Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. Parents, How is Social Distance Affecting Your Life & Work Right Now? Mom's Hierarchy of Needs© study on COVID-19's impact to self-care, household responsibilities & work/life happiness for parents. OK Question Title * 1. Has your childcare been disrupted by COVID-19? Yes No OK Question Title * 2. Since social distancing, school closures and quarantines, are you doing more, less or about the same amount of housework and childcare? More Less About the Same Amount N/A · Childcare (i.e., Bedtime, Bathing, Feeding, Milestones, Wellbeing/Health) · Childcare (i.e., Bedtime, Bathing, Feeding, Milestones, Wellbeing/Health) More · Childcare (i.e., Bedtime, Bathing, Feeding, Milestones, Wellbeing/Health) Less · Childcare (i.e., Bedtime, Bathing, Feeding, Milestones, Wellbeing/Health) About the Same Amount · Childcare (i.e., Bedtime, Bathing, Feeding, Milestones, Wellbeing/Health) N/A · Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) · Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) More · Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) Less · Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) About the Same Amount · Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) N/A · Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) · Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) More · Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) Less · Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) About the Same Amount · Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) N/A OK Question Title * 3. Has your spouse/partner taken on more, less or about the same amount of housework and childcare since social distance/quarantines have taken place? More Less About the Same Amount N/A - I don't live with a spouse or partner · Childcare (i.e., Bedtime, Bathing, Feeding/Meals, Milestones, Wellbeing/health) · Childcare (i.e., Bedtime, Bathing, Feeding/Meals, Milestones, Wellbeing/health) More · Childcare (i.e., Bedtime, Bathing, Feeding/Meals, Milestones, Wellbeing/health) Less · Childcare (i.e., Bedtime, Bathing, Feeding/Meals, Milestones, Wellbeing/health) About the Same Amount · Childcare (i.e., Bedtime, Bathing, Feeding/Meals, Milestones, Wellbeing/health) N/A - I don't live with a spouse or partner · Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) · Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) More · Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) Less · Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) About the Same Amount · Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) N/A - I don't live with a spouse or partner · Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) · Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) More · Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) Less · Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) About the Same Amount · Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) N/A - I don't live with a spouse or partner OK Question Title * 4. Are you working from your home during this time of social distance? Yes No OK Question Title * 5. If you could have access to anything you need to help improve your productivity right now, what would it be? OK Question Title * 6. What do you wish you had to improve your level of work happiness/satisfaction right now? OK Question Title * 7. Self-care is everything you do to maintain mental, emotional and physical well-being. Have your established self-care rituals changed since COVID-19? Are you doing more, less or about the same amount of the following? More Less About the Same Amount ·Self-care (i.e., Sleep, Movement, Health, Stress Level Management) ·Self-care (i.e., Sleep, Movement, Health, Stress Level Management) More ·Self-care (i.e., Sleep, Movement, Health, Stress Level Management) Less ·Self-care (i.e., Sleep, Movement, Health, Stress Level Management) About the Same Amount Self-interests (i.e, Fun, Hobbies, Learning new skills) Self-interests (i.e, Fun, Hobbies, Learning new skills) More Self-interests (i.e, Fun, Hobbies, Learning new skills) Less Self-interests (i.e, Fun, Hobbies, Learning new skills) About the Same Amount Healthy Relationships (i.e. connection with other adults such as partner/friends) Healthy Relationships (i.e. connection with other adults such as partner/friends) More Healthy Relationships (i.e. connection with other adults such as partner/friends) Less Healthy Relationships (i.e. connection with other adults such as partner/friends) About the Same Amount OK Question Title * 8. Beyond the financial hardship, what has been the hardest part of dealing with this new situation? OK Question Title * 9. What unexpected benefits or rewards have you experienced in this new situation? OK Question Title * 10. What do you normally do that you’ve stopped doing in the current situation? OK Question Title * 11. What new things are you doing in the current situation that you hope to keep doing after things go back to normal? OK Question Title * 12. On a five-point scale, (where 1 is doing a Terrible Job and 5 is doing a Great Job) how do you feel you’re doing right now in each of your roles/areas of responsibility? 1. Terribly 2. Not as well as usual 3. The same as usual 4. Better than usual 5. Really well N/A - This doesn’t apply to me As a parent As a parent 1. Terribly As a parent 2. Not as well as usual As a parent 3. The same as usual As a parent 4. Better than usual As a parent 5. Really well As a parent N/A - This doesn’t apply to me As a worker As a worker 1. Terribly As a worker 2. Not as well as usual As a worker 3. The same as usual As a worker 4. Better than usual As a worker 5. Really well As a worker N/A - This doesn’t apply to me As a spouse or partner As a spouse or partner 1. Terribly As a spouse or partner 2. Not as well as usual As a spouse or partner 3. The same as usual As a spouse or partner 4. Better than usual As a spouse or partner 5. Really well As a spouse or partner N/A - This doesn’t apply to me As a caregiver to yourself As a caregiver to yourself 1. Terribly As a caregiver to yourself 2. Not as well as usual As a caregiver to yourself 3. The same as usual As a caregiver to yourself 4. Better than usual As a caregiver to yourself 5. Really well As a caregiver to yourself N/A - This doesn’t apply to me OK Question Title * 13. Does your child (or children) live with you either full or part-time? Yes No OK Question Title * 14. How many children, by age, currently live in your household? Less than 1 year old 1 year old 2 years old 3 years old 4 years old 5 years old 6 years old 7 years old 8 years old 9 years old 10 years old 11 years old 12 years old 13 years old 14 years old 15 years old 16 years old 17 years old 18 years old or older OK Question Title * 15. Are you female or male? Female Male Non-Binary OK Question Title * 16. Do you work for pay? I work for an employer I am a business owner Full-time Full-time I work for an employer Full-time I am a business owner Part-time Part-time I work for an employer Part-time I am a business owner No, I don't work for pay No, I don't work for pay I work for an employer No, I don't work for pay I am a business owner OK Question Title * 17. In what country do you live? Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil British Virgin Island Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte D'Ivoire Croatia Cuba Cyprus Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea Bissau Guyana Haiti Holy See Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka State of Palestine Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand The former Yugoslav Republic of Macedonia Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Vietnam Yemen Zambia Zimbabwe OK Question Title * 18. 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