You are on page 1of 6

Our Lady of Fatima University

College of Nursing
QUESTIONNAIRE FOR EMPLOYEES

A. PROFILE
Name: ___________________________________________
Working years in the community: _________________
Departmental Affiliation: __________________________

B.
1. What are the advantages and disadvantages after implementing
the Local Government Code?
_________________________________________________________________
_________________________________________________________________
________________________________________________________________
2. Are there any hindrances encountered during implementation of
the health – related programs after the RA 7160? What are those
in terms of:
a. Allocation of funds
_____________________________________________________________
__________________________________________________________
b. Organizers
_____________________________________________________________
___________________________________________________________
c. Accessibility of services

_________________________________________________________________________
_________________________________________________

3. How do you give awareness to the community about the
programs for prevention of hypertension?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
__
4. How do you feel about the interventions of the programs?

_______________________________________________________________________________ _______________________________________________________________________________ ________________________________________ 5. what could be your contributions to the programs implemented during the Local Government Code? _______________________________________________________________________________ _______________________________________________________________________________ ________________________________________ . As a health care provider.

Rest assured that all information provided should be taken collectively to maintain strict confidentiality. I. PROFILE OF THE RESPONDENTS Age [ ] below 15 [ ] 16 – 25 [ ] 26 – 35 [ ] 36 – 45 [ ] 46 – 55 [ ] 56 – 65 [ ] 66 above Gender [ ] Male [ ] Female .Our Lady of Fatima University College of Nursing QUESTIONNAIRE CHECKLIST FOR CLIENTS DYNAMICS OF A DEVOLVED IMPLEMENTATION OF HYPERTENSION PREVENTION PROGRAMS IN RIZAL DIRECTION: Kindly answer parenthesis the following questions by checking the [ / ] or filling up the blank that corresponds your answer.

Educational Attainments [ ] Elementary graduate [ ] High school graduate [ ] College graduate [ ] Master’s degree [ ] Doctorate degree [ ] Other (Specify): ____________ Family history of hypertension a. how are you related? [ ] Father [ ] Mother [ ] Brother [ ] Sister [ ] Grandparents [ ] Other (Specify): ______________ Additional information: Family monthly Income [ ] 100.1.001 and above .001.15. 001.001.000 pesos [ ] 20.000 pesos [ ] 15.000 pesos [ ] 5.20.000 pesos [ ] 1.001-5.000 pesos [ ] 10.10. Is there anybody in the family who is suffering from hypertension? [ ] Yes [ ] No b. If yes.

Public announcement c.II. Mouth-to-mouth use 2. Services availability frequency a. Weekly 3 2 1 . Free laboratory & diagnostic tests 3. Twice a month c. Implementation of Hypertension Program a. Thrice a month d. Services available a. Distribution of flyers b. LEVEL OF AWARENESS OF THE CLIENTS 4 – Very much aware 3 – Very aware 2 – Not much aware 1 – Not aware at all 4 1. Once a month b. Free consultation b. Free medicine c.

Financial problem b. Accessibility of the facility 3 2 1 . Availability of diagnostics and laboratory c. Unavailability of medical practitioners b. Patients in-waiting 3 Barriers encountered a.III. Overcrowding patients c. PERCEPTION ON THE IMPLEMENTATION OF REPUBLIC ACT 7160 4 3 2 1 – Always – Sometimes – Seldom . Receives medical treatment/services b. Free medicines c.Never 4 1 Open opportunities a. Free consultation and diagnostic tests 2 Challenge met a.