COVID-19 Household Environment Scale

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COVID-19 Household Environment Scale (CHES)

 

Social Distancing is the practice of reducing physical contact with people outside of the home (e.g., in social, work, or school settings) to avoid transmission of COVID-19 (Coronavirus).

Part 1

Personal Information

Age _____      

Gender: Male __         Female ___      Nonbinary ___

Country where you currently live __________________________  If you are currently living in the US, please provide your zip code: _____________

Years living in current country _____

 

What is the highest grade of school you’ve completed?

  • No formal education completed
  • 1st to 8th grade
  • 9th to 11th grade
  • GED (high school equivalent)
  • High school diploma
  • Some college/university
  • College/university degree

 

Household Information

Total number of people living in the home (including yourself)?________ 

Number who are not members of the family (e.g., friends, roommates, renters) ________

Number of adults aged 65 or above _____

Number of adults requiring caregiving due to health problems or disability (not due to COVID-19) ___           

Number of children: under age 5______ ages 5-11_____  ages 12-18______

            Number of children with a disability or special healthcare need ____

Number of bedrooms in the home ____

Do you or your family own the home? Yes____; No_____

COVID-19 information

Time practicing social distancing

  1. Less than one week
  2. One week to one month
  3. One to two months
  4. More than two months

Are you currently practicing social distancing? Yes____; No_____

Did anyone in your home have symptoms of COVID-19? Yes____; No______

If yes, did they get tested? Yes_____; No_____

If yes, was it a diagnosed case (a positive result)? Yes_____; No______

            If yes, did it require hospitalization? Yes____; No_____

Has anyone in your family (in or outside of your home) passed away from COVID-19 or related complications? Yes____; No_____

During the COVID-19 pandemic are/were you or anyone in the home working in healthcare with direct patient contact? Yes___; No___

During the pandemic, are/were you or anyone in the home working in a job that you considered to be high risk for contracting COVID-19?

Yes____; No_____

Of the adults in the home, how many are working from home? ____

Of the adults in the home, how many stopped working as result of COVID-19? _____

 

Part 2

Compared to BEFORE the COVID-19 pandemic, during social distancing, were/are there more CONFLICTS in your household about...

 

Much less than before

A little less than before

The same as before

A little more

 than before

Much more than before

Does not apply to my household

I prefer not to answer

How to spend leisure time (e.g., watching TV, hobbies, games, exercise)

 

 

 

 

 

 

 

Parenting or childcare

 

 

 

 

 

 

 

Children’s schoolwork

 

 

 

 

 

 

 

Decisions about how people should take care of their health (e.g. taking medicines, going to the doctor, getting enough to eat)

 

 

 

 

 

 

 

Decisions about going out (e.g., on errands, to appointments, for visits)

 

 

 

 

 

 

 

Decisions about visitors to the home

 

 

 

 

 

 

 

Home maintenance (e.g., cleaning or tidying, laundry, repairs)

 

 

 

 

 

 

 

Personal hygiene

 

 

 

 

 

 

 

Food (e.g., what is purchased, what meals are prepared, or amount that is eaten)

 

 

 

 

 

 

 

Work or employment (e.g., finding a job, going to a job, needing a quiet space to work at home)

 

 

 

 

 

 

 

Finances (e.g., spending, purchases, paying bills)

 

 

 

 

 

 

 

Privacy or personal space

 

 

 

 

 

 

 

News or Social Media (e.g., watching too much news, what people believe from social media, what people share on social media)

 

 

 

 

 

 

 

Alcohol, tobacco or drug use

 

 

 

 

 

 

 

Politics

 

 

 

 

 

 

 

 

Compared to BEFORE the COVID-19 pandemic, during social distancing, was/is there is more TOGETHERNESS in your household because of…

 

Much less than before

A little less than before

The same as before

A little more

 than before

Much more than before

Does not apply to my household

I prefer not to answer

Spending leisure time together (e.g., hobbies, television, playing games, social media)

 

 

 

 

 

 

 

Engaging in conversation

 

 

 

 

 

 

 

Doing exercise or fitness activities together

 

 

 

 

 

 

 

Getting involved in the children’s education

 

 

 

 

 

 

 

Facing challenges or solving problems together

 

 

 

 

 

 

 

Helping each other (e.g., with use of technology, health needs)

 

 

 

 

 

 

 

Sharing household tasks (e.g., cooking, gardening, laundry, cleaning)

 

 

 

 

 

 

 

Going on errands together (e.g. to the market or drugstore)

 

 

 

 

 

 

 

Eating together

 

 

 

 

 

 

 

Showing concern or emotional support for each other

 

 

 

 

 

 

 

Showing affection (hugs, kisses)

 

 

 

 

 

 

 

Physical intimacy (sexual relations)

 

 

 

 

 

 

 

Sharing religious or spiritual activities (e.g. praying, meditating, religious lessons)

 

 

 

 

 

 

 

Sharing material resources (e.g., personal items, books, money)

 

 

 

 

 

 

 

Helping others together (e.g., volunteering, charitable work)