multiple)
To what degree have your mental health symptoms increased since the start of the stay at home orders?
I have benefited from more time at home
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I have had time to explore new hobbies
Not being allowed to leave the house or attend regular activities has been difficult
I have used substances (e.g. Alcohol, marijuana, cocaine, heroin, etc) more frequently during the stay at home orders
I am capable of taking action to distance myself from others
Education on _____ would most help me adhere to social distancing (You may select multiple)
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Being able to discuss my questions or concerns with a medical professional would be beneficial to me
It is important to follow the guidelines made by public health officials
I have NOT been practicing social distancing since the COVID-19 pandemic started
How do you see the future for yourself?