1

Chapter 1
THE PROBLEM AND ITS BACKGROUND

Introduction

According to the study by Calma (1997), Tourism is viewed as a manifestation of

moderns societys need for recreations and leisure. It is a result of paid vacation and
available disposable income of the aging society. It is also an expression of an informal
communication and technological change which makes mass travel to distant places
possible.
In todays busy world, each person needs something to invigorate himself out of
the monotonous routine of daily job. The main reason why people go out to try
something new or to travel and explore places is because they desire to recreate or
rejuvenate themselves, to find his inner that is self-exhausted and bored because of too
much work and uncertainties. And when you want to travel, its make easier to go places
that is convenient to go, less traffic, and basically to enjoy the place and the food.
Apparently, some of the famous cities like Makati, Ortigas, etc., are already
congested. Is it nice to experience as you explore the city, you would feel the nature? Or
something that would really worth trying to visit? Probably even if your feet hurt because
of too much walking, the place wherein you can eat will give you the energy or the
positive vibes. Then why not visit The Fort?

2
The City of Taguig is a highly urbanized city located in south-eastern portion
of Metro Manila in the Philippines. From a thriving fishing community along the shores
of Laguna de Bay, it is now an important residential, commercial and industrial canter.
The construction of the C-5 highway and the acquirement of the Fort Bonifacio
development area have paved the way for the cityhood of the municipality.
Fort Bonifacio, also known as Bonifacio Global City or The Fort was once called
Fort McKinley when the United States government first acquired in 1902. Three years
after the Philippines gained independence from the United States, Fort McKinley was
turned over to the Philippine government. In 1957, it was renamed Fort Bonifacio after
Andres Bonifaciothe Father of Philippine Revolution. In 2003, Ayala Land, Inc. and
Evergreen Holdings, Inc. partnered with Bases Conversion and Development Authority
to help shape and develop Bonifacio Global Cityturning an area once synonymous
with war and aggression into the world-class business and residential center it is today
(http://www.fbdcorp.com/history/).

Today, one of the most recognized places at the center of The Fort is Bonifacio
High Street and was developed by Ayala Land. Some simply call it High Street. The mall
redefines the visitors perception to a touch of nature and a combination of the mall
experience. It boasts of chic boutiques, a row of diverse cuisines, trendy bars and at the
center a grass lawn park with interactive sculptures. The place is surrounded by
residential condominiums, business offices, malls, and other buildings under

3
constructions that will soon to be hotels and high end offices for business processing
companies (http://www.philippinestravelwiki.com/manila/bonifacio-high-street).
Furthermore, Bonifacio High Street offers a mixed of variety restaurants can be
found at the vicinity of BHS. Texas Roadhouse Grill, TGI Fridays, Clawdaddy, Cue
Modern BBQ, etc., are some of the famous restaurants managed and owned by the
Americans.
With these yummy places to eat, who wouldnt want to go for food hopping?

Background of the Study

Tourism is becoming one of the fastest growing sectors in the world. It plays an
integral part of economic development strategies in developing nations since the 1960s
(Lin and De Guzman, 2007). For decades, it has been a major component in the
increased of economic activity in the different parts of the world. It created jobs in both
large and small communities and provide additional income in the community. In fact,
the growth of this sector has large impact on employment, foreign exchange earnings,
balance of payments and the economy in general (Pao, 2005).
In the Philippines, tourism plays an important role in the economy. It started to
flourish in the 1970s up to 1980s. Fast growth in Philippine tourism was more obvious
in the early 1990s. In the year 2000, net tourism income in the Philippine totaled to 2.1
billion U.S dollars. Moreover, based on the PTSA study conducted by Virola (2003),
total tourism expenditures amounted to Php 140 billion in 1994 and increases at Php
274 billion in 1998. This implies an average annual increase of 11%.

4
To date, the Philippine tourism sector continues to move forward, as more local
and foreign tourists explore the countrys top attractions that are hailed in prestigious
travel magazines, travel fairs, and online choices an indication of the confidence of the
global market in the Philippines as a friendly tourist destination, making it more fun to
visit and stay in our country (http://www.tempo.com.ph/2014/01/steady-growth-inphilippine-tourism/).

The Relationship between Food and Tourism

For the past research shown that tourists spend almost 40% of their budget on
food when traveling (Boyne, Williams, & Hall, 2002). The 2004 Restaurant &
Foodservice Market Research Handbook states that 50% of restaurants revenue was
generated by travelers (Graziani, 2003). It indicates that there is a positive synergetic
relationship between food and the tourism industry. More importantly, food has been
recognized as an effective promotional and positioning tool of a destination (Hjalager &
Richards, 2002). Similarly, with increasing interest in local cuisine, more destinations
are focusing on food as their core tourism product.
According to the study of Long (2004), Culinary tourism as experiencing and
participating in the foodways of other people which include but are not limited to
consumption, preparation, and presentation of food items. The researcher emphasized
that relishing the food of others is the way which one can really experience and accept
different culture without hesitancy.

5
The significance of the connection between food and tourism cannot be ignored.
Each destination has different levels of attractiveness that can draw tourists from
different countries (Au & Law, 2002). Authentic and interesting food can attract visitors
to a destination.
On the other hand, the destination will use food as the main attraction and will
develop marketing strategies that will focus on the food. It is imperative for marketers of
a culinary destination to know the image currently held by its targeted customers and
how to affect their intention to visit through effective marketing strategies. The study of
Frochot (2003) recommended food images could be utilized to exhibit the cultural
aspects of a country. As such, destinations can use food to represent its cultural
experience, status, cultural identity, and communicating (p.82).
Jones and Jenkins (2002) recommended that food is not only a basic need for
tourists, but also a cultural element that can positively present a destination. Given that
food can be used to project the identity and culture of a destination, food consumption
can be used in the development of a destination image (Quan & Wang, 2004). Thus,
the food of a destination can be used to represent the image and distinctiveness of the
destination.

Bonifacio Global City as an Ideal Manila

According to the study of Boquet (2013), found the following:

With Bonifacio Global City as it main driving force, Taguig City is becoming a
serious rival to Makati Citys Central Business District, even if the same
developer, Ayala Land, runs both areas. The usual characteristics of a CBD are a

6
dominant share of jobs in the service sector, a decrease in resident population,
the highest level of transport accessibility, main shopping streets, high land rates
and high rents. Except for the diminution of population, since it is built mostly on
previously undeveloped land, and is therefore closer to a Garreaus Edge City in
that regard, Bonifacio Global City is indeed a CBD. In Garreaus definition of
Edge Cities, it will not be just another business district, but a district showing an
other face of MetroManila, trying hard to demarcate itself from the rest of the
metropolitan area (p.14).
Another study by Faix (2007), found the following:
Central Manila suffers from the constant problems of traffic jams, crime and air
pollution. Makati City is, like CBDs, too much car-oriented and mono-cultured
(offices and hotels). Bonifacio Global City tries to be the perfect combination and
antithesis to Manila and Makati, attracting business (global corporations), public
facilities (schools and uni- versities), retail and leisure facilities (shopping centres
and restaurants) as well as low-rise and high-rise housing developments and
condominiums, with provision of open space and greenery in the heart of what
will become a dense urban district, thus seeking to become an ideal city.

The Fort is now making a huge development away from Metro Manilas daily
traffic, flooded areas, congested and pollution problems that encourage the tourists,
investors and local folks to visit the place and invest.
When youre in the Bonifacio High Street, you will feel the new experience it can
offer, its like youre in another country because of its robust economy that showcase
great improvement of tourism development. And if youre a local customer, most of the
time youll try something new in the place, like the food wherein you can have lots of
variations from local cuisine to international.

7
Talking about food habits and taste every household in this era has changed a
lot. Regarding this, many trading activities are growing up such as hotels, restaurants,
and business organizations. As we all know, High Street is becoming the place to eat
when you want to explore different cuisines, locally and internationally.
Such organizations in the vicinity have their own reputation to build up and their
own brand towards the market and the customers. All these trading activities depend on
the service on the service quality and the customer satisfaction, which are the main
themes of this research to elaborate. Both service quality and customer satisfaction are
important from the point of view of marketing in terms of sellers and buyers.
But what does it take to compete with the foreign players in terms of managing
and owning a local restaurant?

Impact of Tourism Development

Although tourism development is contemplated to have a vital role in enhancing
local economies, by being a source for new employment opportunities, additional tax
receipts, foreign exchange benefits, and revenues (Ko & Stewart, 2002), there has been
evidence that tourism development has potential for negative outcomes (Ko & Stewart,
2002). Tourism development is considered to be a counter-posed phenomena which
brings with it both adverse and positive impacts (Gilbert & Clark, 1997, p.343).
Awareness in the impacts of tourism development has evolved over the past four
decades. In the 1960s, studies regarding tourism impacts highlighted the positive
impacts of tourism development, with greater interest on negative impacts emerging in

8
the 1970s (Zhang et al., 2006).
Understanding the impacts of tourism, be they positive or negative, on a
destination and the associated perceptions and attitudes of residents towards tourism
continues to be an important issue in the field of tourism research (Cavus & Tanrisevdi,
2003). Resident perceptions and attitudes towards tourism development could play a
vital role in the planning and policy considerations for successful development,
marketing and operations (Zhang et al., 2006).
The researchers got very much interested about the impact of food to the tourism
development in a specific place. This study entitled, The Effects of American
Restaurants to the Tourism Industry at Bonifacio High Street, is an attempt to
understand the relationship between a destinations food image and the travelers
intention to visit. Moreover, the study features necessary information on the importance
of customer satisfaction and how does it can be utilized by the management of local
restaurants to formulate their marketing strategies to win customers and to survive the
stiff competition against the giant players in the market.

Conceptual Framework
INPUT

PROCESS

Local Residents and

Tourist Profile
In terms of:

Assessment
Data
Collection/Analysis/
Findings on the
Effects of American
Restaurants to the
Tourism Industry at
Bonifacio High
Street

Age
Gender
Marital Status
Occupation

Destinations Food
Image Intention to
Visit

OUTPUT

Factors on
Customer
Satisfaction

Recommendations on
Marketing Strategies
for Local Owners

Figure 1. Concept Framework of the Study

The conceptual framework of the study shows that in the input phase are the
various factors need to consider in exploring the relationship of food image (from
various American restaurants) on the intention of the tourist to visit. It is hoped that by
making this investigating, the researchers will be able to develop a realistic picture of
the effectiveness of the American restaurants to promote the growth of its tourism
industry in the place and how does it can help the local players to formulate new
strategies to encourage more of the customers satisfaction that could lead to customer
loyalty.
The pursuit for understanding will be done through the following process: data
collection, and data interpretation, findings, conclusions, and recommendations.
The output of this pursuit will the assessment, factors on customer satisfaction,
and recommendations to help the local players to be more competitive in the market.
Statement of the Problem

10
The study aims to explain the relationship between a destinations food image
and the travelers intention to visit. Thus, the research attempts to analyze the
satisfaction of customers in American restaurant at The High Street.
More specifically the researchers will seek answers to the following questions:
1. What is the relevance of students profile to the present study in terms of:
1.1. Age
1.2. Gender
1.3. Marital Status
1.4. Occupation
2. In terms of customer satisfaction, what features of the food/cuisines/restaurants
are particular important to you when you travel?
3. Do you think that there is a relationship between a destination and the
attractiveness of the food/cuisine it offers?
4. Is there any significant difference on the assessment of customer satisfaction
between the local residents of Bonifacio Hight Street from the tourists to support
tourist development in the area?
5. Is there any significant difference on the assessment in establishing the
relationship of food image to the intention to visit between the local residents of
Bonifacio Hight Street from the tourists?
Null Hypothesis
The following null hypothesis will be tested in this study:
1.

That the assessment of customer satisfaction no impact to support tourism development

at The High Street.

2.

That there is no significant difference of on the assessment in establishing the

relationship of food image to the intention to visit between the local residents of
Bonifacio Hight Street from the tourists.

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Significance of the Study

Knowing tourists perceptions toward a destination image is crucial because it

influences customers decision-making processes (Crompton, 1979; Gartner & Hunt,
1987; Mayo, 1973). In addition, marketers have long been aware of the association
between destination image and consumer behavior (Jenkins, 1999). According to Laws
et al.(2002), the type of image will depend on the following two factors: a) the
destinations uniqueness or specialty and b) how to `attract visitors to the destination.
Result of this study will be of importance to the following:

Local Owners The findings of this study could help further improve their
marketing strategies in promoting quality food and good service that will win the
customer satisfaction from the local residents and the tourists in the place.
Customers This study will provide insights to help them choose of their food
destination. It will also give them variations of cuisine wherein they can really enjoy the
place and would love to go back at The High Street to do more trips and experience
memorable bonding at the place.
Researcher This study will help further knowledge on the local tourism industry
and how it will have a positive impact in the place. Furthermore, it will help them to have
a better picture of customer satisfaction and what does it take to win their loyalty.
Lastly, the current study provides an agenda for future research and
development in response to continuous search for contemporary approaches to address

12
further the relevance of food to promote tourism industry and factors in satisfying the
customers.
Scope and Limitations of the Study
This research attempts to establish the relationship of food to tourism industry
and to analyze the satisfaction of customers in the American restaurants located at The
Bonifacio High Street. The study will collect statistical information of the customer and
their level of satisfaction and the relation of food image to the intention to visit.
Only the local residents of The High Street and the tourists will serve as the
respondents of the study. Exempted from the study are in the administrative and top
management of the establishments in the vicinity.
The research will be conducted to determine the effect of the existence of foreign
brand restaurants as perceived by the local customers during September 2014. Thus,
any or all developments that occurred thereafter are deemed excluded.

These

developments may contain situations in tourism industry and other future trends that
may influence the findings, observations and recommendations of the study.

Definition of Terms

Culinary Tourism is the intentional, exploratory participation in the foodways of

an other participation including the consumption, preparation, and presentation of a
food item, cuisine, meal system, or eating style considered to a culinary system not
ones own (Long, 2004).
Customer Satisfaction - is the result of the correlation between a customer s

13
assumption and a customers feelings. By way of explanation, customer satisfaction is
identified as the distinction between assumed quality of service and the customer s
involvement or feelings after having perceived the service.(Bateson & Hoffman 2000).
Destination Image is the sum of ones beliefs, ideas, and impressions of a
destination (Crompton, 1979).
Tourist: A temporarily leisured person who voluntarily visits a place away from
home for the purpose of experiencing a change (MacCannell, 1976).
Tourism is travel for recreational, leisure, or business purposes.
Tourism Industry refers to an industry that creates highly competitive job
opportunities for people. Tourism industry is a biggest industry offers a great tourism
product and services.

Chapter 2
REVIEW OF RELATED LITERATURE AND STUDIES

Through the review of related literature and related studies, researchers were
provided the knowledge and background on the topic or subject being studied. A
collection of extensive related literature is an essential part of a research paper in a way
that it serves as the framework of the study to make it substantial, credible, and reliable.
It serves as the feet of a research study so it can stand on its own and make it strong
enough for future researches to build upon.

14
The researchers gathered all literatures, both foreign and local, that are deemed
important to the topic at hand.

Foreign Literature

The growth of interest and activity in health promotion has been accompanied by
many attempts to examine the nature of health concept in particular cultures. It is
argued (Pender, 1996, Katz et al, 2002, Tones and Green, 2004) that health promoters
such as hospital nurses are unlikely to improve health and to bring about change unless
they have adequate understanding of the meaning of health and its determinants. Thus,
if peoples health is to be promoted effectively, the concept of health needs to be
explored culturally. To this end, there is a need to establish a theoretical background
about the meaning of health itself before any attempt to examine health promotion
related issues.

Health Concept: Meaning and Development

When health related literature is reviewed it becomes obvious that the concept of
health is still one of the most frequently reported concepts. Health has not only been
associated with peoples health behaviour (Paxston et al, 1994, Ogden et al, 2002,
Hjelm et al, 2005) but also with the populations mortality, morbidity, life satisfaction,
happiness, health policy, sexual health, education and economy (Buchanan, 2000,
Davey et al 2000, Helman, 2000, McPake, et al, 2002).

15
The concept of health however is contested and has diverse and sometimes
conflicting meanings that are both socially and culturally constructed. The concept of
health was derived from the old English word hoelth which means being safe, sound
and whole (Pender, 1996,). Historically, physical wholeness was of major importance for
acceptance in social groups. Physical power and nature were frequently linked together.
Those people suffering from disease or malformation were ostracised from society. The
reason was not only because of the fear of contagion from physically obvious disease
but also according to Blaxter (2001) there was repulsion at grotesque appearances. In
light of this, it is not unexpected that the review of literature found that being healthy
was constructed as natural in a certain environment or in harmony whereas unhealthy
was constructed as unnatural or contrary to nature (Davey et al, 2001).
Health was defined by the WHO (1946) as:
The state of complete physical, mental, and social wellbeing and not only the
absence of disease and infirmity.

This definition has proved to be robust and it is frequently cited in the literature in
particular within nursing and health promotion contexts, and it would be worth reviewing
its effectiveness and applicability. The definition was revolutionary as it consists of three
aspects of health including physical, mental and social well-being. It has many
advantages, which were recognized by many authors (Bunton and Macdonald, 2002,
Katz et al, 2002, Lee and Newberg, 2005). This is not surprising as it is postulated
(Pender, 1996, Bowling 2005) that the WHOs definition reflects concern for the
individual as a total person rather than the sum of parts. In addition, the definition places

16
health within the environmental context rather than a disease focus. Recently, health
promotion authors go further to contend that the WHOs definition is well acknowledged
in the literature not only because its positive reference to well-being but also it is useful
to be adapted at a political level centering on equity and empowerment and asserting
that health is a standard of living (Tones and Tilford, 2001, Tones and Green, 2004).
Although they did not offer obvious guidance about how to incorporate these ideas into
practice, their suggestions might demonstrate that the WHOs definition of health can be
used as a framework for promoting health at both the individual and political level.
Medical writers, on the other hand, advocate to lesser extent that the WHOs definition
can be deemed as a milestone to distinguish between positive health such as well-being
and negative aspects of health which exclusive emphasis on disease prevention
(Downie et al, 1991).
On this basis, the WHOs definition made a significant addition to the literature by
arguing that health is beyond the disease-linked issues and it is rooted in the
individuals social life.
The WHOs definition is totally unrealistic and too idealistic. This is because it
assumes that someone somewhere can achieve a 100% state of health. This implies a
misunderstanding of the meaning of health as a complex qualitative experience shaped
by an individuals context (Katz et al, 2001). It could also lead to a central confusion
about the meaning of complete or incomplete health. For example, is the health of a
person with a physical disability complete or incomplete?
To add to the problem, the definition is based on the assumption that peoples
views of the state of health are alike. Such an assumption has been discredited by

17
considerable evidence. Earlier studies have shown that people define the state of health
in many different ways such as fitness, energy, sexual activity and even wealth (Hjelm et
al, 2005).
Likewise, Ewles and Simnett (2004) expressed their concerns about the quality
of the WHOs conceptualization of health which implies a static position whereas life
and living are anything but static. This indicates a misunderstanding of the fact that
health in its holistic facets (e.g. physical, mental, spiritual) is in a state of continuous
change.
Young (1996) acknowledges the advantages of the WHOs definition but she
points out other problems as below:
.. Such a wide ranging definition can sometimes make it difficult to determine
things which are not covered by the heading health concerncould we, for
example, consider a woman experiencing relationship difficulties with her
husband and family unhealthy? (p:242).

As indicated above it seems that the too broad a definition of health makes it
difficult to specifically address the needed health interventions to achieve the desired
outcomes. This raises significant concerns, which could lead to misinterpretations
among health care providers themselves.
A further weakness of the WHOs definition of health stems from the possibility of
linking its meaning with health promotion. Whilst it could be used as a framework for
health promotion (Tones and Green, 2004), adopting the WHOs definition as a
guideline for promoting peoples health might produce not only ineffective heath

18
promotion activities but also unrealistic expected outcomes such as a 100% complete
health status.
Thus, health care providers need to acknowledge that the aims of maintaining
health should be within realistic boundaries and reasonable expectations.

Health Promotion: Historical Background

Health Promotion dates back up to the time when religion and superstition
influenced peoples belief on health and illness. The Babylonians, the Greeks,
Egyptians, Palestinians, Romans, and the Chinese have laid down the foundation of
most of the health promotion practices that we enjoy today. Concepts on hygiene and
sanitation were introduced to civilization by the Greeks whose belief in health and
illness was mandated by their gods and goddesses; the quarantine practices that
benefit people of today especially in communicable diseases can be traced back during
the Palestinian times under the Mosaic Code which emphasized the importance of
segregation by separating what is clean from the unclean. The public health sanitation
like street cleaning, building construction, ventilation, heating, and water sanitation that
we enjoy today are some of the accomplishments of the Romans and Egyptians
(Murray, 2009). Even during that time, health was already considered of prime
importance and its enhancement was necessary, some for the purpose of achieving
balance of the mind, body and spirit and some as a form of luxury and personal
indulgence. Whatever the purpose may be, these ancient practices bear the underlying

19
fact that an individual, even in the earliest times, is always in search of activities that
can prolong life and improve the quality of life (Marks, et al, 2005).
As Health Promotion gains popularity, myriad of definitions rose and overlap with
one another. Oftentimes, the term health promotion is used interchangeably with health
education, health maintenance, and health protection. The leading organization in
managing health, the World Health Organization (WHO) defined Health Promotion as
the process of enabling people to increase control over, and to improve their health.
(WHO, 1986).
During this definitions inception, five key strategies were also identified namely building healthy public policy, creating physical and social environments supportive of
individual change, strengthening community action, developing personal skills such as
increased self-efficacy, and Reorienting health services to the population and
partnership with patients (Ottawa Charter, 1986). This definition coincides with the
definition of Marks, et al (2005) which is any event, process, or activity that facilitates
the protection or improvement of the health status of individuals, groups, communities,
or populations. It targets a wider range of population as it intends to focus on the
community level which includes environmental interventions such as targeting the built
environment (e.g. fencing around dangerous sites) and involve legislation to safeguard
the natural environment (Marks, et al, 2005). It encompasses a broader scope as it
represents a comprehensive social and political process and with actions directed
towards changing social, environmental, and economic conditions so as to alleviate
their impact on public and individual health (Health Promotion Glossary, WHO, 1998).

20
Definition of Health Promotion

A more individualistic approach on Health Promotion is reflected on the definition

of Pender, et al. (2006) which states that Health Promotion is the behavior motivated by
the desire to increase well-being and actualize human health potential. This definition,
on the other hand, includes the behavioral approach of health promotion, which
focuses on secondary and primary prevention to improve health status through lifestyle
and behavior changes of individuals (Leddy, 2006).
These behavioral interventions are primarily concerned with the consequences
of individuals actions whose focus is on the concept of empowerment (Marks, et al.,
2005). The objective of this approach is to generate changes in the behavior of an
individual towards health, so that independence and self-reliance can be fostered. This
can be achieved by increasing the awareness and knowledge of an individual on health
and ways on how to improve it through health education. Health Education is defined
as any planned combination of learning experiences designed to predispose, enable,
and reinforce voluntary behavior conducive to health in individuals, groups, or
communities (Green and Kreutuer, 2005).
Using Traviss Illness-wellness Continuum, movement in the direction of wellness
state must begin with awareness, followed by education, then growth (Kozier, 2008).
Therefore, health Education capitalizes on awareness and knowledge in initiating
behavioral change in an individual. This insight reflects the difference between health
promotion and health education, where health education serves as a tool in
implementing health promotion. To further operationalize the definition of health

21
promotion, Breslow stated on his commentary on health promotion in JAMA, 1999 that
each person has a certain degree of health that may be expressed as a place in a
spectrum.
From that perspective, promoting health must focus on enhancing the peoples
capacities for living. That means moving them toward the health end of the spectrum,
just as prevention is aimed at avoiding disease that can move people toward the
opposite end of the spectrum. For this reason, Health promoting behaviors must be
geared towards the High-Level Wellness of Traviss Illness-Wellness Continuum.
Another definition of Health Promotion deals with the actions done to promote
health. Health behavior refers to the actual actions performed by an individual to
improve health. Health behavior alone is defined as any activity undertaken by an
individual regardless of actual or perceived health status, for the purpose of promoting,
protecting, or maintaining health, whether or not such behavior is objectively effective
toward that end (WHO, 1998).

Health Promotion: Theories and Models

There are a number of theories proposed in the literature that attempt to guide
the work of health promotion as well as health education. Although no one theory is
sufficient to fully explain health promotion behaviours, practitioners need to understand
their implications for practice (Naidoo and Wills, 2000). Behavioural change theories are
examined first because hospital health providers roles in health promotion is guided by

22
their ideologies as explored in this chapter (Maidwell, 1996, Furber, 2002, Cross, 2005,
Casey, 2007).
Models of health related behavioural change are often derived from
sociopsychology (Cole, 1995). This field examined the link between effective health
promotion interventions and the social influence process (Mittelmark, 1999).
Sociocognitive or social learning theory was used as a means to explain health
behaviours and to focus on the social context of behavioural change and its underlying
cognitive process (MacDonald, 2000). Thus, it is driven by the notion that behaviour is
guided by expected consequences. It indicates that health related behaviours are a
result of the interaction between patients beliefs and environmental elements (e.g. lung
problems and pollution) (Tones and Green, 2004). Despite this, however, sociocognitive theories are based on a preventive health framework and thus sit more
comfortably with traditionally defined health education as opposed to a wider reaching
health promotion ideology operating at social and economic levels (Clark, 1998, Cullen,
2002). Therefore, these theories attempt to examine patients reactions to the threat of
illnesses and thus seek actions to minimize or eliminate this threat through health
education. However, changing individuals behaviour is a problematic and complex task.
Not only might it lead to victim blaming but also to cognitive dissonance (Festinger,
1958). This is based on the concept that when clients face a situation when the
delivered health education message is in conflict with their current beliefs and attitudes,
they react in a manner that could create dissonance (e.g the belief that smoking would
reduce stress) (Festinger, 1958).

23
The theory contradicts to some extent the rational empirical theory that assumes
that clients will make rational decisions based on view of information given to them
(Baird, 1998).
Although the above theories are ideologically different, they link together health
related actions, individuals beliefs and indeed their agendas. The most developed
models and theories in health promotion are based on psychosocial theories and are
threatened by their limitations. The theory of reasoned action (Ajzen and Fisherbein,
1980) indicates that intentions to perform an action are determined by the individuals
attitudes towards the behaviour and the social norm. Thus, their beliefs are predictors of
intentions that, in turn, predict actual behaviour.
Likewise, Penders (1987) health promotion model explains the link between
individuals beliefs and their behaviours but fails to consider the impact of
socioeconomic issues. Instead the model views the environment as it relates to
behaviour rather than how it relates to health(King, 1994, p.214).
On the other hand, the health belief model (Becker, 1974), is largely guided by a
preventive health approach as opposed to socio-economic and political approach to
positive health. More recent socio-cognitive models did not give indications on how they
might be operationalised in practice (Niven, 2000, Stuifbergen et al, 2000) or were too
complex to use especially in a limited resourced setting (Whitehead, 2001a). The last
two models have not yet been validated and thus their effectiveness is questioned.

Health Promotion Practices

24
Health Promoting Practices or Behaviors of an individual differ from one person
to another. Pender (2006) stated it best that each person has unique personal
characteristics and experiences that affect subsequent actions. There are five levels
that affect a persons behavior (Sharma, 2008). First, are the individual factors, like the
attitude of a person. If a person believes that a healthy body will permit him to perform
more challenging tasks, then engaging in health promotion activities would come
naturally.
According to Fawcett (2005), Environment, culture, family background, work
ethic, educational level, social standing, and gender may contribute to the individuals
perception of heath and illness. Then personal view and understanding on the concept
of health and illness also falls on this level. In the earlier times, if a disease is believed
to be caused by an entry of an evil spirit, holes are bored into the skull of the patient to
release these spirits.
In the Philippines, if illness or disability is caused by nunu sa punso or aswang,
people immediately visit an arbolaryo and submit the patient to a tawas to detect the
spirit believed to cause the disease.
In addition to this, an individuals environment also play a crucial role in his health
promotion practices as stated in an article from the Global Health Promotion (Jul, 2010)
entitled How does socio economic position link to health behaviour?
Sociological pathways and perspectives for health promotion by Weyers S., et
al. The study showed that the characteristics of the neighbourhood environment
influence health behaviour of its residents above and beyond their individual

25
background. Therefore, the physical environment also determines the health promotion
practices of an individual. Also included in the individual factors are the age, civil status,
spiritual beliefs, occupation, and educational attainment of the individual.
Second level is the Interpersonal factors where an external factor affects the
behavior, example of which is a spouse requesting for a healthy breakfast.
Third level refers to organizational factors which include policies that contribute to
a better health like a company that allots 1 hour of exercise for employees every
morning. Fourth level is community factors, such as the physical environment an
individual is surrounded with. For example, if the person needs to fetch water every day
from the communal faucet that is 1 kilometer away from his house, then that activity can
be considered as a vigorous form of exercise. Last is the role of public policy factors.
For example, if a memorandum coming from the Mayor mandates the cleaning of
suspected breeding and resting sites for Dengue mosquitoes three times a week, then
that memorandum compels the residents to do such (Sharma, 2008).
In this study, the factors that are taken into consideration are the 6 dimensions of
health-promoting lifestyle identified in the Health Promotion Lifestyle Profile II (Walker,
et al., 1996). These are the Spiritual Growth, Interpersonal Relations, Nutrition, Physical
Activity, Health Responsibility, and Stress Management. Health Promotion Lifestyle
Profile II is used to measure the health promoting behavior of an individual.
Lifestyle, according to Pender (2006), is defined as discretionary activities that
are regular and part of ones daily pattern of living and significantly influence health
status. In this study, the term lifestyle is synonymous with Health Promoting Behaviors.

26
Spiritual growth or health is defined as the ability to develop ones inner nature to its
fullest potential which includes the ability to discover and articulate ones basic purpose;
to learn how to experience love, joy, peace, and fulfillment (Pender, et al., 2006, p.
104).
Spiritual health is essential in assessing the heath promoting practices because
this affects the clients interpretations of life events and health (Chuengsatiansup, 2003
as cited in Pender, et al. 2006). Numerous studies have been done supporting this
significant correlation of spirituality and health experiences. One of these is a study
entitled Spiritual health, clinical practice stress, depressive tendency and health
promoting behaviours among nursing students by Hsiao Y. et al. (2010) wherein
Spirituality was positively associated with health-promoting behaviors. This relationship
will contribute to the holistic approach in assessing the health promotion practices of an
individual.
Interpersonal Relations, likewise, is also vital in assessing health promotion
practices as this reflects the social relationship an individual posses. According to Lucas
(2005), positive social relationships stimulate the production of a health promoting
hormone and block the production of hormones usually related to stress. Positive social
relationships offer a venue for verbalization of feelings of the individual which is
necessary for the individual to get in touch with their feelings and emotions and enables
the individual to select the most appropriate strategy in dealing with stress through
feedbacks from others.
This dimension is related to the third dimension of the HPLP II which is Stress
Management as high levels of social support have also been linked to positive affect,

27
and may thus protect against distress from life events associated with high stress
(Lucas, et al., 2005 p. 130). Stress is defined as anything that may threaten the
physical and psychological well-being of a client. Assessment of how an individual
handles these stresses may serve as a better predictor of his health promoting
practices.
Fourth and fifth dimensions of the HPLP II are the Nutrition and Physical Activity,
respectively. Nutrition involves the way an individual selects and consumes foods that
are essential in promoting a health well-being. Their selection of food must be
consistent with the guidelines provided by the Food guide Pyramid. Physical Activity, on
the other hand, involves regular participation in light, moderate, and/or vigorous activity
(Walker, et al., 1996).
Assessment of physical activity is important since sedentary lifestyle, for many
individuals, begins with childhood and continues until adulthood (Pender, et al., 2006, p.
102) and lack of physical exercise has been directly related with the occurrence of
cardiovascular diseases.
Last, but not the least, is the dimension on Health Responsibility, which involves
an active sense of accountability for one own well-being (Walker, et al., 1996). This
includes paying attention to ones health through education and exercise of informed
consumerism. As Pender, et al., (2006) mentioned, individuals play a significant role in
the determination of their own health status because self-care represents the dominant
mode of health care in our society.
Like breathing, no one else can take care of ones health than the person owning
that health. The desire to enhance health and well-being must come from within.

28
One must bear in mind that human health promotion is a moral endeavor. In the
individual level, health promotion provides services that will assist humans in their
functioning taking into consideration their particular circumstance.
Therefore, a need to include the factors that influence a persons health status
like mental, physical, spiritual, and environmental factors in the assessment of an
individual is a must (Edelman, et al., 2006). This will only be possible if thorough
assessment will be done on the health promotion practices of the respondents.
Prolonging life and improving its quality is the objective of Health Promotion
(Marks, et al., 2005). In order to achieve this goals, health promotion must concentrate
more on enhancing the physical, psychological, and emotional well-being of an
individual instead of focusing on reducing the risk of acquiring diseases. A more positive
approach to promote health is needed to stimulate in individuals the desire to enhance
the quality of life.
Local Literature

The need for health promotion in the Philippines goes back to the time of the
Ramos Administration, when the Administrative Order No. 341 entitled Implementing
Philippine Health Promotion Program through Healthy Places was created. It was
written along with the belief that there is a need to undertake more health promotion
and disease prevention measures as a result of the reported increase in the incidence
of preventable diseases in Asia and in the country (AO No. 341, 1997). The PHPP
gives priority to women, and children, adolescent youth, workers, elders, disabled and

29
chronically ill persons, ethnic minorities, rural people, and urban poor (Palaganas,
2003).
Time went on and health promotion was given a renewed interest as a result of
the association of degenerative diseases with the lifestyle of an individual. In 2002,
Mortality statistics showed that 7 of the 10 leading causes of deaths in the country are
associated with the unhealthy lifestyle of the client: tobacco smoking, physical inactivity,
and an unhealthy diet (Cuevas, et al., 2007). This rise in the occurrence of degenerative
and lifestyle diseases called for a need to take on a new approach to health promotion
that will go beyond the interaction between the client and a physician. Hence, the
creation of the National Policy on Health Promotion (Administrative Order No. 58 s.
2001).
This Administrative Order promotes the utilization of a socio-ecological
approach to health promotion that would include the environment and other sectors
that affect the over-all well-being of a person. The vision for Health Promotion, By the
year 2010, Filipinos are managing their own health serves as the framework for health
promotion.
This study will contribute to the attainment of the said goal through the creation of
appropriate health promotion programs/strategies that can change the lifestyle of the
target population by starting with proper assessment of their current health promotion
practices. This fulfills a fraction of the health sectors responsibility to build capacity for
policy development, leadership, health promotion practice, knowledge transfer and
research, and health literacy (Anden, 2010).

30
Without

sincere

efforts

directed

towards

achieving

socio-economic

transformation no lasting improvements are expected in the field of health (Palaganas,

2003, p. 90). Health Promotion may sound easy to say but it is very much harder to do,
especially if the community is underdeveloped. Brgy. 454 is an urban community
wherein there are depressed areas situated in Sampaloc, Manila.
As Palaganas (2003) puts it, many mistaken practices result from ignorance and
superstition. It can be drawn that the health promotion practices of the community may
still be possibly linked with the practices and beliefs of the past, which are no longer
applicable today. At the same time, there is also a lack of medical professionals that
would correct their current practice and provide them with the correct ones.

Synthesis

After reading and compiling the relevant literatures above, one idea remains
that for a health worker to come up with a program that will meet the needs of the
community in terms of health promotion, a thorough, accurate assessment of their
health promotion practices is of supreme importance. It is the responsibility of the health
worker/provider to gather all the information that she can get in order to come up with

31
a program/plan that is specifically designed according to the specific needs of Brgy.
454, Sampaloc, Manila. This includes the consideration of all the factors that may
influence the health promotion practices of the individual such as the individual
characteristics as these may affect the way a person takes care of his health as
reflected in the 6 dimensions stated in the Health Promotion Lifestyle Profile II.
The readings in this chapter will help the researcher to further describe and
analyze the health promotion practices of the residents of Brgy. 454. These literatures,
both foreign and local will enlighten the researcher with the what, why and how of the
health promotion practices that the residents perform and will be used as a stepping
stone in the creation of the intended output of this study.

Chapter 3
RESEARCH METHODLOGY

This chapter presents the methodology of the study. Specifically, it discusses

the research design, population, sample, and sampling techniques, instrumentation,
data gathering procedures, data analysis.

32
Research Design
This study is observational in nature which utilizes a cross-sectional design which
is commonly used in conducting a health promotion research (Crosby, et al, 2006).
According to John Creswell (2005), a cross sectional study examines the current
attitudes, beliefs, opinions or practices of a certain group or community. To further
examine the target population, a survey research was utilized to understand the
characteristics of the population and estimate the levels of knowledge about any given
health threat or health protective behavior; and health-related attitudes, beliefs,
opinions, and behaviors (Crosby, et al, 2006).
Therefore, this study will utilize a cross-sectional survey design as it determines
the common health promotion practices done in Brgy. 454 Lardizabal Sampaloc, Manila.

Population, Sample, and Sampling Techniques

The respondents of this study will be fifty residents of Brgy. 454, mostly aged 3040 years old. This selection is based on the belief of the researcher that individuals in
the specified age group are mature enough to involve themselves in the improvement of
their health and capabilities. Moreover, people in this age group would represent those
who mostly engaged in activities that may negatively affect their health situation such as
alcohol abuse, smoking, and lack of physical exercise.

33
Therefore, their health promotion practices call for further investigation. The
respondents were selected using the purposive sampling technique where the
researcher selected those individuals who could provide richer and more significant
information about the study. Purposive sampling is a technique where the researcher
intentionally select individuals and sites to learn and understand the central
phenomenon (Creswell, 2005).

Instrumentation

The researcher utilized the Health Promotion Lifestyle Profile II, an instrument
used to measure the health promoting behavior of an individual, focusing on the six
domains

of

health

responsibility, physical

activity, nutrition,

spiritual

growth,

interpersonal relations, and stress management. These dimensions are reflected in the
following items:

1. Health-Promoting Lifestyle 1 to 52
2. Health Responsibility 3, 9, 15, 21, 27, 33, 39, 45, 51
3. Physical Activity 4, 10, 16, 22, 28, 34, 40, 46
4. Nutrition 2, 8, 14, 20, 26, 32, 38, 44, 50
5. Spiritual Growth 6, 12, 18, 24, 30, 36, 42, 48, 52
6. Interpersonal Relations 1, 7, 13, 19, 25, 31, 37, 43, 49
7. Stress Management 5, 11, 17, 23, 29, 35, 41, 47

34
This instrument, based on the Health Promotion Model of Nola J. Pender, was
originally produced in 1987 by Susan Walker, Professor Emeritus of University of
Nebraska, College of Nursing. This 52-item examination used a 4-point Likert Scale to
determine the behavior of the individual with a format of Never, Sometimes, Often,
and Routinely.
In order to accommodate the level of education of the residents of Brgy. 454, the
instrument was translated into the Filipino language. Considering the translation made,
this study will also serve as mean in measuring the appropriateness of the HPLP II tool
in the Philippine setting.
No pilot study is needed since the instrument to be used has been tested and
validated as evidence by the number of studies that utilized the said survey tool.

Data Gathering Procedure

In order to obtain the much-needed data, the researchers followed a series of

steps. First is to talk to the Barangay Captain if they can conduct a survey and present a
letter explaining about their study. Once permission is granted, the researcher will
begin the data gathering.
To select the respondents, the researcher will obtain a list of names of the
residents from their office, together with their addresses. The researchers will personally

35
visit the selected respondents and will ask if they have hypertension. If yes, the
researchers would provide them with the questionnaire. Beforehand, a letter asking for
their participation will be given to the participant. They participants have the right to
refuse involvement in the said study.
Collection of the questionnaire will follow afterwards for the collation and analysis
of data. Necessary statistical treatment will be applied in order to come up with the
results needed for the study.

Data Analysis

The HPLP II surveys data was coded and analyzed by the researchers. The
descriptive statistics were calculated using mean. The researcher examined the
demographic survey by evaluating percentage of subjects who responded to the
questions with a particular answer. Percentages also were used to evaluate the sample
characteristics.

The researchers used Pearsons r to statistically examine the HPLP II scores and
the average systolic and diastolic blood pressure measurements for correlations. The
researcher had hoped to discover significant correlations between the six dimensions of
the HPLP II survey and the average blood pressure measurements. The six categories
are health responsibility, physical activity, nutrition, spiritual growth, interpersonal
relations, and stress management. The health-promoting lifestyle is the seventh
category and it includes all 52 questions. Health-promoting lifestyle category contains all

36
six dimensions under one title. By looking at the six dimensions individually, the
researcher actually broke down the health-promoting lifestyle category for a more
thorough analysis.

Statistical Treatment of Data

The data that will be obtained in this study will be statistically treated with the
necessary formulas to facilitate the analysis and interpretation of findings. The Health
Promotion Lifestyle Profile II, the instrument used by the researcher, already has a
proposed method of scoring the results.
The score for the over-all health promoting lifestyle will be obtained by computing
the Mean of the individuals responses. Likewise, the scores for each subscale will be
obtained using the same computation. The mean, denoted by an x, is the most sensitive
measure of center since it takes into account all scores in a distribution when it is
calculated (Bordens, 2007). The formula for the mean is:

x =
n

Where:

Ex is the summation of scores

n is the number of scores in the distribution.

37
To

answer

question

number

4,

PEARSON

PRODUCT-MOMENT

CORRELATION COEFFICIENT will be utilized. This is a measure of association that

provides an index of the direction and magnitude of the relationship between two sets of
scores (Bordens, 2007).

Where:

N no. of cases
XY sum of the products of x and y
X sum of the xs
Y sum of the ys
X2 sum of the squares of xs
Y2 sum of the squares of the ys

To test the significance of the computed r

Where:

n the number of respondents

38
r the computed coefficient of correlation

Chapter 4
PRESENTATION OF FINDINGS, ANALYSIS & INTERPRETATION OF DATA

This chapter presents the results and discussion of data gathered based on the
following: a) to know the demographic profile of the residents of Brgy. 454 Lardizabal, b)
to illustrate the health promotion practices of the residents of Brgy. 454 Lardizabal, and
c) to specify common barriers to health promoting lifestyle among the respondents. The
study was conducted using Health Promotion Lifestyle Profile II.

RQ1: What is the demographic profile of the residents of Brgy. 454 Lardizabal
in terms of:

39

The ages of the subjects ranged from 30 years old to 50 years old or older.
Estimated sixteen percent (N=5) were between the ages of 30 to 35 years old, twentytwo percent (N=7) were between the ages of 36 - 40 years old, twenty-five percent
(N=8) were between the ages of 41 to 45 years old, and thirty-eight percent (N=12)
were ages 46 to 50 years old. Majority of the subjects were married. Of the thirty-two
subjects, estimated sixty-nine percent (N=22) were married, sixteen percent (N=5) were
separated, nine percent (N=3) were widowed, and six percent (N=2) were single. For
most, highest level of education was high school. Estimated forty-seven percent (N=15)
had attended high school, thirty-four percent (N=11) had attended grade school and
nineteen percent (N=6) had attended tertiary. The rest of the variables were also
illustrated on the table below.

Table 1 Demographic Profile of the Respondents

Total Sample
Characteristic
Male
Female

n=32
25
7

Percentage
78.13
21.88

Age

30 to 35
36 to 40
41 to 45
46 to 50

5
7
8
12

15.63
21.88
25.00
37.50

Marital Status

Single
Married
Separated
Widow

2
22
5
3

6.25
68.75
15.63
9.38

Gender

40
Educational Attainment

None
Primary
Secondary
Tertiary

0
11
15
6

0.00
34.38
46.88
18.75

Occupation

Employed
Unemployed

17
15

53.13
46.88

Spiritual beliefs

Catholic
Iglesia ni Kristo
Born Again
Others

16
6
2
8

50.00
18.75
6.25
25.00

A few questions asked about medications, home blood pressure monitoring,

transportation, living conditions, employment, and help at home. Eighty-four percent
(N=27) of the subjects took all medications as prescribed. Thirty-four percent (N=11) of
the subjects measured their blood pressures at home on a regular basis, while sixty
percent (N=19) had a blood pressure machine at home. Ninety-four percent (N=30) of
the subjects had transportation available for their primary care appointments. Seventyfive percent (N=24) had someone at home to help with health needs and twenty-five
percent (N=8) did not have help at home. Nevertheless, seventy-eight percent (N=25)
reported living alone and nineteen percent (N=6) did live with someone. Sixty-nine
percent (N=22) did not believe money was a barrier in controlling blood pressure

RQ2: What are the health promotion practices of the residents

of Brgy. 454 Lardizabal?

41
A summary of the HPLP II survey responses is located in Table 2. All fifty-two
questions from the HPLP II and all blood pressure measurements were examined using
Pearsons Correlation Coefficient. The following categories had significant results:
interpersonal relations, spiritual growth, health responsibility, and stress management.

Table 2 Summary of Health Promotion Practice

42

R3: What are the common barriers to health promoting lifestyle among the
respondents?

43

Interpersonal Relations was analyzed with the average blood pressure

measurements and yielded several moderately significant correlations. The results for
Interpersonal Relations are located in Table 3. First, an inverse correlation with
moderate significance was found (r= -0.398, p=0.024, p<0.05) between systolic blood
pressure measurements and praising other people easily for their achievements.
Secondly, a moderate correlation (r=-0.355, p=0.046, p<0.05) was found between
systolic blood pressure measurements and discussing my problems and concerns with
people close to me. Thirdly, a moderate correlation was discovered between systolic
blood pressure measurements and maintaining meaningful and fulfilling relationships
with others. Lastly, a moderate correlation (r=-0.374, p=0.035, p<0.05) was discovered
between systolic blood pressure measurements and touching and being touched by
people I care about.

Table 3. Interpersonal
Relations

Systolic
Number
Subjects

Question
Discuss my problems

44

Diastolic

of r=Correlation

r=Correlation

p=Significanc p=Significanc
e

and
concerns

with

people

close to me.
Praise other
easily

r=
N=32

0.355** r=-

p= 0.046

0.269

p= 0.137

people

for

their

r=

0.398** r=

achievements.
N=32
Maintain meaningful and

p= 0.024

fulfilling

r=

relationships

0.008

p= 0.965

-0.428** r=

0.129
\

with others.
N=32
Spend time with close

p= 0.015
p= 0.481
r=
-0.269 r=
0.051

friends.
Find it easy to show

p= 0.136

concern,

r=

love,

and

p= 0.783
0.130

r=

-0.123

warmth to others.
N=32
Touch and am touched

p= 0.478
p= 0.502
r=
-0.374** r=
0.110

by people I care about.

N=32
Find ways to meet my

p= 0.035
p= 0.551
r=
-0.315 r=
0.090

needs for intimacy.

Get support from

p= 0.079

N=32

p= 0.626

a
r=

network

of

caring

r=

-0.249

-0.320
p= 0.169

people.
Settle conflicts
others
discussion
compromise.

N=32

p= 0.074

with

through

r=

and

r=
N=32

p= 0.477

-0.146

0.130 p= 0.426

45
Spiritual Growth was analyzed with the average systolic blood pressure
measurement. Three questions from the survey correlated significantly with the average
systolic blood pressure measurement. The questions were as follows: look forward to
the future (r=-0.363, p=0.041, p<0.05), work toward long-term goals in my life (r=-0.393,
p=0.026, p<0.05), and find each day interesting and challenging (r=-0.369, p=0.037,
p<0.05).
Health Responsibility had only one question that resulted in a moderately
significant correlation with systolic blood pressure. The significant correlation was noted
between discuss my health concerns with health professionals and the average systolic
blood pressure measurement(r=-0.412, p=0.019, p<0.05).

Stress Management had two moderately significant results. The average systolic
blood pressure and take some time for relaxation each day was correlated (r=-0.353,
p=0.048, p<0.05). The second correlation was between the question, balance time
between work and play, and systolic blood pressure (r=-0.353, p=0.048, p<0.05).
Among the different categories of the HPLP II, only one category provided a
correlation with elevated diastolic blood pressure. Under Stress Management, an
inverse, moderate correlation was discovered between subjects getting enough sleep
and diastolic blood pressure (r=-0.505, p= 0.003, p<0.05). In other words, subjects who
claimed to get enough sleep had lower diastolic blood pressures.

46

Chapter 5
SUMMARY AND CONCLUSIONS

This chapter summarizes the study on the research made in assessment to

health promotion lifestyle of the residents of Brgy. 454 with hypertension.

The

conclusions given were drawn from the outcomes of the research and observations on
the impact made. Recommendations were based from findings and conclusions of the
study.

Summary

47
This study would perform the concept of the Health Promotion Lifestyle Profile II
to assess residents health promotion practices and to discover common barriers to
health promoting lifestyle with hypertension.
Existing literature was reviewed to determine if any prior studies had been done
to assess health promotion practices in relation to hypertension that provides this
information. It was discovered that many studies had been done by health educators
and professionals on what they perceived to be important in developing healthy
promotion program that would greatly affect the lifestyles of the respondents in a
community. Knowing residents of Brgy. 454s perceptions based on their evaluation
could help health providers better understand the needs of their community and design
a specific program intended for the residents with hypertension.
The method of research to be used in this study is observational in nature which
utilizes a cross-sectional approach to determine the health promotion practices of ages
30-to-50-year-old respondents. Survey research was conducted in Brgy. 454 Sampaloc,
Manila with purposive sampling.
The HPLP II surveys data was coded and analyzed by the researchers. The
descriptive statistics were calculated using mean. The researcher examined the
demographic survey by evaluating percentage of subjects who responded to the
questions with a particular answer. Percentages also were used to evaluate the sample
characteristics.
The researchers used Pearsons r to statistically examine the HPLP II scores and
the average systolic and diastolic blood pressure measurements for correlations. The

48
researcher had hoped to discover significant correlations between the six dimensions of
the HPLP II survey and the average blood pressure measurements.

Conclusion
The following conclusions have been drawn based on the findings presented:

1. The demographic data provided great insight into the type of sample
population obtained for this study. The sample population mostly consisted of
high school educated, married, Caucasian males, who were between the
ages of 66 to 75 years old. All 32 subjects were hypertensive and
uncontrolled. The subjects (N=32) had at least two blood pressure readings
(consecutively) that were greater than 140/90 mmHg.
2. Several categories of the HPLP II had moderately significant results that were
inversely correlated. The Interpersonal Relations category revealed that
having a relationship with others affects systolic hypertension. Interpersonal
relations did not affect diastolic blood pressures. A moderately strong
correlation was discovered between discussing my problems and concerns
with others and systolic blood pressure measurements, indicating that not
discussing concerns or problems with others increases systolic blood
pressure. In addition, a stronger correlation was found among systolic blood
pressure and praising other people easily for their achievements, indicating
that not praising others increases systolic blood pressure. Lastly, maintaining
meaningful and fulfilling relationships with others had the strongest

49
correlation in the category. Maintaining meaningful and fulfilling relationships
decreases systolic blood pressures.
3. Spiritual Growth had a significant impact on systolic blood pressures, but not
on diastolic blood pressures. A correlation was found between looking
forward to the future and systolic blood pressure, signifying looking forward
to the future decreased systolic blood pressure. Another health behavior in
this category, working toward long-term goals and finding each day
interesting/challenging, was correlated with systolic blood pressures. Not
having long-term goals or not finding each day interesting increased the
systolic pressure.
4. Health Responsibility and Stress Management had significant correlations
with systolic blood pressures. In Health Responsibility, the statement discuss
my health concerns with health professionals was moderately correlated to
systolic blood pressure. This result indicated that discussing problems with
health professionals, such as nurses or providers, decreased an elevated
systolic blood pressure. One statement from the Stress Management
category, take some time for relaxation each day was correlated to systolic
blood pressures, signifying that not taking some time for relaxation and not
balancing time between work and play may increase systolic blood pressures.
5. The other categories from the HPLP II, such as Nutrition and Physical Activity,
did not significantly correlate to systolic or diastolic blood pressures.
6. Hypertension has been deemed as the most notable disease among Filipinos.
In hopes to contribute for a better health program, the purpose of this study

50
was to discover the barriers to a health-promoting lifestyle among the
residents of Brgy. 454. The results significantly show that stress management,
interpersonal relationships, spiritual growth, and health responsibility effects
systolic blood pressure, either negatively or positively. The problems with
stress management, interpersonal relationships, spiritual growth, and health
responsibility can be considered barriers to controlled hypertension.

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APPENDIX A
HEALTH PROMOTION LIFESTYLE PROFILE II

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Pangalan: ________________________________________
Kasarian: _________

Edad: ________

Estado sa buhay: ______________

Pinakamataas na naabot sa pag-aaral: __________________________________

Trabaho: ____________________

Relihiyon: _______________

Blood pressure average___________

Please circle your answer for each question.

1) Do you take all your blood pressure medications as prescribed? Yes or No
2) Do you measure your blood pressure at home on a regular basis? Yes or No
3) Do you own a blood pressure machine? Yes or No
4) Do you have transportation (i.e. car, bus, or someone to bring you) to the hospital for
your primary care appointments? Yes or No
5) Can you afford your blood pressure medications? Yes or No
6) Do you believe money is a problem with controlling blood pressure? Yes or No
7) Do you believe transportation is a problem with controlling your blood pressure? Yes
or No

DIREKSYON:
Ang papel na ito ay naglalaman ng mga katanungan patungkol sa inyong
kasalukuyang pamamaraan ng pangangalaga sa inyong kalusugan. Bawat
katanungan at maaring sagutin sa pamamagitan ng PAGTSEK () sa letra na

56
naaayon sa inyong kasagutan:

P para sa PALAGING GINAGAWA;

M para sa MADALAS GINAGAWA;
Mi para sa MINSAN GINAGAWA, at
H para sa HINDI GINAGAWA.

KATANUNGAN
1. Pinag-uusapan ang aking mga suliranin at

alalahanin sa mga taong malapit sa akin.

2. Pumipili ako ng mga pagkaing mababa sa taba at
kolesterol.
3. Dumadaing sa tuwing may hindi pangkaraniwang senyales
o sintomas sa isang doctor o iba pang propesyonal sa
pangkalusugan.
4. Sumusunod sa mga programang pang-ehersisyo.
5. Natutulog ako ng sapat na oras.
6. Ako ay lumalaki at nagbabago tungo sa pamamaraang
positibo.
7. Pinupuri ko ang ibang tao sa kanilang mga tagumpay.
8. Limitado ang aking pagkain ng matatamis na pagkain at
paggamit ng asukal sa pagkain.
9. Ako ay nagbabasa o nanonood ng mga programa
patungkol sa kalusugan.
10. Ako ay nag-e-ehersisyo na tumatagal ng 20 minuto
tatlong

beses

sa

isang

lingo

(gaya

ng

paglalakad,

pagbibisikleta, pagsayaw, o pag-akyat ng hagdan).

Mi

57
11. Ako ay naglalaan ng oras upang magpahinga sa loob ng
isang araw.
12. Ako ay naniniwala na ako ay mayroong misyon sa buhay.
13. Napapanatili kong maganda at mkahulugan ang aking
mga relasyon sa ibang tao.
14.Kumakain ako 6 hanggang 11 na hain ng tinapay,kanin, at
noodles sa loob ng isang araw.
15. Nagtatanong ako sa doctor o nurse sa tuwing hindi ko
naiintindihan ang kanilang mga instruksyon.
16. Sumasali ako sa mga gawaing nakakapagehersisyo ng
aking katawan gaya ng matagalang paglalakad (30-40
minuto) limang beses o higit pa sa isang lingo.
17. Tinatanggap ko ang mga bagay sa aking buhay na hindi
ko na mababago.
18. Umaasa ako sa isang magandang hinaharap.
19. Ako ay naglalaan ng oras para makasama ko ang
malalapit kong mga kaibigan.
20.Kumakain ako ng 2 hanggang 4 na hain ng prutas sa loob
ng isang araw.
21.Ako ay kumukuha ng pangalawang opinion (2 nd opinion)
kapag nanghihingi payo tungkol sa aking kalusugan.
22. Ako ay lumalahok sa mga gawaing pisikal na nagbibigay
kasiyahan sa akin katulad ng paglangot o pagsasayaw).
23. Nag-iisip ako ng mga magagandang bagay bago
matulog.
24. Ako ay kuntento sa aking sarili at sa aking buhay.
25. Madali sa akin ang magbigay ng pagkabahala,
pagmamahal, at init sa aking kapwa.
26.Kumakain ako ng 3 hanggang 5 na hain ng gulay sa loob
ng isang araw.
27. Kumukonsulta ako sa mga propesyonal sa

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kalusugan tungkol sa aking kalusugan.
28. Ako ay nag-iinat 3 beses sa isang lingo.
29. Gumagamit ako ng mga paraan para ma-kontrol ang
aking pagod.
30. Pinagtatrabahuan ko ang aking mga pangarap sa buhay.
31. Ako ay natitinag ng mga taong malalapit sa akin at
ganoon din ako sa kanila.
32.Ako ay umiinom ng 2 hanggang 3 timpla/hain ng gatas, o
ng mga pagkaing may gatas sa loob ng isang araw.
33. Sinusuri ko ang aking katawan sa anumang pagbabago o
senyales isang beses sa isang buwan.
34. Ako ay nage-ehersisyo sa pang-araw-araw na gawaing
bahay gaya ng pag-iigib o paglilinis ng bahay.
35. Binabalanse ko ang trabaho at paglalaro o pagsasaya.
36. Interesado ako sa mga mangyayari sa aking buhay arawaraw.
37. Naghahanap ako ng mga paraan upang matugunan ang
aking pangangailangang personal.
38.Kumakain ako ng 2 hanggang 3 hain ng manok, baboy,
isda, at itlog sa loob ng isang araw.
39. Ako ang humihingi ng impormasyon sa mga propesyonal
tungkol sa tamang pangangalaga sa aking kalusugan.
40. Dinadama at binibilang ko ang aking pulso tuwing nag-eehersisyo.
41. Ako ay nagpapahinga at nagmumuni-muni sa loob ng 1520 minuto araw-araw.
42. Alam ko ang mga bagay na mahahalaga at importante sa
aking buhay.
43. Ako ay nakakakuha ng suporta sa mga taong mahal ko.
44. Binabasa ko ang mga sustansiya na nasa likod ng pakete
ng mga pagkain.

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45. Dumadalo ako sa mga pagtitipon na may kinalaman sa
aking kalusugan.
46. Naaabot ko ang tamang bilang ng tibok ng aking
puso sa tuwing ak ay nag-e-ehersisyo.
47. Ako ay nagdadahan-dahan sa pagtatrabaho upang
maiwasan ang pagkapagod.
48. Ako naniniwala na ako ay konektado sa isang nilalang na
may higit na kakayahan sa akin.
49. Naayos ko ang aking mga di-pagkakaunawaan sa ibang
tao sa pamamagitan ng pagkukumpromiso.
50. Kumakain ako ng agahan araw-araw.
51. Humihingi ako ng gabay o payo kung kinakailangan.
52. Ihinaharap ko ang aking sarili sa mga bago at kakaibang
pagsubok sa aking buhay.