Survey on Access to Health Care and Pharmaceuticals During the Pandemic

For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.

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Table of Contents

Demographic questions (DEM)

Demographic questions (DEM) - Question identifier:DEM_Q05A

What is your first and last name?

First name

Long Answer Length = 80

Demographic questions (DEM) - Question identifier:DEM_Q05B

What is your first and last name?

Last name

Long Answer Length = 80

Demographic questions (AGE)

Demographic questions (AGE) - Question identifier:AGE_Q01A

What is your date of birth?

Year

Min = 1897; Max = 2018

Demographic questions (AGE) - Question identifier:AGE_Q01B

What is your date of birth?

Month

  • 01: January
  • 02: February
  • 03: March
  • 04: April
  • 05: May
  • 06: June
  • 07: July
  • 08: August
  • 09: September
  • 10: October
  • 11: November
  • 12: December

Demographic questions (AGE) - Question identifier:AGE_Q01C

What is your date of birth?

Day

Min = 1; Max = 31

Demographic questions (AGE) - Question identifier:AGE_Q02

What is your age?

Min = 0; Max = 999

Demographic questions (DHH)

Demographic questions (DHH) - Question identifier:DHH_Q05

To determine which geographic region you live in, please provide your home postal code.

Long Answer Length = 6

Household Information (HHC)

Household Information (HHC) - Question identifier:HHC_Q05

Including yourself, how many people [18] years of age or older live in your household?

  • 01: 1
  • 02: 2
  • 03: 3
  • 04: 4
  • 05: 5
  • 06: 6
  • 07: 7
  • 08: 8
  • 09: 9
  • 10: 10
  • 11: 11
  • 12: 12
  • 13: 13
  • 14: 14
  • 15: 15
  • 16: 16
  • 17: 17
  • 18: 18
  • 19: 19
  • 20: 20 or more

Sex and gender (GDR)

Sex and gender (GDR) - Question identifier:GDR_R05

The following questions are about sex at birth and gender.

Sex and gender (GDR) - Question identifier:GDR_Q05

What was your sex at birth?

  • 1: Male
  • 2: Female

Sex and gender (GDR) - Question identifier:GDR_Q10

What is your gender?

  • 1: Male
  • 2: Female
  • 3: Or please specify

Sex and gender (GDR) - Question identifier:GDR_R15

Please verify that all of the information is correct.

Your information
Sex assigned at birth: [Male/Female/Information not provided]
Gender: [Male/Female/^GDR_S10/Information not provided]

General health (GEN)

General health (GEN) - Question identifier:GEN_R05

The following questions are about health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

General health (GEN) - Question identifier:GEN_Q05

In general, how is your physical health?

Would you say:

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor

General health (GEN) - Question identifier:GEN_Q10

Compared to before the COVID-19 pandemic, how would you say your physical health is now?

Is it:

  • 1: Much better now
  • 2: Somewhat better now
  • 3: About the same
  • 4: Somewhat worse now
  • 5: Much worse now

General health (GEN) - Question identifier:GEN_Q15

In general, how is your mental health?

Would you say:

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor

General health (GEN) - Question identifier:GEN_Q20

Compared to before the COVID-19 pandemic, how would you say your mental health is now?

Is it:

  • 1: Much better now
  • 2: Somewhat better now
  • 3: About the same
  • 4: Somewhat worse now
  • 5: Much worse now

Chronic conditions (CHR)

Chronic conditions (CHR) - Question identifier:CHR_Q05

Have you been diagnosed by a health care professional with any of the following long-term health conditions? Include only conditions that have lasted six months or more.

  • 01: Chronic lung condition (e.g., emphysema or bronchitis)
  • 02: Asthma
  • 03: Chronic heart disease
  • 04: Diabetes (Exclude gestational diabetes.)
  • 05: Chronic kidney disease
  • 06: Liver disease (e.g., chronic hepatitis)
  • 07: High blood pressure
  • 08: Chronic blood disorder
  • 09: A weakened immune system (e.g., due to disease or medication)
  • 10: Chronic neurological disorder
  • 11: Stroke
  • 12: Alzheimer's disease or other dementia
  • 13: Mental health condition (e.g., depression, anxiety)
  • 14: Cancer
  • 15: Arthritis
  • 16: Other
  • 17: None of the above

Disability status (DIS)

Disability status (DIS) - Question identifier:DIS_Q05

Do you identify as a person with a disability?

  • 1: Yes
  • 2: No

COVID-19 diagnosis (CS)

COVID-19 diagnosis (CS) - Question identifier:CS_Q05

Do you think you have had COVID-19?

  • 1: Yes
  • 2: No
  • 3: Don't know

COVID-19 diagnosis (CS) - Question identifier:CS_Q25

Have you ever been tested for COVID-19?

  • 1: Yes
  • 2: No

COVID-19 diagnosis (CS) - Question identifier:CS_Q30

How long did it take to receive the result of the most recent test?

  • 00: Less than 1 day
  • 01: 1
  • 02: 2
  • 03: 3
  • 04: 4
  • 05: 5
  • 06: 6
  • 07: 7
  • 08: 8 or more

COVID-19 diagnosis (CS) - Question identifier:CS_Q35

Have you ever had a positive test result?

  • 1: Yes
  • 2: No
  • 3: Waiting for results

COVID-19 diagnosis (CS) - Question identifier:CS_Q40

Were you hospitalized for COVID-19?

  • 1: Yes
  • 2: No

COVID-19 diagnosis (CS) - Question identifier:CS_Q70

Did you ever consider getting tested for COVID-19 but did not get tested?

  • 1: Yes
  • 2: No

COVID-19 diagnosis (CS) - Question identifier:CS_Q75

When you considered getting tested, which of the following situations applied to you?

  • 01: Showing symptoms
  • 02: Recent exposure to someone not living with you who had symptoms or was confirmed as having COVID-19
  • 03: Recent exposure to someone you live with who had symptoms or was confirmed as having COVID-19
  • 04: Recent international travel
  • 05: You are a healthcare worker with direct patient contact (Include personal care worker, first responder)
  • 06: You are not a healthcare worker, but your work exposes you to the public (Include grocery or retail store worker, bus driver)
  • 07: Recent exposure at school or daycare
  • 08: Did not have any symptoms but had concerns of infecting others
  • 09: Other

COVID-19 diagnosis (CS) - Question identifier:CS_Q85

Did you experience any of the following difficulties related to COVID-19 testing?

  • 01: Testing unavailable
  • 02: Testing difficult to access (e.g., transportation issues, limited hours)
  • 03: Getting tested is inconvenient
  • 04: Takes too long to get results
  • 05: Do not trust that results are kept confidential
  • 06: Afraid of test procedure
  • 07: Too sick to go to testing site
  • 08: Other
  • 09: Did not experience any difficulties

Regular health care provider (RHC)

Regular health care provider (RHC) - Question identifier:RHC_Q05

Do you have one health professional that you regularly see or talk to when you need care or advice for your health?

  • 1: Yes
  • 2: No

Regular health care provider (RHC) - Question identifier:RHC_Q05A

Who is your regular health care provider?

  • 1: Family doctor or general practitioner
  • 2: Specialist physician (e.g., cardiologist, gastroenterologist)
  • 3: Nurse practitioner
  • 4: Other

Access to health care services (AHC)

Access to health care services (AHC) - Question identifier:AHC_Q05

In the past 12 months, which of the following health care services did you need? Include any services that you have received or are waiting to receive.

  • 01: Consultation or treatment from a family doctor or nurse practitioner
  • 02: Consultation with a specialist medical doctor (e.g., surgeon, allergist, orthopedist, or cardiologist)
  • 03: Treatment for or monitoring of a chronic condition (e.g., high blood pressure, heart disease, kidney disease, diabetes
    Exclude cancer.)
  • 04: Cancer treatment (e.g., radiation, chemotherapy)
  • 05: Screening or diagnostic testing (excluding COVID-19 testing) (e.g., cancer screening, diagnostic imaging, blood tests)
  • 06: Reproductive care or gynaecological services (e.g., prenatal or postnatal, maternity, fertility, treatment of gynaecological concerns or problems, abortion or pregnancy termination services)
  • 07: Surgery (Include any past or scheduled surgical procedures.)
  • 08: Mental health or addiction services such as counselling or therapy
  • 09: Dental care, such as dental cleaning, denture fitting, cavity fillings
  • 10: Other
  • 11: None of the above

Access to health care services (AHC) - Question identifier:AHC_Q10A

Were your appointments (for consultation or treatment from a family doctor or nurse practitioner):

  • 1: Over the phone
  • 2: Video meeting
  • 3: In person
  • 4: Appointment has not yet been scheduled
  • 5: Other

Access to health care services (AHC) - Question identifier:AHC_Q10B

Were your appointments (for consultation with a specialist medical doctor):

  • 1: Over the phone
  • 2: Video meeting
  • 3: In person
  • 4: Appointment has not yet been scheduled
  • 5: Other

Access to health care services (AHC) - Question identifier:AHC_Q10C

What type of screening or diagnostic testing did you need?

  • 1: Cancer screening or diagnosis (e.g., mammography, pap smear, colonoscopy, sigmoidoscopy, stool test, breast imaging as part of screening program, biopsy)
  • 2: Infectious disease screening (e.g., STI or HIV screening)
  • 3: Other blood or urine testing
  • 4: Diagnostic imaging (e.g., MRI, CT scan, x-ray, ultrasound)
  • 5: Other

Access to health care services (AHC) - Question identifier:AHC_Q10D

Which type of reproductive care or gynaecological services did you need?

  • 1: Prenatal, postnatal or maternity
  • 2: Fertility
  • 3: Treatment of gynaecological concern or problem (e.g., cyst, endometriosis, issues with menstrual cycle)
  • 4: Other

Access to health care services (AHC) - Question identifier:AHC_Q10E

Which type of surgery did you require?

  • 1: Joint replacement (e.g., hip replacement, knee replacement)
  • 2: Vision surgery (e.g., cataract surgery)
  • 3: Cancer surgery (e.g., breast, bladder, colorectal, lung, prostate)
  • 4: Cardiac surgery (e.g., coronary artery by-pass graft (CABG))
  • 5: Hysterectomy
  • 6: Other

Access to health care services (AHC) - Question identifier:AHC_Q10F

Where did you seek mental health or addiction services?

  • 1: Family doctor or general practitioner
  • 2: Psychology or counselling office
  • 3: Emergency room
  • 4: Community resource
  • 5: Online portal (e.g., Wellness Together Canada)
  • 6: Other

Access to health care services (AH)

Access to health care services (AH) - Question identifier:AH_Q10

You mentioned previously that you needed health care services during the past 12 months. Did you receive all the health care services you needed?

  • 1: Yes, received all the health care services needed
  • 2: No, did not receive all the health care services needed

Access to health care services (AH) - Question identifier:AH_Q15

Which service have you not received?

  • 01: Consultation or treatment from a family doctor or nurse practitioner
  • 02: Consultation with a specialist medical doctor (e.g., surgeon, allergist, orthopedist, or cardiologist)
  • 03: Treatment for or monitoring of a chronic condition (e.g., high blood pressure, heart disease, kidney disease, diabetes)
  • 04: Cancer treatment (e.g., radiation, chemotherapy)
  • 05: Screening or diagnostic testing (excluding COVID-19 testing) (e.g., cancer screening, diagnostic imaging, blood tests)
  • 06: Reproductive care or gynaecological services (e.g., prenatal or postnatal, maternity, fertility, treatment of gynaecological concerns or problems, abortion or pregnancy termination services)
  • 07: Surgery (Include any past or scheduled surgical procedures.)
  • 08: Mental health or addiction services such as counselling or therapy
  • 09: Dental care, such as dental cleaning, denture fitting, cavity fillings
  • 10: Other

Access to health care services (AH) - Question identifier:AH_Q20

Did you experience any of the following problems with the scheduling of your appointments?

  • 1: One or more of your appointments was cancelled, rescheduled or delayed due to the COVID-19 pandemic
  • 2: One or more of your appointments was cancelled, rescheduled or delayed due to other reasons (Exclude any reason related to the COVID-19 pandemic.)
  • 3: One or more of your appointments has not been scheduled yet
  • 4: Did not experience any problems with the scheduling of your appointments

Access to health care services (AH) - Question identifier:AH_Q25A

Which service had an appointment cancelled, rescheduled or delayed due to the COVID-19 pandemic?

  • 01: Consultation or treatment from a family doctor or nurse practitioner
  • 02: Consultation with a specialist medical doctor (e.g., surgeon, allergist, orthopedist, or cardiologist)
  • 03: Treatment for or monitoring of a chronic condition (e.g., high blood pressure, heart disease, kidney disease, diabetes)
  • 04: Cancer treatment (e.g., radiation, chemotherapy)
  • 05: Screening or diagnostic testing (excluding COVID-19 testing) (e.g., cancer screening, diagnostic imaging, blood tests)
  • 06: Reproductive care or gynaecological services (e.g., prenatal or postnatal, maternity, fertility, treatment of gynaecological concerns or problems, abortion or pregnancy termination services)
  • 07: Surgery (Include any past or scheduled surgical procedures.)
  • 08: Mental health or addiction services such as counselling or therapy
  • 09: Dental care, such as dental cleaning, denture fitting, cavity fillings
  • 10: Other

Access to health care services (AH) - Question identifier:AH_Q25B

Which of the services that you needed had an appointment cancelled, rescheduled or delayed due to another reason?

  • 01: Consultation or treatment from a family doctor or nurse practitioner
  • 02: Consultation with a specialist medical doctor (e.g., surgeon, allergist, orthopedist, or cardiologist)
  • 03: Treatment for or monitoring of a chronic condition (e.g., high blood pressure, heart disease, kidney disease, diabetes)
  • 04: Cancer treatment (e.g., radiation, chemotherapy)
  • 05: Screening or diagnostic testing (excluding COVID-19 testing) (e.g., cancer screening, diagnostic imaging, blood tests)
  • 06: Reproductive care or gynaecological services (e.g., prenatal or postnatal, maternity, fertility, treatment of gynaecological concerns or problems, abortion or pregnancy termination services)
  • 07: Surgery (Include any past or scheduled surgical procedures.)
  • 08: Mental health or addiction services such as counselling or therapy
  • 09: Dental care, such as dental cleaning, denture fitting, cavity fillings
  • 10: Other

Access to health care services (AH) - Question identifier:AH_Q25C

Which of the services that you needed did not have an appointment scheduled?

  • 01: Consultation or treatment from a family doctor or nurse practitioner
  • 02: Consultation with a specialist medical doctor (e.g., surgeon, allergist, orthopedist, or cardiologist)
  • 03: Treatment for or monitoring of a chronic condition (e.g., high blood pressure, heart disease, kidney disease, diabetes)
  • 04: Cancer treatment (e.g., radiation, chemotherapy)
  • 05: Screening or diagnostic testing (excluding COVID-19 testing) (e.g., cancer screening, diagnostic imaging, blood tests)
  • 06: Reproductive care or gynaecological services (e.g., prenatal or postnatal, maternity, fertility, treatment of gynaecological concerns or problems, abortion or pregnancy termination services)
  • 07: Surgery (Include any past or scheduled surgical procedures.)
  • 08: Mental health or addiction services such as counselling or therapy
  • 09: Dental care, such as dental cleaning, denture fitting, cavity fillings
  • 10: Other

Access to health care services (AH) - Question identifier:AH_Q30

Did you experience any other difficulties getting the health care service you needed?

Would you say:

  • 01: Difficulty getting a referral
  • 02: Waited too long between booking appointment and visit
  • 03: Service not available in your area
  • 04: Transportation (e.g., travel restrictions, lack of public transportation)
  • 05: Cost
  • 06: Quarantine rules or office closures
  • 07: Service not available in the official language of your choice
  • 08: Lack of availability of culturally appropriate health services
  • 09: Lack of First Nations, Métis or Inuit traditional medicines, healing or wellness practices
  • 10: Other
  • 11: None of the above

Access to health care services (AH) - Question identifier:AH_Q35

To what extent has your life been affected by difficulties getting health care services or waiting to receive services you needed?

Would you say:

  • 1: Extremely affected
  • 2: Very affected
  • 3: Moderately affected
  • 4: Slightly affected
  • 5: Not at all affected

Access to health care services (AH) - Question identifier:AH_Q40

What were the impacts of the difficulties getting health care services or having to wait to receive services you needed?

Would you say:

  • 1: Worry, anxiety or stress
  • 2: Pain
  • 3: Problems with activities of daily living (e.g., dressing, preparing meals or driving)
  • 4: Overall health deteriorated, condition got worse
  • 5: Other

Oral health (OHC)

Oral health (OHC) - Question identifier:OHC_Q05

In the past 12 months, did you experience any pain in your mouth or teeth?

  • 1: Yes
  • 2: No

Oral health (OHC) - Question identifier:OHC_Q10

Did you try to seek medical or dental attention?

  • 1: Yes
  • 2: No

Oral health (OHC) - Question identifier:OHC_Q15

Where did you seek medical or dental attention?

  • 1: Dental office in person
  • 2: Dental office through virtual consultation
  • 3: Emergency department in a hospital
  • 4: Medical doctor's office in person
  • 5: Medical doctor's office through virtual consultation
  • 6: Other

Oral health (OHC) - Question identifier:OHC_Q20

Did you receive all the medical or dental attention you needed?

  • 1: Yes
  • 2: No

Oral health (OHC) - Question identifier:OHC_Q25

Why did you not try to seek medical or dental attention?

  • 1: Pain resolved on its own or was not severe enough
  • 2: Cost
  • 3: Fear of possible COVID-19 exposure
  • 4: Transportation difficulties
  • 5: Other

Health care inequity and barriers (BHC)

Health care inequity and barriers (BHC) - Question identifier:BHC_Q10

In the past 12 months, did you delay contacting a medical professional about a problem with your physical, emotional or mental health for any of the following reasons?

  • 1: Fear of possible COVID-19 exposure in health care settings (e.g., hospital, clinic)
  • 2: Fear of possible COVID-19 exposure outside of health care settings (e.g., transportation, public spaces)
  • 3: Concern of overloading the health care system
  • 4: Other
  • 5: Did not delay contacting a medical professional

Health care inequity and barriers (BHC) - Question identifier:BHC_Q15

During the past 12 months, did you feel that any health professional held negative opinions about you or treated you unfairly because of any of the following reasons?

Would you say:

  • 01: Your Indigenous identity
  • 02: Your ethnicity or culture
  • 03: Your race or skin colour
  • 04: Your religion
  • 05: Your language
  • 06: Your accent
  • 07: Your physical appearance (Include discrimination on the basis of weight, height, hair style or colour, clothing, jewelry, tattoos and other physical characteristics. Exclude discrimination on the basis of skin colour.)
  • 08: Your sex or gender (Sex refers to sex assigned at birth.
    Include gender diverse identities such as two-spirit or non-binary.)
  • 09: Your sexual orientation (e.g., heterosexual, lesbian, gay, bisexual)
  • 10: Your age
  • 11: A physical or mental disability
  • 12: Some other reason
  • 13: Did not experience any of the above

Medication use (MEU)

Medication use (MEU) - Question identifier:MEU_Q05

In the past 12 months, did you have insurance to cover at least some of the cost of prescription medications?

  • 1: Yes, had insurance for all of the last 12 months
  • 2: Yes, had insurance for part of the last 12 months
  • 3: No

Medication use (MEU) - Question identifier:MEU_Q10

Was your coverage affected by the COVID-19 pandemic (e.g., loss of job or benefits)?

  • 1: Yes
  • 2: No

Medication use (MEU) - Question identifier:MEU_Q15

Did you previously have coverage (more than 12 months ago)?

  • 1: Yes
  • 2: No

Medication use (MEU) - Question identifier:MEU_Q20

Was your coverage affected due to the COVID-19 pandemic (e.g., loss of job or benefits)?

  • 1: Yes
  • 2: No

Medication use (MEU) - Question identifier:MEU_Q25

In the past 12 months, have you taken or were you prescribed any prescription medications?

  • 1: Yes
  • 2: No

Medication use (MEU) - Question identifier:MEU_Q30

What health conditions were these prescriptions meant to treat?

  • 01: Heart disease, high cholesterol, or high blood pressure
  • 02: Asthma
  • 03: COPD (chronic obstructive pulmonary disease)
  • 04: Mental health condition (e.g., depression, anxiety)
  • 05: Diabetes
  • 06: Gut problems (e.g., peptic ulcer, heartburn, bowel disease)
  • 07: Arthritis
  • 08: Chronic pain
  • 09: An infection (e.g., bacterial, fungal, or viral)
  • 10: A type of cancer
  • 11: Oral health problem (e.g., medication for pain or infection)
  • 12: Contraception or birth control
  • 13: Other condition

Medication use (MEU) - Question identifier:MEU_Q35

In the past 12 months, did you do any of the following because of the cost of your prescriptions?

Did you:

  • 1: Not fill or collect a prescription
  • 2: Skip doses of your medication
  • 3: Reduce the dosage of your medication
  • 4: Delay filling a prescription
  • 5: None of the above

Medication use (MEU) - Question identifier:MEU_Q40

In the past 12 months, were you unable to fill a prescription when you needed it because of any of the following problems?

Would you say:

  • 1: Unable to get new prescription from health care provider
  • 2: Unable to fill enough prescription due to 30-day limit on prescriptions
  • 3: Unable to fill prescription because of challenges going to the pharmacy (e.g., fear of contracting COVID-19, cost of transportation)
  • 4: Other
  • 5: None of the above

Medication use (MEU) - Question identifier:MEU_Q45

In the past 12 months, did you have to pay for any prescription medications?

  • 1: Yes
  • 2: No

Medication use (MEU) - Question identifier:MEU_Q50A

What was the approximate out of pocket cost in the past 12 months?

  • 1: $0 to $249
  • 2: $250 to $499
  • 3: $500 to $749
  • 4: $750 to $999
  • 5: $1000 or more

Medication use (MEU) - Question identifier:MEU_Q50B

Was the amount you paid in the past 12 months lower, higher or about the same as the previous 12 months?

  • 1: Lower
  • 2: Higher
  • 3: About the same

Medication use (MEU) - Question identifier:MEU_Q55

In the past 12 months, did you have any difficulty accessing any over-the-counter medications that you felt you needed? Over-the-counter medications could include such things as pain killers, antacids, allergy medication and hydrocortisone creams.

  • 1: Yes
  • 2: No
  • 3: Did not require over-the counter medications

Medication use (MEU) - Question identifier:MEU_Q60

What were the reasons you had difficulty accessing over-the-counter medications?

  • 1: Medication not available
  • 2: Did not want to go to pharmacy
  • 3: Unable to travel to pharmacy
  • 4: Could not afford the medication
  • 5: Other

Indigenous identity (IS)

Indigenous identity (IS) - Question identifier:IS_Q01

Are you First Nations, Métis or Inuk (Inuit)?

  • 1: No, not First Nations, Métis or Inuk (Inuit)
  • 2: Yes, First Nations (North American Indian)
  • 3: Yes, Métis
  • 4: Yes, Inuk (Inuit)

Indigenous identity (STI)

Indigenous identity (STI) - Question identifier:STI_Q05

Are you a Status Indian (Registered or Treaty Indian as defined by the Indian Act of Canada)?

  • 1: Yes, Status Indian (Registered or Treaty)
  • 2: No

Indigenous identity (STI) - Question identifier:STI_Q10

Are you a registered member of a Métis organization or Settlement?

  • 1: Yes, registered member of a Métis organization or Settlement
  • 2: No

Indigenous identity (STI) - Question identifier:STI_Q15

Select or specify the name of Métis organization or Settlement

  • 1: Métis Nation of Ontario
  • 2: Manitoba Metis Federation
  • 3: Métis Nation - Saskatchewan
  • 4: Métis Nation of Alberta
  • 5: Métis Nation British Columbia
  • 6: Or please specify

Indigenous identity (STI) - Question identifier:STI_Q20

Are you enrolled under, or a beneficiary of, an Inuit land claims agreement?

  • 1: Yes
  • 2: No

Indigenous identity (STI) - Question identifier:STI_Q25

Which Inuit land claims agreement?

  • 1: Inuvialuit Final Agreement
  • 2: Nunavut Agreement (Nunavut Land Claims Agreement)
  • 3: James Bay and Northern Quebec Agreement (Nunavik)
  • 4: Labrador Inuit Land Claims Agreement (Nunatsiavut)
  • 5: Other

Sociodemographic characteristics (PG)

Sociodemographic characteristics (PG) - Question identifier:PG_Q05

The following question collects information in accordance with the Employment Equity Act and its Regulations and Guidelines to support programs that promote equal opportunity for everyone to share in the social, cultural, and economic life of Canada.

Are you:

  • 01: White
  • 02: South Asian (e.g., East Indian, Pakistani, Sri Lankan)
  • 03: Chinese
  • 04: Black
  • 05: Filipino
  • 06: Arab
  • 07: Latin American
  • 08: Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai)
  • 09: West Asian (e.g., Iranian, Afghan)
  • 10: Korean
  • 11: Japanese
  • 12: Other

Place of birth, immigration and citizenship (DEM1)

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30A

Where were you born?

  • 1: Born in Canada
  • 2: Born outside Canada

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30B

Are you a Canadian citizen?

  • 1: Yes, a Canadian citizen by birth
  • 2: Yes, a Canadian citizen by naturalization (Canadian citizen by naturalization refers to an immigrant who was granted citizenship of Canada under the Citizenship Act.)
  • 3: No, not a Canadian citizen

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30C

Are you a landed immigrant or permanent resident?

  • 1: No
  • 2: Yes

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q35

In what year did you first become a landed immigrant or a permanent resident?

Min = 0; Max = 9999

Language (LAN)

Language (LAN) - Question identifier:LAN_Q01

Can you speak English or French well enough to conduct a conversation?

  • 1: English only
  • 2: French only
  • 3: Both English and French
  • 4: Neither English nor French

Language (LAN) - Question identifier:LAN_Q04A

What is the language that you first learned at home in childhood and still understand?

If you no longer understand the first language learned, indicate the second language learned.
English

  • 1: Yes
  • 2: No

Language (LAN) - Question identifier:LAN_Q04B

What is the language that you first learned at home in childhood and still understand?

If you no longer understand the first language learned, indicate the second language learned.
French

  • 1: Yes
  • 2: No

Language (LAN) - Question identifier:LAN_Q04C

What is the language that you first learned at home in childhood and still understand?

If you no longer understand the first language learned, indicate the second language learned.
Other

  • 1: Yes
  • 2: No

Education (ED)

Education (ED) - Question identifier:ED_Q05

What is the highest certificate, diploma or degree that you have completed?

  • 1: Less than high school diploma or its equivalent
  • 2: High school diploma or a high school equivalency certificate
  • 3: Trades certificate or diploma
  • 4: College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
  • 5: University certificate or diploma below the bachelor's level
  • 6: Bachelor's degree e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B.
  • 7: University certificate, diploma or degree above the bachelor's level

Labour market activities (LMAM)

Labour market activities (LMAM) - Question identifier:LMAM_R01

Many of the following questions concern your activities last week.

Last week is from [(THISDATE - 7)] to [(THISDATE - 1)].

Labour market activities (LMAM) - Question identifier:LMAM_Q01

During that week, did you work at a job or business?

  • 1: Yes
  • 2: No

Labour market activities (LMAM) - Question identifier:LMAM_Q02

During that week, did you have a job or business from which you were absent?

  • 1: Yes
  • 2: No

Labour market activities (LMAM) - Question identifier:LMAM_Q03

What was the main reason you were absent from work that week?

Would you say:

  • 1: Planned absence not related to COVID-19 (e.g., vacation, work schedule, maternity or parental leave, seasonal job or business)
  • 2: Unplanned absence not related to COVID-19 (e.g., illness or disability other than COVID-19, caring for children or elder relative for non-COVID-19 reasons, labour dispute (strike or lockout))
  • 3: Business closure or layoff related to COVID-19
  • 4: Personal circumstances related to COVID-19 (e.g., personal safety, own or household member's diagnosis, self-isolation after recent travel, taking care of children due to school closure)

Total household income (THI)

Total household income (THI) - Question identifier:THI_R01

Now a question about total household income.

Total household income (THI) - Question identifier:THI_Q01

What is your best estimate of your total household income received by all household members, from all sources, before taxes and deductions, during the year ending December 31, ^REFYEAR?

Min = -99999999; Max = 99999999

Administrative information (ADM)

Administrative information (ADM) - Question identifier:ADM_R05

To enhance the data from this survey and to minimize the reporting burden for respondents, Statistics Canada will combine your responses with your health information. Statistics Canada may also add information from other surveys or administrative sources.

Administrative information (ADM) - Question identifier:ADM_Q10

Having a provincial or territorial health card number will assist us in linking to this other information. Do you have a provincial or territorial health card number?

  • 1: Yes
  • 2: No

Administrative information (ADM) - Question identifier:ADM_Q10A

For which province or territory is your health card number?

  • 10: Newfoundland and Labrador
  • 11: Prince Edward Island
  • 12: Nova Scotia
  • 13: New Brunswick
  • 24: Quebec
  • 35: Ontario
  • 46: Manitoba
  • 47: Saskatchewan
  • 48: Alberta
  • 59: British Columbia
  • 60: Yukon
  • 61: Northwest Territories
  • 62: Nunavut
  • 88: Does not have a Canadian health number

Administrative information (HN)

Administrative information (HN) - Question identifier:HN_Q05A

What is your health card number?

Enter a health card number for ^HNPROV_E. In ^HNPROV_E, the health number is made up of ^DIGITS_E. Do not insert blanks, hyphens or commas between the numbers.

^HNSPEC_E

Long Answer Length = 80

Data sharing agreements (DSA)

Data sharing agreements (DSA) - Question identifier:DSA_R01

To avoid duplication of questionnaires, Statistics Canada may enter into agreements to share the data from this survey, including postal code, with the Public Health Agency of Canada, Health Canada[, the 'Institut de la Statistique du Québec/' '] and provincial and territorial ministries of health. Names, addresses, telephone numbers and health numbers will not be shared. Only organizations that have agreed to keep your information confidential and use it only for statistical purposes will receive the data.

Data sharing agreements (DSA) - Question identifier:DSA_Q01

Do you agree to share your information with the Public Health Agency of Canada, Health Canada[, the 'Institut de la Statistique du Québec/' '] and provincial and territorial ministries of health?

  • 1: Yes
  • 2: No
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