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
- Less than one week
- One week to one month
- One to two months
- 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...
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Much less than before
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A little less than before
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The same as before
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A little more
than before
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Much more than before
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Does not apply to my household
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I prefer not to answer
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How to spend leisure time (e.g., watching TV, hobbies, games, exercise)
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Parenting or childcare
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Children’s schoolwork
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Decisions about how people should take care of their health (e.g. taking medicines, going to the doctor, getting enough to eat)
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Decisions about going out (e.g., on errands, to appointments, for visits)
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Decisions about visitors to the home
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Home maintenance (e.g., cleaning or tidying, laundry, repairs)
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Personal hygiene
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Food (e.g., what is purchased, what meals are prepared, or amount that is eaten)
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Work or employment (e.g., finding a job, going to a job, needing a quiet space to work at home)
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Finances (e.g., spending, purchases, paying bills)
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Privacy or personal space
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News or Social Media (e.g., watching too much news, what people believe from social media, what people share on social media)
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Alcohol, tobacco or drug use
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Politics
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Compared to BEFORE the COVID-19 pandemic, during social distancing, was/is there is more TOGETHERNESS in your household because of…
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Much less than before
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A little less than before
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The same as before
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A little more
than before
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Much more than before
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Does not apply to my household
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I prefer not to answer
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Spending leisure time together (e.g., hobbies, television, playing games, social media)
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Engaging in conversation
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Doing exercise or fitness activities together
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Getting involved in the children’s education
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Facing challenges or solving problems together
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Helping each other (e.g., with use of technology, health needs)
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Sharing household tasks (e.g., cooking, gardening, laundry, cleaning)
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Going on errands together (e.g. to the market or drugstore)
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Eating together
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Showing concern or emotional support for each other
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Showing affection (hugs, kisses)
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Physical intimacy (sexual relations)
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Sharing religious or spiritual activities (e.g. praying, meditating, religious lessons)
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Sharing material resources (e.g., personal items, books, money)
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Helping others together (e.g., volunteering, charitable work)
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