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QUESTIONNAIRE

Code Number: ______________ Part I. Socio-demographic Profile 1. Age: _____________ 2. Position in the Family a. Mother b. Father ( ) ( )

3. Occupation: _____________ 4. Educational Attainment: a. Primary b. Secondary c. Tertiary ( ) ( ) ( )

5. Religion: _____________ 6. Family Monthly Income: > 3001 and above > 2501 – 3000 > 1501 – 2500 > 1001 – 1500 > 501 – 1000 > 100 – 500 ( ) ( ) ( ) ( ) ( ) ( )

Health Promotive Behaviors/Measures Our family prevents diseases by: Health Promotive Behaviors/Measures 1. Having a regular exercise 6. Attending health education or seminars about health 13. A. Isolating sick member 18. Not drinking liquor 8. Consulting physician 17. idea and point of view to the questions honestly by putting check mark corresponding to your health beliefs and practices. Health Related Beliefs and Practices Direction: Kindly indicate your response. Proper and complete immunizations 10. Proper personal hygiene 5. Regulating activities Alway s 4 3 Often 2 Seldo m 1 Never .Maintaining cleanliness inside and outside our home 2. Washing hands before and after meals 4. Eat nutritious foods or have a balanced diet 3. Taking vitamins and food supplements 11. Taking rest 20. Sterilizing food utensils 19. Taking medications 21. amulets or anting-anting 14. Recognizing the existence of supernatural being 15. Wearing/using charms. Washing wounds with herbal preparations 16. Ensuring clean and safe water sources for drinking 9. Regular check-up 12. Not smoking 7.Part II.

Submitting a sick person to santiguar/himotbot 13. Taking medicine even without prescription from the doctors 7. lakad bulan 10. Performing rituals to cure the sick such as orasyon 12. Submitting a sick person to hinibang/sibang 15. in taking care of wound) 4. Bed rest 2. Applying therapeutic procedures such as sponge bathing 6.B. Using herbal medicines like aloe leaf. ginseng. Curative/Remedial Measures Diseases/ illnesses are cured/treated by: Curative/Remedial Measures 1. Provide easy to digest food like hot soup/lugaw 5.g. Seeking medical consultation 9. Praying to alleviate pain or treat diseases 11. Taking medicines with prescription form doctors 8. Monitoring body temperature 3. Submitting as sick person to hilot or massage 14. Proper hygiene (for e. Providing an offering or pag-aalay for the supernatural creatures to cure a certain illness Alway s 4 3 Often 2 Seldom 1 Never .

What are the Health Seeking Related Problems Encountered? Direction: Kindly rank your answer according to the most encountered problem in seeking medical consultation wherein.Part III. 1 – Most encountered 7 – Least encountered ________ Inadequate health facilities in the Barangay ________ Poor transportation ________ Lack of family budget ________ Unawareness to signs and symptoms of certain disease ________ Lack of trust to medical professional due to past experiences ________ Unavailability of medical health practitioners in the Barangay ________ Lack of medical assistance from the government .