1. Gender: A. Male B. Female
2. Age:
3. Marital status: A. Single B. Married/Co-habitation/Common-law
4. Do you have children? A. Yes B. No
5. If yes, please list their ages:
6. Do you have dependants other than children? A. Yes B. No
7. Are you: A. Support staff B. Academic staff C. Student
8. If you are a student or faculty, what faculty are you in? Select a Faculty from the List: Agriculture, Forestry, and Home Economics Arts Augustana Business Education Engineering Extension Campus Saint-Jean Graduate Studies and Research Law Medicine and Dentistry Native Studies Pharmacy Nursing Open Studies Phys Ed Public Health Rehabilitation Medicine Science
If you are a staff member then please skip to Question 14.
9. If you are a student, are you: A. In-province student B. Out-of-province student C. International student
10. If you are a student, are you a: A. Undergraduate B. Postgraduate
11. If you are a student, what year of your program are you in? A. 1 B. 2 C. 3 D. 4 E. 5 F. >5
12. What are your living arrangements? A. Off campus with family B. On your own in residence C. On your own off campus D. With roommate(s) in residence E. With roommate(s) off campus
13. If the university suspended classes and asked students to go home, what would you do? A. I would return home B. I would find a place to stay in Edmonton C. I would remain on campus because it would be safe/reasonable to do so D. I would remain on campus because I would not have the resources to go home E. I would go elsewhere
14. How would you rate your current health status? A. Excellent B. Good C. Poor D. Very poor
15. How much do you rely on each of the following information sources for health news? (1=very little, 5=very much)
16. How confident are you in the accuracy of the information you receive from each of the following sources? (1=not confident, 5=very confident)
RISK PERCEPTION
17. How likely do you think you may be affected by the following disease or injuries in the next year? (1=very unlikely, 5=very likely)
18. If a pandemic hit Edmonton, how likely do you think YOU would be infected? (1=very unlikely, 5=very likely)
19. What is/are your reasons for believing that you would be unlikely or likely to be infected?
20. If YOU were to develop influenza during a pandemic, how do you think it would affect YOU? (1=very unlikely, 5=very likely)
21. When a pandemic hits, should the University remain open? A. Yes, all faculties and departments should provide service as best as possible. B. Yes, but only necessary operations (e.g. keep plant operations running, but cancel classes) C. No, close it.
22. When a pandemic hits, what would cause you to stay at home/prevent you from going out into public places? A. Pandemic is in Canada B. Pandemic is in Alberta C. Pandemic is in Edmonton D. Co-workers/colleagues/family become ill at school/work E. Nothing will stop me from going to work/school
23. If the university were to close, what should determine when it closes? A. Pandemic is in Canada B. Pandemic is in Alberta C. Pandemic is in Edmonton D. Confirmed cases on campus E. Percentage of staff and students absent >30% F. Other:
GENERAL KNOWLEDGE
24. How do you think pandemic influenza is spread? (check any that apply) a. Close contact with an infected person b. Blood transfusion c. Sexual transmission d. Cough and sneeze from an infected person e. Touching doorknobs previously handled by an infected person, etc. f. Contact with infected wild birds, chickens
25. How do you think pandemic influenza can be prevented? (check any that apply) a. Nothing can prevent pandemic influenza b. Hand washing c. Cover mouth when coughing or sneezing d. Vaccination e. Vitamins and herbal supplements f. Antivirals g. Antibiotics h. Quarantine i. Staying home and avoiding public places j. Moving to a province/country where there is no influenza outbreak k. Wearing protective equipment in public places (e.g. masks, gloves) l. Sauerkraut
26. How do you think pandemic influenza can be treated once you have it? (check any that apply) a. Nothing can treat pandemic influenza b. Antibiotics c. Antivirals d. Vaccination e. Bed rest f. Drinking fluids g. Complimentary medicine (e.g. acupuncture) h. Chicken soup
26a. If you believe antivirals can treat influenza, please name the antiviral(s) here: I don't know the names of any antivirals
27. Do you think it is possible to develop a vaccine before we know what strain of influenza is causing the pandemic? A. Yes B. No C. I don't know
WILLINGNESS TO VOLUNTEER DURING A PANDEMIC
If pandemic influenza were to strike a community, it is likely that many people will be very sick. Health care institutions and other important services (e.g. fire departments) may be severely understaffed due the effects of the pandemic. This sort of an emergency will require as many healthy people as possible to help out.
28. In the past, I have volunteered with: (check all that apply) a. Sports and recreation b. Hospital/health care setting c. Schools d. Religious institutions e. Social services (e.g. Meals on Wheels, Big Brothers) f. Other
29. I would be willing to volunteer to help during a pandemic if: (1=very unlikely, 5=very likely)
30. I would be willing to volunteer to help: (1=very unlikely, 5=very likely)
30.1. In a hospital
30.2. In the community
Those who volunteer during a pandemic may be at greater risk of infection. There is debate as to whether they should be compensated for their contribution.
31. How much do you agree or disagree with the following statements? (1=strongly disagree, 5=strongly agree)
32. Should health care students be strongly encouraged to volunteer in the event of health care worker shortages? A. Yes B. No C. I don't know
33. Should retired health care workers be strongly encouraged to volunteer in the event of health care worker shortages? A. Yes B. No C. I don't know
In the event of a pandemic, the government has the power to require any qualified person to help. It has been suggested that the government should first require health care students to provide health services before requiring the general public.
34. Do you think health care students have a moral/ethical/professional obligation to volunteer during a pandemic? A. Yes B. No C. I don't know
35. If there are not enough volunteers coming forward to meet the needs during a pandemic do you think that the government would be justified in requiring people to work? A. Yes B. No C. I don't know
36. Do you think health care students should be penalized if they refuse to provide services as required by the government? A. Yes B. No C. I don't know
37. Do you think health care academic staff should be penalized if they refuse to provide services as required by the government? A. Yes B. No C. I don't know
38. If there was a penalty involved with refusing to provide aid if required, what penalty should the government and /or University be able to impose? (check any that apply) a. Expulsion from school/termination from work b. Jail time c. Fine d. Other e. None of the above
HEALTH CARE RESOURCE ALLOCATION
During a pandemic there will likely not be enough health care resources (e.g. vaccines, ventilators, hospitals beds, antivirals) for all who might need them at once. Choices are going to have to be made as to who will have priority to scarce resources. For example, in a given group of five people there may only be enough vaccine to vaccinate two people, which two people should get it?
39. What level of priority access to scarce resources should the following groups receive? (1=low priority, 5=high priority)
40. Of the following "priority-access" plans, which do you most prefer? (choose one) A. Save those who are most likely to die if not treated. B. First come, first served (no specific priority groups). C. Save women and children first. D. Save children first. E. Save the most lives possible, irrespective of differences. F. Save that group of people that will likely have the most years of life to live because of the treatment. G. Save people according a priority ranking system (similar to the list in #39).
41. What have you not been asked and would like to say about pandemic planning at the University of Alberta?
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