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A Thesis Proposal Presented to the

Faculty of the Graduate School


In Partial Fulfillment Of the Requirement for the Degree



Vanessa M. Abalos, RN

August 7, 2010


In this time of the 20th century, it is worthwhile to say that health

promotion has already reached its peak with the evolution of health promotion

from being just a concept to becoming a specialization and a profession in most of

the countries worldwide. Various organizations committed in the promotion of

health of the people such as World Health Organization, Australian Health

Promotion Association, and Canadian Public Health Association had made

significant contributions that catapulted the concept of Health Promotion into a

whole new level, making health the priority and the business of every human

being. Over the past two decades, explosion of interest and participation in health

promotion and wellness activities (Murray, 2009) became rampant as evidenced

by more people engaging in health-promoting activities such as exercise, proper

diet, and healthy lifestyle.

One of the most famous definitions of Health Promotion comes from the

World Health Organization which is the “process of enabling people to increase

control over, and to improve, their health (Ottawa Charter, 1986)”. Unknown to

the knowledge of many, health promotion is a concept distinct from the terms

health education and health maintenance in such a way that health promotion

conveys an umbrella effect on the other two terminologies and focuses on the
improvement of health, its goodness and wellness and enhancing the people’s

capacities for living (McKenzie, et al, 2005), regardless of any impairment on

their physical, mental, social, environmental, and spiritual condition. Health

promotion pushes a person forward towards the optimum goal of health. If health

maintenance refers to those activities that avoid illnesses, disabilities, etc.

(Murray, 2009), health promotion pertains to activities that aims to empower the

individuals to seek for better health. These actual behaviors that individuals

perform in seeking better health refer to Health Promotion Practices.

Health Promotion refers to the efforts to promote positive health (Naidoo,

2005). Whatever a person does to improve their health refers to health promotion

practices. However, these practices differ from one person to another depending

on how they define and understand health as influenced by their culture, religion,

spiritual beliefs. It also differs based on the geographical location of the area and

its socioeconomic status. Therefore, health promotion practices in one location

may not be necessarily the same in another location. Furthermore, certain health

promotion programs may need specific tailoring based on the current practices of

the target population. This scenario warrants a closer look in the health promotion

practices before arriving at a conclusion that would describe the health promotion

practices of the residents of Brgy. Bukal, Cavinti, Laguna.

This study aims to describe the Health Promotion Practices commonly

done by the residents of Brgy. Bukal, Cavinti, Laguna. Output of this study would

serve as a tool to document areas for improvement to enhance the health status of

the individuals in Brgy. Bukal.

Health Promotion Practices plays a big role in continuously enhancing

positive health. As a nurse, it is one of our major responsibilities to ensure that the

health promotion practices known to people are correct and makes a significant,

positive contribution to the optimum well-being of the community. As a

professional, it is expected that one has the knowledge and skills to meet the

needs of an individual or group. This puts the clients in the position to trust that

the “professional will keep the given entity’s best interest as the primary goal and

will strive to meet their needs (Endelman, et al., 2006)”.

Just as all nursing interventions begin with assessment, this study reflects

the first phase of the nursing process as it identifies the overall health status of

Brgy. Bukal. This acquisition of information will serve as the beginning of an on-

going process that can lead to the development of future nursing interventions.

This study will be conducted in Brgy. Bukal, Cavinti, Laguna, where the

researcher is currently assigned as a Clinical Instructor to supervise students in

their Community Immersion.

Brgy. Bukal is one of the 19 barangays of the Municipality of Cavinti,

Laguna with a total population of 1,200 and approximately 350 households. It has

a total land area of 543 hectares with 9 puroks namely Masigla, Maligaya 1,

Maligaya 2,Manigning, Magiliw, Marikit, Mahinhin, Marilag, and Isla.

Being the third adopted community chosen to be the recipient of the

Community Organizing Participatory Action Research (COPAR) program,

Makati Medical Center – College of Nursing (MMC-CN) is currently

implementing the first two phases of the COPAR Process which are the Pre-entry

and Entry Phase where the focus of nursing activities are purely integration and

desensitization of the community people to the presence of the students from

MMC-CN (Jimenez, 2005).

This is the second time that the said barangay has accommodated nursing

students having their community immersion, the first encounter being

approximately 10 years ago as mentioned by the community people. Since then,

no other studies have been conducted in and about the said barangay and most of
the records, if not destroyed by time, are not anymore applicable today. Due to the

lack of appropriate records of the barangay that can supposedly be used to further

describe the community specifically on their health promotion practices, this

raised a question in the mind of the researcher, “Are the health promotion

practices of the residents of Brgy. Bukal 10 years ago still applicable up to this


This scenario prompts the researcher to conduct a study on the current

health promotion practices of the residents of Brgy. Bukal. With the advent of

modern technology and the rise of new health-related breakthroughs and

discoveries, an assessment of their health promotion practices is needed to

determine the timeliness and effectiveness of these practices. At the same time,

the researcher is also motivated to improve the health status of the said rural

community, following the human perspective in health promotion as stated by

Lucas (2005) in his book Health Promotion Evidence and Experience that the

starting point in health promotion is the “desire to improve the quality of people’s

lives without necessarily adopting disease prevention as a primary aim”.

“An assessment should produce both needed change and increased

empowerment (Homan, 2008)”. For that reason, this study will find out the

common methods done by the residents of the community in promoting health

and the results of which will serve as a basis for designing and developing an
appropriate health education programs that will address the current need of the



This research study works under the model of Dr. Nola J. Pender which is

the Health Promotion Model. This model works on the premise that individual

characteristics, including prior related behavior, personal factors, and

biopsychosocial factors have a direct effect on the desired health-promoting

behavior. At the same time, these individual characteristics also affect the feelings

and perception of the individual. All these combined affect an individual’s

commitment to a plan of action and the performance of the health-promoting

behavior (Murray, 2009). The researcher believes that the individual

characteristics of the residents of Brgy. Bukal such as the age, gender, civil status,

educational attainment, occupation, and spiritual beliefs affect their health-

promoting practices. Although the researcher will not give much attention on the

feelings and perception of the individual, the totality of this study under the

Health Promotion Model will serve as a reference in determining the compliance

of the residents of Brgy. Bukal to the Health Promotion Program that will be

implemented later on as the outcome of this study.


OF BRGY. Practices in
terms of: Health
• Age
• Health Promotio
• Gender Responsibility n
• Civil • Interpersonal Program
Status Relations

• Educatio • Nutrition
nal • Physical

Figure 1

Figure 1 explains the interrelationship of the variables of the study which

focuses on the research on the common health promotion practices of the

residents of Brgy, Bukal.

It begins with the profile of the residents of Brgy. Bukal in terms of their

age, gender, civil status, educational attainment, occupation, and spiritual beliefs

as it relates with their health promotion practices in terms of Health

Responsibility, Interpersonal relations, Nutrition, Physical Activity, Spiritual

Growth, and Stress Management. These two set of variables would lead to the
development of a health promotion program that would address the issues and

concerns of the community. This would require an analytic interpretation and

implication of findings.


The study aims to design a health promotion program through the

identification of the common health promotion practices done by the residents of

Brgy. Bukal.

Specifically, this study seeks to find answers on the following questions:

1. What is the demographic profile of the residents of Brgy. Bukal in terms


1.1. Age

1.2. Gender

1.3. Civil Status

1.4. Educational Attainment

1.5. Occupation

1.6. Spiritual beliefs

2. What are the health promotion practices of the residents of Brgy. Bukal in

terms of:

2.1. Health Responsibility

2.2. Interpersonal Relations

2.3. Nutrition

2.4. Physical Activity

2.5. Spiritual Growth

2.6. Stress Management

3. What are the common situations/scenarios that prompts the residents to

perform health promotion practices in terms of:

3.1. Health Responsibility

3.2. Interpersonal Relations

3.3. Nutrition

3.4. Physical Activity

3.5. Spiritual Growth

3.6. Stress Management

4. Is there a significant relationship between the profile of the residents and

their health promotion practices;

5. Based on the results of the study, what program can be designed to address

and enhance the health promotion practices of the residents of Brgy. Bkal?


To the residents of Brgy. Bukal

• The outcome of this study can benefit the residents of

Barangay Bukal by raising their consciousness on how to

promote positive health and their unique behavior as residents

of Brgy. Bukal. This will provide a solid and scientific

description of the health promotion practices they perform

thereby strengthening their exclusive identity. This can also

provide an opportunity to re-evaluate their own practices in

enhancing health and identifying their weaknesses thus the

creation of programs that can address the needs of Brgy. Bukal.

Results of this study can also lead to the development of

policies that will guide and control the behavior of the residents

towards a better health.

To the Community Health Workers of Brgy. Bukal and in Cavinti, Laguna

• This study will benefit the Community Health Workers of

Brgy. Bukal by providing a concrete and scientific description

of the common practices done by the residents in the said

barangay thereby increasing their personal knowledge. This

description will provide an accurate knowledge of the client

and serve as the foundation where programs designed to

improve the health of the community can be built upon.

To Nursing Practice

• The scientific result of this study can serve as a basis and

framework in developing and implementing programs

pertaining to health promotion especially to those living in

Southern Tagalog region. With the current knowledge on

health promotion produced by this study, future nursing

interventions in maintaining and managing health will have a

rational basis, thus contributing to the evidence-based practice

in the nursing field. The intended output of this study, which is

the Health Promotion Program can be implemented in other

areas where similar problems or concerns manifest.

To Nursing Education

• This study can enrich the health promotion literature by

providing a documentation of the health promotion practices of

the habitants in one of the areas in Southern Tagalog region,

thus advancing the theoretical knowledge in health promotion.

Findings in this study can be used as a reference material in

teaching Health Promotion in the Colleges of Nursing and

Public Health.

To Nursing Research

• This study can provide a scientific and statistical reference on

the current health promotion practices done in a rural

community which can be used as a document, reference

material, and a guide to future researchers who wish to conduct

a similar study. This study can be used as a building block for

subsequent research that can raise questions that would entail a

more complex, experimental research.


The focus of this study is the heath promotion practices commonly done

by the residents of Barangay Bukal in terms of Health Responsibility,

Interpersonal Relations, Nutrition, Physical Activity, Spiritual Growth, Stress


.The researcher chose Brgy. Bukal as a convenient place to conduct the

study since the researcher will stay in the area 6 days in a week for the next 8

weeks to follow-up students undergoing Community Immersion. Therefore, the

data to be utilized in this study is readily available and accessible to the

researcher. Moreover, the researcher believes that a rural community like Brgy.

Bukal would yield more significant results that can contribute to the substance of

the study.

The subject of the study will be the long-time residents of Brgy. Bukal.

Five representatives from each of the eight puroks of the said barangay together

with the ten Brgy. Officials will be selected as respondents of this study. Data

gathering techniques will be limited to observation and distribution of survey


1. Health – refers to a state of complete physical, social, and mental well-

being, and not merely the absence of disease of infirmity (WHO)

2. Health Education – refers to “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)”.

3. Health Promotion – refers to efforts to improve the health status of an

individual and enhance his capacity to achieve health.

4. Health Promotion Practices – also known as Health Promotion

Behaviors; refers to

the actual behaviors performed by anindividual in order to improve health.

5. Health Maintenance – refers to the desire of an individual to actively

avoid the occurrence of illness or disease.

6. Health Protection – refers to behaviors that protect a person from

acquiring an illness or disease.

7. Health Responsibility – refers to

8. Interpersonal Relations – refers to social relationship of an individual. It

includes the kind of communication done by an individual to fulfill his

personal and intimate needs.

9. Nutrition – refers to the selection and consumption of food of an


10. Physical Activity – refers to an individual’s participation in light,

moderate, or vigorous activity (Walker, S., 1996).

11. Spiritual Growth – refers to the ability of an individual maximize human

potential through searching for meaning, finding a sense of purpose, and

working towards goals in life (Walker, S., 1996). It also refers to the belief

of an individual to a higher form of being.

12. Stress Management – refers to the coping mechanisms done by an

individual to reduce tension or manage stress.


Review of Related Literature

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.

The researcher gathered all literatures, both foreign and local, that are

deemed important to the topic at hand. Each literature was read and scrutinized,

and significant statements were selected and paraphrased by the researcher to

come up with this compilation of literature.

Foreign Literature and Journals

Health Promotion dates back up to the time when religion and superstition

influenced people’s 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 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 definition’s 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).

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 individual’s 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 Travis’s 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 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 people’s

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 Travis’s 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)”.

This definition introduces the other two terminologies that are frequently

confused with the promotion of health. There is a mention of the word protection

of health, which, according to Sharma (2008), are actions leading to protection of

health are those behaviors that protect a person from developing ill-health or

specific disease, example of which is immunization against Tetanus. Another is

the word maintenance of health where actions under health maintenance “are

those that seek to maintain health – avoid illness, disability, and so forth. Example

would be wearing of seatbelts, eating a balanced diet, and quitting smoking

(Murray, 2009)”. This kind of behavior is “motivated by a desire to actively avoid

illness, detect it early, or maintain functioning within the constraints of illness

(Pender, et al., 2006, p. 7)”. These two terminologies bear the two significant

words “prevent” and “avoid”, both conveying a negative connotation and focus

on the presence of disease. Using Travis’s Illness-Wellness Continuum, Health

Protection and Health Maintenance behaviors do not encourage movement of an

individual toward the High level of Wellness but maintain health on a status quo,

preventing health from moving towards the other end of the continuum which is

the Premature Death (Kozier, 2008), whereas Health promotion encourage

movements to the positive side of the continuum. To clearly delineate the

difference between the two, let’s take the example of a man jogging around the

village every morning. The man jogs everyday because he believes that this will

improve his stamina and increase his energy (Health Promotion) and at the same
time he is doing this to prevent burn fats and avoid cardiovascular diseases

(Health Protection or Disease Prevention) (Pender, et al., 2006).

These three foci of health behavior: promotion, protection, and

maintenance of health can now be summed up as “all actions with a potentially

measurable frequency, intensity, and duration performed at the individual,

interpersonal, organizational, community, or public policy level for primary,

secondary, and tertiary prevention (Sharma, 2008)”.

Health Promotion Behavior, or Health Promotion Practices are used

interchangeably in this study, although the term Health-promoting behavior is

now being used more often in health literature and bears a renewed interest as

behavior is motivated by a desire to promote personal health and well-being

(Pender, et al., 2006).

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 person’s 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 individual’s 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 individual’s

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 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 one’s daily

pattern of living and significantly influence health status”. In this study, the term

lifestyle is synonymous with Health Promoting Behaviors.

Spiritual growth or health is defined as the “ability to develop one’s inner

nature to its fullest potential which includes the ability to discover and articulate

one’s 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 client’s 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, 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, begin 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 one’s 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 one’s health than the person owning

that health. The desire to enhance health and well-being must come from within.
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 person’s 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 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” serve 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 sector’s responsibility to

“build capacity for policy development, leadership, health promotion practice,

knowledge transfer and research, and health literacy (Anden, 2010)”.

“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. Bukal is

a rural community situated in Cavinti, Laguna. As a rural community, it is

expected that progress in terms of the eight subsystems of a community

particularly in health is far behind from those living in the urban community. The

basic source of living of the residents in Brgy. Bukal is pag-lalala or weaving of

hats, which they sell for Php 12.00 per piece. The average income of a family

household ranges from Php700.00 to 1,000.00 a month. This amount of income

can hardly provide them enough funds to take appropriate measures in promoting

health. This situation reflects the description of Palaganas (2003) of those living

in the rural area – people hardly eats three times a day, lack of proper education,

belief in superstition and evil spirits when it comes to health, lack of funds to

support health, etc. As Palaganas (2003) puts it, “many mistaken practices result

from ignorance and superstition”. Since Brgy. Bukal is a rural community,

conclusion 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. Among all Filipinos, only a small portion are physician, nurses,

dentists, medical technologists, physical therapists, public health workers, or other

health workers (Policarpio, 2006). Therefore, the lack of health workers in a rural

community specifically in Brgy. Bukal does not come as a surprise since this

small amount “good samaritans” are maldistributed in areas where the richer

sectors of society are concentrated (Palaganas, 2003, p. 73).

In this kind of situation, nurses are an “indispensable human resource to

take care of people’s health (Palaganas, 2003, p. 153). Especially in this time

where there is a shift from hospital-based to community-based nursing will

consequently affect the nursing role in the health care delivery system (Mallari,

2005). Focus will now be geared towards the health of the community, and the

key to a healthy community is the promotion of health.

Specifially, the Community Health Nurse serves 1. As an advocate as they

seek to promote and enhance the quality health; 2. As an Epidemiologist as she

uses the epidemiological approach in studying their health and dealing with

community wide problems; and 3. As a Health Planner as the nurse creates health

programs for the community (Jimenez, 2006). In order to fulfill this function, the

nurse must take the first step in creating a program which can be used to meet the
needs of the people and that is the assessment of health promotion practices of the

residents of Brgy. Bukal.

Relevance of the Literature to the Study

After reading and compiling the relevant literatures above, one idea

remains – that for a nurse 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 nurse to gather all the information that she can get in order to come up with

a program/plan that is specifically designed according to the specific needs of

Brgy. Bukal, Cavinti, Laguna. 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. Bukal. 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.



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. Bukal, Cavinti,



The respondents of this study will be the Baranggay officials of Brgy.

Bukal and the top 3 officials of each of the eight puroks, mostly aged 20-40 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.

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)”.


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,


7. Stress Management 5, 11, 17, 23, 29, 35, 41, 47

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.

Bukal, 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



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

of steps. First of which will be to distribute the necessary communication letters

written by the researcher and approved and noted by the researcher’s adviser and
the Dean of the Graduate School, respectively, to the Municipal mayor of Cavinti,

Hon. Florceli Esguerra and the Brgy. Captain of Brgy. Bukal, Mr. Aben

Calinagan. Once permission is granted, the researcher will begin the data


To select the respondents, the researcher will obtain a list of names of the

Brgy. Officials of Bukal and the different officers per purok, together with their

addresses. The researcher will personally visit the selected respondents and

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


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 individual’s 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:


Where: Ex is the summation of scores

n is the number of scores in the distribution.

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).

N ∑ XY − ( ∑ X )( ∑Y )
[N ∑ X 2
− ( ∑ X ) N ∑Y 2 − ( ∑Y )
2 2
N no. of cases
∑XY sum of the products of x and y
∑X sum of the x’s
∑Y sum of the y’s
∑X2 sum of the squares of x’s

∑Y2 sum of the squares of the y’s

To test the significance of the computed r

n −2
1− r2


n the number of respondents

r the computed coefficient of correlation


(Tagalog Version)

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 PAGBILOG sa letra na

naaayon sa inyong kasagutan:



Mi para sa MINSAN GINAGAWA, at


Pangalan: ____________________________________ Edad: ________

Kasarian: _________

Estado sa buhay: ___________ Pinakamataas na naabot sa pag-aaral:


Trabaho: ________________ Relihiyon: _______________

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

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

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).
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

16. Sumasali ako sa mga gawaing nakakapag-

ehersisyo 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 (2nd

opinion) kapag nanghihingi payo tungkol sa aking

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

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

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

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

35. Binabalanse ko ang trabaho at paglalaro o

36. Interesado ako sa mga mangyayari sa aking buhay

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-e-ehersisyo.
41. Ako ay nagpapahinga at nagmumuni-muni sa

loob ng 15-20 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.

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

52. Ihinaharap ko ang aking sarili sa mga bago at

kakaibang pagsubok sa aking buhay.


Foreign Literature

Bordens, S. Research Design and Methods. A Process Approach.

McGraw-Hill, International © 2007

Cosby, R., et al., Research Methods in Health Promotion. John

Wiley and Sons, Inc. © 2006

Creswell, J., Educational Research. Planning, Conducting, and

Evaluating Quantitative and Qualitative Research. Pearson Education, Inc.

© 2005
Endelman, C. et al., Health Promotion Throughout the Life Span

6th Edition. Mosby, Inc. © 2006

Homan, M. Promoting Community Change. Making It Happen in

the Real World. 4th Edition. Thomson Brooks/Cole. © 2008

Houser, J., Nursing Research. Reading, Using, and Creating

Evidence. Jones and Barlett Publishers. © 2008

Leddy, S., Integrative Health Promotion: Conceptual Basis for

Nursing Practice. Jones and Barlett Publishers, Inc. © 2006

Lucas, K. et al., Health Promotion. Evidence and Experience.

SAGE Publications, Ltd. © 2005

Marks, et al., Health Psychology: Theory, Research, and Practice.

SAGE Publications, Ltd. © 2005

McKenzie, J., et al., Planning, Implementing, and Evaluating

Health Promotion Programs, 4th Edition. Pearson Education, Inc., © 2005

Miller, C., Nurses’ Toolbook for Promoting Wellness. McGraw-

Hill, Inc. © 2008

Murray, R., Health Promotion Strategies through the Life Span.

Pearson Education, Inc. ©2009

Naidoo, J., Public Health and Health Promotion: Developing

Practice. Bailliere Tindall© 2005

Pender, N. et al., Health Promotion in Nursing Practice 5th Edition.

Pearson Education Inc., © 2006.

Scriven, A., Health Promoting Practice: The Contribution of

Nurses and Allied Health Professionals. © 2008

Sharma, M., Theoretical Foundations of Health Education and

Promotion. Jones and Barlett Publishers, © 2008

Local Literature

Cuevas et al.. Public Health Nursing in the Philippines. National

League of Philippine Government Nurses, Inc. © 2009

Dayrit, M., National Policy on Health Promotion. Sta. Cruz,

Manila © 2001

Jimenez, C., Community Organizaing Participatory Action

Research (CO-PAR) for Community Health Development. SynerAide

Research and Publications. © 2006.

Palaganas, E., Health Care Practice in the Community. First

Ediction. Educational Publishing House © 2003.

Policarpio, J., Economics in Health for the Allied Health Sciences.

C&E Publishing, Inc. © 2006

Ramos, F., Implementing Health Promotion Program through

Healthy Places. Malacañang, Manila © 1997


Hsiao, Y., et al., Spiritual health, clinical practice stress, depressive

tendency and health promoting behaviours among nursing students.

Journal of Advanced Nursing, © 2010 Jul; 66(7): 1612-22.

Weyers S., et al., How does socio economic position link to health

behaviour? Sociological pathways and perspectives for health promotion.

Global Health Promotion © 2010 Jun; 17(2): 25-33

Unpublished Literatures

Anden, A., Basic Course on Health Promotion and Education for

Health Promotion and Education Officers (HEPOs) and Information

Officers (IOs). National Center for Health Promotion, DOH, © 2010

Walker, S., Psychometric evaluation of the Health-Promoting

Lifestyle Profile II. University of Nebraska Medical Center, © 1996

Local Studies
Lorena. J., Designing Parenting Skills Program Through Temper

Tantrum Management of Toddlers. © 2008.

Mallari, G. Competencies of Graduating Nursing Students in

Implementing Primary Health Care: Basis for Enhancing Community

Otiented BSN Curriculum. © 2005