Edited by: Andrzej Klimczuk, Warsaw School of Economics, Poland
Reviewed by: Andreas Ihle, Université de Genève, Switzerland; Hamdi Chtourou, University of Sfax, Tunisia
This article was submitted to Sociological Theory, a section of the journal Frontiers in Sociology
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Drawn from the stress process model, the pandemic has imposed substantial stress to individual economic and mental well-being and has brought unprecedented disruptions to social life. In light of social distancing measures, and in particular physical distancing because of lockdown policies, the use of digital technologies has been regarded as the alternative to maintain economic and social activities. This paper aims to describe the design and implementation of an online survey created as an urgent, international response to the COVID-19 pandemic. The online survey described here responds to the need of understanding the effects of the pandemic on social interactions/relations and to provide findings on the extent to which digital technology is being utilized by citizens across different communities and countries around the world. It also aims to analyze the association of use of digital technologies with psychological well-being and levels of loneliness. The data will be based on the ongoing survey (comprised of several existing and validated instruments on digital use, psychological well-being and loneliness), open for 3 months after roll out (ends September) across 11 countries (Austria, France, Germany, India, Malta, Portugal, Romania, Spain, Turkey, and UK). Participants include residents aged 18 years and older in the countries and snowball sampling is employed via social media platforms. We anticipate that the findings of the survey will provide useful and much needed information on the prevalence of use and intensities of digital technologies among different age groups, gender, socioeconomic groups in a comparative perspective. Moreover, we expect that the future analysis of the data collected will show that different types of digital technologies and intensities of use are associated with psychological well-being and loneliness. To conclude, these findings from the study are expected to bring in our understanding the role of digital technologies in affecting individual social and emotional connections during a crisis.
The ongoing COVID-19 pandemic, is one of the worst pandemics in human history and in the last 100 years, on a global scale and has resulted in ~21,294,845 (267,291—in the last 24 h) infected cases, and 761,799 deaths (5,985—in the last 24 h) (World Health Organization,
To date, there is a growing body of scholarly research relating to the impact of COVID-19 and citizens across different countries and continents. This includes Ammar et al. (
Scholarly research surrounding the use, benefits and impacts of digital technology in the lives of older citizens, as well as those of younger citizens (Ito et al.,
When focusing on social isolation, loneliness and the digital divide, there is a myriad of scholarly research surrounding older adults and includes exploring older adults' attitudes toward technology adoption and use (Mitzner et al.,
Based on the growing literature highlighted above and in the next section, coupled with the rise of digital technologies in terms of social networking sites, virtual conferencing, etc. there is alternative thoughts and approaches to maintaining social connections and activities during the crisis. In general, this growth in scholarly research illustrates a fast-moving arena within the fields of sociology, general social sciences, computer science and gerontechnology. In addition to a series of national and international research projects focusing on the various impacts and roles that technology can play within society (Ivan et al.,
The purpose and rationale of this paper is to describe a study protocol which includes a description of the Consortium members, the online instrument used for data collection, coupled with future work and dissemination activities. This study protocol details the urgency and the international response to the COVID-19 pandemic. We anticipate the preliminary findings will provide an insight into the use of digital technologies and the impacts of using digital technologies on psychological well-being and loneliness.
In what follows we summarize previous projects that have targeted individuals through using online tools to collect data across different countries and individual's age-groups.
The ACT (aging + communication + technologies) project (ACT project, 2014–2021) is a Canadian-funded partnership that brings more than 45 international researchers, community partners and institutions together. By means of different pilot projects and case studies, ACT aims to explore and understand the transformational experiences of aging through various mediums of communication. It develops research in three main areas.
First, “Agency in Aging” encompasses a program of research that involves individuals and communities in the development of participatory action research projects in the field of the digital arts that have both scholarly and creative outcomes. Second, “Critical Mediations” examines the everyday life practices, the various mediated experiences of adults in later life, and the existing cultures of aging. Finally, “Telecommunication Technologies” investigates aging in the context of networked societies. Of interest to this paper are two cross-country projects, one which consists of an online longitudinal study about older audiences in the digital media environments and another, Grannies on the Net, about the role of information and communication technologies (ICTs) in grandmothers' interactions with close and distant social ties.
The online longitudinal research about older audiences in the digital media environments (2016–2020) (Loos et al.,
The results of the Grannies on the Net project, which examines the role of ICTs in grandmothers' interactions with close and distant social ties, uncovered the varying motives and use strategies grandmothers deploy to communicate with a diversity of actors while revealing commonalities in the challenges they face in different cultural contexts. We tackled the role of ICT in reducing grandmothers' feeling of loneliness and their need to share everyday experiences with loved ones (Ivan and Hebblethwaite,
The Technology In Later Life (TILL) project (
The notion of exploring and understanding how intergenerational relationships can be enhanced and maintained via technology use was also suggested (Marston et al.,
Finally, intergenerational experiences were noted through data collection in the TILL study and were pivotal in continuing social connections with family and friends (Freeman et al.,
The Technology 4 Young Adults (Technology 4 Young Adults (T4YA) Project,
The interdisciplinary research project “Internet and Mental Health” (2016–2019) aimed to investigate the psychosocial effects of using online media. In Germany, a nationally representative survey of 1,929 adolescents and younger adults (aged 14–39 years) focused on topics such as social media and gaming disorder (Reer et al.,
The “Being Connected at Home - Making use of digital devices in later life” project (BCONNECT HOME, 2018–2020) investigates fundamental changes in the contemporary experience of later life, at the intersection of digital infrastructures, place and the experience of “being connected” (Fernández-Ardèvol et al.,
The ACCESS Project (Supporting Digital Literacy and Appropriation of ICT by older people, 2018–2021) aims to provide and evaluate socially embedded learning opportunities for older adults who are digitally excluded. The aim of the project is to support older adults to learn and appropriate new digital technologies later in life in Austria, Germany, Italy, Finland and Japan. It addresses a research gap by exploring informal, non-formal and formal learning settings in later life and further developing it through combination of such approaches with different forms of learning (courses, senior-to-senior approaches, praxlabs) (Gallistl et al.,
The project “App-Solute News: Intergenerational Learning, Digitalisation and the Media” (2020–2022) looks at the daily routine of newspaper reading in the context of the transition from analog (printed paper) to digital (e-paper and app). Intergenerational teams of students and adults 60+ in the region of Styria in Austria will compare their reading habits, work with printed papers and e-paper apps, and create digital stories about their experiences. The aim is to investigate the narratives that are formed in these intergenerational encounters with regard to the transition from analog to digital. The project aims at understanding the role of age and age-related stereotypes in digitalisation processes.
Building upon the extensive projects conducted before, this study is expected to bring in a sociological lens to look into the influence of using digital technologies. The ongoing COVID-19 pandemic as a health crisis has resulted in the disruption of work, family support, education and social interaction. These changes may have formed heath, social and economic stressors to one's psychological well-being in the times of ongoing crisis. The stress-process model illustrates how economic strains and changing social circumstances become long-term stressors that impact individual health and well-being and how various sociodemographic groups may have different degrees of impacts (Pearlin et al.,
While the aforementioned projects address issues related to the use and impact and appropriation of digital technology in people's lives, this paper reports on a study that, although addressing adjacent goals to those of the projects above, emerges in the context of the current COVID-19 pandemic scenario. Freeman et al. (
The project- COVID-19: Technology, Social Connections, Loneliness and Leisure Activities (
Secondly, ecology theory will afford the Consortium to examine, explore and discuss the role played by digital technologies during the pandemic, as the medium to improve citizens' social connections, which in turn enables citizens social resources and support to reduce feeling of loneliness. Additionally, the ecology theory will facilitate application associated to 1. the levels of loneliness, 2. the decomposition of the user profile and, 3. to ascertain the types of digital technology used by citizens during the pandemic across four areas: 1. Individual, 2. Relationship (e.g., family, peers, and friends), 3. Community (e.g., groups, networks, workplace, neighborhoods), and 4. Societal (Berkes and Folke,
The aim of this paper is to describe the online instrument of the COVID-19: Technology, Social Connections, Loneliness and Leisure Activities (
The surveys across 11 countries under the project: COVID-19: Technology, Social Connections, Loneliness and Leisure Activities (
explore the behavior and use of technology by citizens during the COVID-19 pandemic
explore how citizens use technology to connect with COVID-19 support groups
explore how citizens use technology to share information during the COVID-19 pandemic
explore the health and well-being of citizens during COVID-19 relating to loneliness and digital health literacy
explore the perception and notion of a national emergency alert system by citizens
explore the behavior and narratives of users who are using technology to maintain familial and friendship social connections and build new connections during the COVID-19 pandemic.
As can be seen, these aims are incorporated into the online survey and will provide important data on how people have been using digital technologies and the differentiations of digital technologies during the pandemic. Moreover, the survey also covered health-related questions, which enable researchers to look into the health and well-being of the respondents.
Ethical approval for conducting the online survey was initially granted by the lead and respective University, The Open University (HREC/3551/MARSTON) located in the UK.
Subsequent ethical approval has been processed and approved by the National University of Political Studies and Public Administration (SNSPA–Romania), Open University of Catalonia (Spain), Singapore University of Social Sciences (Singapore), Department of Health Sciences Management, University of Malta–(Malta), the Department of Informatics Engineering (DEI)/Center for Informatics and Systems (CISUC) at the University of Coimbra (Portugal), the Department of Mass Communication and Media Studies at the Central University of Punjab (India), Nursing Science, Age and Care Research Group at the Medical University Graz (Austria), Department of Sociology at the University of Vienna, the Department of Age and Care Research Group at the University of Graz (Austria), the Department of Communication at the University of Münster (Germany), and Canakkale Onsekiz Mart University in Turkey.
All versions of the survey, study information sheet and certification from respective Universities have been shared with The Open University Human Research Ethics Committee (HREC) to ensure those respective records are maintained and kept up to date.
All documentation lists the ethical approval granted by the lead University and the respective University ethical committee or board. Informed consent was obtained by all participants taking part in this online survey.
Upon completion and deployment of the English version of the survey, the project lead (HRM) contacted colleagues in a bid to expand the survey and increase participant recruitment. This resulted in the lead for Romania (RO) requesting the word documents to be translated and rolled out across Romania.
This, in turn, led to the UK and RO leads utilizing their existing networks and inviting their respective colleagues to join the project. HRM provided a description of the study, responsibilities, and expectations to prospective partners, and once a partner confirmed their involvement, the English survey and study information sheet was provided to the respective partner to allow for back/translation to commence. A copy of the ethics application by HRM at The Open University was shared with the respective partner to facilitate the respective partner to expedite their own ethical approval process.
Given the focus of this work and the restrictions imposed by the respective Universities and Countries, participant recruitment is being conducted through multiple channels in what constitutes a
To obtain insights into the current COVID-19 health crisis during the lockdown period, a virtual
Currently, some surveys are still ongoing, and it is not possible to provide a complete overview of participant demographics of this study. However, the 11 study sites involved in the project include an interesting subset of countries, representing different socio-economic groups and population characteristics (
Demographic characteristics of the countries included in this study (United Nations, (
Austria | 9,006,398 | 109 | 43 | 82.05 | 0.12% | High-Income |
France | 65,273,511 | 119 | 42 | 83.13 | 0.84% | High-Income |
Germany | 83,783,942 | 240 | 46 | 81.88 | 1.07% | High-Income |
India | 1,380,004,385 | 464 | 28 | 70.42 | 17.70% | Lower-Middle Income |
Malta | 441,543 | 1380 | 43 | 83.06 | 0.01% | High-Income |
Portugal | 10,196,709 | 111 | 46 | 82.65 | 0.13% | High-Income |
Romania | 19,237,691 | 84 | 43 | 76.50 | 0.25% | High-Income |
Singapore | 5,850,342 | 8358 | 42 | 86.15 | 0.08% | High-Income |
Spain | 46,754,778 | 94 | 45 | 83.99 | 0.60% | High-Income |
Turkey | 84,339,067 | 110 | 32 | 78.45 | 1.08% | Upper-Middle-Income |
United Kingdom | 67,886,011 | 281 | 40 | 81.77 | 0.87% | High-Income |
The online survey rolled out for the study uses the Qualtrics platform as the sole method of deployment across different networks. The English version of the survey is based on previous iterations and studies conducted by the lead author (Marston,
For a new survey to be added to the Qualtrics platform, a copy is made within the platform and the lead author transfers (manually, copy and paste) the translated version of the survey into the new project. The project is named in that respective language. Once the translation is transferred, the survey is exported into Microsoft Word, saved, and shared with the partner(s) to review for any errors, changes in questions to reflect the cultural context and resent for amendments within the Qualtrics platform. In some instances back to HRM, the survey may have several colleagues from one institution reviewing the documentation and suggesting revisions. Once the respective partners have agreed that the documentation is correct, the respective online measuring instrument goes through some usability testing, on various hardware devices, and changes are suggested. Once this stage has been agreed, the instrument is copied again, and republished, in preparation for rollout.
Displays the survey iterations.
1 | Hannah R. Marston, Sarah Earle | UK | English | USA, Canada, Singapore, Australia | 03.04.2020 | Approved |
2 | Loredana Ivan | Romania (RO) | Romanian | Romania | 20.04.2020 | Approved |
3 | Mireia Fernández-Ardèvo, D. Blanche Tarragó, A. Rosales Climent, M. Gomez Leon | Spain | Catalan Spanish | Spain and Hispanic America | 04.05.2020 | Approved |
4 | Sophie Colas | France | French | France, Switzerland, Belgium, Quebec (CA) | 12.05.2020 | Approved via The Open University |
5 | Pei-Chun Ko | Singapore | Mandarin | Singapore | 12.05.2020 | Approved |
6 | Halime Öztürk Çalikoǧlu, Hasan Arslan, Burcu Bilir | Turkey | Turkish | Turkey | 26.06.2020 | Approved |
7 | Rubal Kanozia | India | Hindi | India | 31.05.2020 | Approved |
8 | Vera Gallistl, Ulla Kriebernegg, Franziska Groβschädl, Gerhilde Schüttengruber, Rebekka Rohner, Hanna Kottl | Austria | German | Germany,Switzerland | 05.06.2020 | Approved |
9 | Feliz Reer, Thorsten Quandt | Germany | German | Austria/Switzerland | 04.06.2020 | Approved |
10 | Sandra C. Buttigieg | Malta | British English | Malta | 19.05.2020 | Approved |
11 | Paula Alexandra Silva | Portugal | European Portuguese | Portugal | 29.05.2020 | Approved |
The surveys build on previous iterations from the Technology 4 Younger Adults (T4YA) study (Marston,
In total there have been seven scholarly works published using earlier iterations of this survey (Marston,
This new iteration of the English version of the survey comprises 65-items (
Presents an overview of the measuring variables included in the COVID-19 technology, self-isolation, health, well-being, and leisure activities study.
Participant Consent Q1 | Participant consent | NA | NA |
Section A |
Computer ownership, purpose of using a computer, length and frequency of use, video game console ownership, favorite type of game to play. How the internet is accessed, frequency of using the internet, purpose of using the internet. Type of social media platforms used, frequency and purpose of using social media platforms. | • Have you used a computer? (select answer) |
(Marston, |
Section B |
COVID-19 related questions: purpose of using technology/internet/social media platforms to share information, communicate with support groups, challenges faced during COVID-19. | • Since COVID-19, have you become a member of a community support group on social media (e.g., Facebook or similar)? |
Q17-25 - new items added aimed specifically at Covid-19 experiences. |
Section C |
13-items, 1–7 pt Likert COVID-19 related questions | • Making new social connections/friendships |
New items added relating to Covid-19 |
Section D |
18-item measure, 1–7 pt Likert Psychological well-being | • “I am good at managing the responsibilities of daily life.” |
Ryff and Keyes, |
Section E |
8-item measures, 1–5 pt Likert scale eHealth/digital literacy | • I know where to find helpful health resources on the Internet |
Norman and Skinner, |
Section F |
UCLA Loneliness scale |
• How often do you feel that you are “in tune” with the people around you? |
Russell, |
Section G |
Social networks, virtual assistants and emergency alert systems | • During the COVID-19 pandemic, how frequently have you communicated with members of your social network? Please rate your answers below on each of the sliders |
New items added to the survey. |
Section H |
Demographic questions: gender, age, country, ethnicity, geographic location, education, sexuality, marital status, #of people living your home, #of children living your home, employment status, disability, self-isolation | • Do you meet the criteria for being vulnerable or extremely vulnerable? |
(UK Government, ( |
Furthermore, a slight change in wording for questions relating to the national emergency alert system were renamed to “Public Warning System” in Singapore. Both versions in India (English and Hindi) as well as the version in European Portuguese, French and German do not include the question relating to ethnicity. In some instances, the types of educational qualification were altered to represent the respective cultural contexts. This occurred for translations in Catalan and Spanish, European Portuguese, and German. The Spanish version was also aimed at rolling out in extended networks across Hispanic America. Additionally, in both the Catalan and Spanish versions the questions relating to a national emergency alert system were deleted, and this was on the guidance of the partners in the project, because they felt that in their targeted countries there were either no such systems in place, or no public discussion on the matter, making the question difficult to answer in most instances.
The project lead for the UK shares a copy of the study information sheet and a copy of the English survey with the new consortium partner. If a partner has additional colleagues, communication is limited to reduce the risk of information being misunderstood and to ensure all communication between the two coordinators is correct. This is a practical approach during the survey translation(s) and testing phases.
Each new country/partner applies for ethical approval through their respective University ethics committee. Additional documentation from the UK partner is shared based on the favorable opinion granted by the Open University (HREC/3551/MARSTON). A copy of the ethics application is also shared to assist the respective partner in completing their ethics application. Furthermore, each partner has the option to attach this document and the favorable opinion to their respective application.
The Qualtrics platform is used to create and deploy the survey to adhere to the Open University policies. All translated surveys from each study partner are transferred into a new project within the platform and exported to Microsoft Word for checking by the Consortium partner. Each revision within the platform is published and allows the consortium partner to test their respective survey for user experience (UX)/usability issues and formatting. At each revision, the consortium partner receives an updated version of the survey via a Word document and is able to review the survey online.
Once ethical approval is granted, the survey was “published” via the Qualtrics platform, which created an independent link that is shared via various channels (specific email(s), anonymous link etc.). The COVID-19: Technology, Social Connections, Loneliness and Leisure Activities (
To assist prospective participants to identify the correct survey to complete, a series of flags are placed at the side of each translated section (
Figure displays three partners involved in the study and their respective flags, study information, contact information. For each partner/country, there were additional links to the online survey, study information sheet, and consent form.
Figure displays three partners involved in the study and their respective flags, study information, contact information. For each partner/country, there were additional links to the online survey, study information sheet, and consent form.
Figure displays three partners involved in the study and their respective flags, study information, contact information. For each partner/country, there were additional links to the online survey, study information sheet, and consent form.
Figure displays three partners involved in the study and their respective flags, study information, contact information. For each partner/country, there were additional links to the online survey, study information sheet, and consent form.
For each country/consortium partner, there is a contact email address available on the study website and the study information sheet. This facilitates the participant(s) to contact the researcher in charge of the survey in each particular language (
In this section of the study protocol, we outline how the collected data and subsequent analysis will drive the results forward. Each survey translation closes at various times and at present between 4th July and 29th September 2020. The data analysis will take the form of descriptive statistics with crosstabulations and multivariate regression models to provide preliminary descriptive findings. This in turn will drive the results to afford the Consortium members to explore and understand the collected data from the standpoint of (a) age, (b) gender, (c) education, and (d) country.
Our sample is a convenience sample in all countries included in the study and we do not claim to have statistical and national representative at the country level. Still, we will conduct further analysis if the structure of our sample in each country is comparable with the structure of the adult population with Internet access (age, gender, education level and economic status).
To consider the differences across the countries and cultures included in the study, this project relies on a research team that consists of native speakers and local researchers, who are and will play an important role in contextualizing the respective data. Additionally, members of the research team have the role in comparing the data across the main socio-demographics (age, gender, level of education, economic status) and to provide valuable information regarding the comparability of the sample in the current proposal with the structure of the total adult population in the respective countries.
We anticipate the collected data will provide an insight into the prevalence of different types of digital technologies with the crosstabulations of various sociodemographic characteristics. While each study site will be conducting their own data analysis, we will also be merging the different data sets into STATA to facilitate greater statistical analysis via multivariate analyses to understand the impact(s) of digital technologies on well-being and loneliness. All surveys will be closed by the end of September.
As part of the ethical process at The Open University an online repository is used—Open Research Data Online (ORDO). A separate project has been created by the lead, and all partners have been invited to join the project. ORDO will be used to store all final documents, data and associated information relating to this study. Each country/region has its individual folder to facilitate ease of organization, access and following the policies of The Open University.
This is a cooperative project that responds to the need of urgent information during the unexpected COVID-19 pandemic. The project lead has already defined the operational dynamics of the study to grant fast and sustainable outputs (academic journals, policy recommendations) as well as other dynamics in search of the establishment of a consortium able to create an intellectual community around the gathered data. Each study site has worked with the project lead to ensure the translated survey has conducted backwards translation of the online survey and to ensure the meaning(s) of the survey questions are not lost. Each site lead was responsible for their own participant recruitment—via mailing lists, various social media channels (e.g., Twitter and Facebook) and will be responsible for data analysis.
In this study protocol we are describing how this international, multi-centered project has been designed to explore and understand how digital technology and associated platforms are being used by citizens and how digital technology impacts on their day-to-day lives during the COVID-19 pandemic, across different countries, regions and cultures. With this in mind, participants of the study are welcome to complete a survey if they are over 18 years old. Given the unprecedented crisis on a global scale, citizens in society are living and experiencing life differently to what society was prior to the pandemic and also differently depending on the country they live in. Therefore, it is important to explore how technology is having an impact on citizens from the age of 18+ years, rather than just focusing on older adults as this will allow for comparisons between generations.
In particular, it is essential to capture the possibilities that digital technology affords citizens during this pandemic a as way of garnering insights with the view to working toward respective pathways to impact, which in turn has the ability to inform policy and decision makers at local, regional, national and international levels. The fact that this survey is being deployed across several different languages, affords the Consortium members to reach out and understand different cultures and demographics. Furthermore, this project lends itself to understanding the necessary multidimensional perspective required to develop effective and meaningful pathways associated to social science and behavioral research, public engagement, knowledge translation and pathways to impact in the future. Moreover, this international project affords the Consortium partners to understand how digital technology is used and impacts society at a time when social distancing measures were varied and may afford the research team to understand and explore possible suggestions and solutions to feed into policy.
This study protocol describes the COVID-19: Technology, Social Connection, Loneliness and Leisure Activities project and we anticipate the findings driven from the collected data will contribute to the fields of gerontechnology, Human Computer Interaction (HCI), gerontology, and social sciences by the creation of a Master dataset and individual datasets from each site. Furthermore, this research will contribute to the existing scholarly research (Morris et al.,
Currently, existing scholarly research demonstrates the growing interest in contemporary academe surrounding the use of digital technology as a bridge to maintain social connections and interactions while reducing loneliness; with the aim of understanding how technology has impacted the lives of many citizens worldwide. This study protocol describes how this particular study, to the knowledge of the Consortium, is the first to take an international, interdisciplinary rapid response to the COVID-19 pandemic, while contributing to existing respective disciplines.
The social impacts of the pandemic can be understood through the lens of the digital divide with the intersectionality of education, gender and age. The project is expected to bring in first-hand data to understand the prevalence of technology associated to the different socio-demographic groups. This in turn will afford us to understand whether the COVID-19 pandemic narrows the digital gap or widens it. Incorporated with the loneliness scale and the questions of the activities, researchers can examine the extent to which digital technology use influences individuals' mental well-being and social connections, and the heterogeneity among social groups.
Future work surrounding the Consortium members and the collected data will explore funding opportunities to enable the next phase of this project—pathways to impact and dissemination activities. The former may include an Open Educational Resource (OER) developed and accessible via The Open University which will include input from all project partners and will include content related to the findings. This in turn will enable citizens, policy makers, stakeholders, and researchers on a global scale to access, learn, and understand how digital technologies played a role and impacted the lives of citizens across 11 countries. Dissemination activities will include traditional academic outputs (e.g., journal papers and conference presentations), seminars, booklets/reports and where appropriate contributing to policy.
The studies involving human participants were reviewed and approved by The Open University (UK) HREC/3551/MARSTON. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. All study sites received ethical approval prior to survey deployment. The French version of the online survey was approved via the Open University.
HM: conceptualization. HM, LI, MF-A, AR, MG-L, DB-T, SE, P-CK, SC, BB, HÖ, HA, RK, UK, FG, FR, TQ, SB, PS, VG, RR, and the COVID19 Technology Consortium Group: writing – original draft preparation, review, and editing. All authors contributed to the article and approved the submitted version.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Thank you to all author/site led for conducting survey translation(s) in preparation for survey deployment. We would also like to thank all participants who completed the online survey via the various social media channels, mailing lists, and snowball approaches.