STAKEHOLDERS’ COMPLAINCE ON THE DEPARTMENT

OF HEALTH’S DENGUE PREVENTIVE MEASURES

A Thesis Proposal
Presented to the
Faculty of School of Advance Studies
Pangasinan State University
Urdaneta City

In Partial Fulfillment
Of the Requirements for the Degree
Master of Arts in Education
Major in Science Education

ANTONNETE T. MELEGRITO

July 2020

i
 APPROVAL SHEET

In partial fulfillment of the requirements for the degree, Master of Arts in

Education, this thesis proposal entitled “STAKEHOLDERS’ COMPLAINCE ON

THE DEPARTMENT OF HEALTH’S DENGUE PREVENTIVE MEASURES” has

been prepared and submitted hereby recommended for oral examination.

MARIA THERESA M. DIZA, MA HONELLY MAE S. CASCOLAN, PhD

Critic Reader Adviser

Approved by the Committee on Oral Examination

ADONIS S. BAUTISTA, DBA

Chairman

CRISTETA C. DULOS, PhD RAQUEL C. PAMBID, PhD

Member Member

EMMANUEL ROSS B. TOMAS, EdD

Member

Accepted in partial fulfillment of the requirements for the degree of Master

of Arts in Education.

ADONIS S. BAUTISTA, DBA DEXTER R. BUTED, DBA

Executive Director University President

ii
 TABLE OF CONTENTS

Page
TITLE PAGE i

APPROVAL SHEET ii

TABLE OF CONTENTS iii

LIST OF TABLES v

LIST OF FIGURES vi

I. THE PROBLEM 1

Background of the Study 1

Statement of the Problem 6

Research Hypothesis 7

Scope and Delimitation of the Study 7

Significance of the Study 8

Definition of Terms 9

II. REVIEW OF RELATED LITERATURE 11

Related Literature 11

Epidemiology of Dengue in the Philippines 11

Current Status of Dengue Disease

in the Philippines 13

Department of Health’s Dengue Prevention and

Control Policies 18

Stakeholders in Healthcare Sector 18

Role of Stakeholders in Dengue Prevention 23

iii
 Related Foreign Studies 24

Related Local Studies 28

Theoretical Framework 30

Conceptual Framework 32

III. RESEARCH METHODOLOGY 34

Research Design 34

Respondents and the Locale of the Study 35

Research Instrument 35

Validation of the Instrument 35

Data Gathering Procedure 36

Statistical Treatment of Data 37

BIBLIOGRAPHY 38

APPENDICES 45

A Research Questionnaire 45

B Electronic Form of the Research Questionnaire 49

C Sample Questionnaire Validation Tool 60

CURRICULUM VITAE 64

iv
 LIST OF TABLES

Table No. Page

1 Table of Interpretation 37

v
 LIST OF FIGURES

Figure No Page

1 Paradigm of the Study 33

vi
 1

Chapter 1

THE PROBLEM

Background of the Study

Better health is central to human happiness and well-being. It also makes

an important contribution to economic progress, as healthy populations live

longer, are more productive, and save more. Many factors influence health status

and a country's ability to provide quality health services for its people. Healthcare

offices, such as the Department of Health and its underlying bureaus, are

important actors, but so are other government departments, donor organizations,

civil society groups, communities and educational institutions themselves.

Government offices invests in roads that can improve access to health services,

inflation targets can constrain health spending, and civil service reform can

create opportunities - or limits - to hiring more health workers. Schools can also

be an agent in the promotion of better human health by providing, not only the

students but their parents as well, information regarding the importance of being

healthy. The school can also be an agent wherein stakeholders can participate in

the promotion of a healthy lifestyle.

Dengue is a disease of many tropic and subtropics regions that can occur

epidemically; caused by dengue virus, a member of the family Flaviviride.

Dengue is transmitted in humans by two species of Aedes mosquitoes namely,

Aedes aegypti and Aedes albopictus (Gale Encyclopedia of Medicine, 2008).

There are four distinct serotypes of dengue virus which can all cause a spectrum

of disease, ranging from asymptomatic infection to the most severe form of the
 2

disease Dengue Hemorrhagic Fever (DHF). The symptoms of dengue infection

are high fever, severe headache, painful joints and muscles, vomiting, nausea,

pain behind the eyes and skin rashes. These symptoms almost last for about one

week, but weakness and tiredness may last for several weeks. In some patient’s

dengue fever leads to development of DHF and the patient may reflect problems

including blood in the urine or stool, bleeding gums or bloody nose. These

symptoms may lead to death if untreated (Leitmeyer, et al, 1999).

Dengue fever, also known as break bone fever, is an infectious mosquito-

borne disease which is caused by the dengue virus and occurs in tropical and

subtropical areas of the world. The dengue virus belongs to the Flaviviridae

family of viruses that cause diseases in human. Dengue is a self-limiting disease

that clears up by it usually within a couple of weeks. The incubation period for

dengue is five to eight days. Researchers are working on dengue fever vaccines,

but the best prevention for now is to reduce mosquito habitat in areas where

dengue fever is common (Brinton & Dispoto, 2008).

With 106,630 dengue cases reported through the Philippines Integrated

Disease Surveillance and Response (PIDSR) system from 1 January to 29 June

2019, including 456 deaths, the current dengue incidence is 85% higher than in

2018, in spite of a delayed rainy season. Whereas the Case Fatality Rate (CFR)

of 0.43% as of 29 June 2019 is lower than in the same time period in 2018

(0.55%), this is still significantly higher than the regional average of 0.22% in the

Western Pacific (IFRC, 2019).

 3

The Philippines’ Department of Health (DOH) declared a National Dengue

Alert on 15 July 2019, urging regional DOH offices to step up dengue

surveillance, case management and outbreak response in primary health

facilities and hospitals, as well as through community and school-based health

education campaigns, clean-up drives, surveillance activities, case

investigations, vector control, and logistics support for dengue control

(insecticides, RDTs, medicine, etc) in line with an Advisory on Dengue

Preparedness and Outbreak Response issued earlier this year. The National

Disaster Risk Reduction Management Council (NDRRMC), raised the code blue

alert, activating the national Health Cluster, led by DOH (De Vera & Ramos,

2019).

Between 1 January to 29 June 2019, including 456 deaths were officially

reported through the routine surveillance system from the DOH, with a CFR of

0.43%. With a median age of 12 years, the most affected age group among

dengue cases is 5-9 years (23%). Similarly, the most affected age group among

dengue deaths is 5-9 years (39%). The majority of dengue cases are male

(53%), whereas the majority of dengue deaths are female (52%). Most affected

regions are II, IVA, V, VI, VII, VIII, IX, II, BARMM and NCR. Iloilo, Capiz, Aklan,

Antique and Guimaras provinces in Region VI declared an outbreak, with many

municipalities seeking a state of calamity to access emergency funding to

mobilize additional resources (DOH, 2019).

Stakeholders plays an important in the promotion of health and safety

awareness in the community. In a parlance, the term stakeholder, according to

 4

Freeman (1984) is “an organization… [or] any group or individual who can affect

or be affected by the achievement of the organization’s objectives”. In the

healthcare services, the term stakeholder typically refers to those entities that are

integrally involved in the healthcare system and would be substantially affected

by reforms to the system. The major stakeholders in the healthcare system are

patients, physicians, employers, insurance companies, pharmaceutical firms and

government (Rodriguez-Osorio & Dominguez-Cherit, 2018). In some cases, the

term may be used in a more narrow or specific sense — say, in reference to a

particular group or committee — but the term is commonly used in a more

general and inclusive sense.

Dengue control can be effectively addressed with stakeholder

involvement. Combatting and spreading awareness regarding dengue is a

responsibility shared by many, and intersectoral cooperation is a strategic

approach for successful interventions. (Suwanbamrung, 2010; Khun &

Manderson, 2008; Sanchez, Perez, Perez, et al, 2015; Heintze, Velasco-Garrido

& Kroeger, 2017). Community-based programs have aimed at modifying health-

risk behaviors and the conditions that produce and support them. These

programs have included community-wide health education, risk factor

intervention, and efforts designed to change laws or regulatory policy in areas

where health is affected. These undertakings rely on community organization

techniques to boost community leadership and resources, and to plan

interventions (Wickizer, Von Korff, Cheadle, et al, 2013). Most community-based

programs for dengue control have focused on eliminating domestic repositories

 5

of the mosquito vector and ensuring that they are free of Aedes mosquitous.

Stakeholder participation research has concentrated on neighborhoods which are

subject to intervention and/or are vulnerable communities; such research has not

considered groups who implement and could sustain these interventions, or are

responsible for disease control (Espino, 2014).

Societal sectors that have some interest in, or responsibility for the control

of dengue have been identified: national control programs, local governments,

environment and urban planning, education, science and technology, the media,

the private sector, and communities in endemic areas (Heintze, et al, 2017;

Halstead, 2011; Erlanger, Keiser & Utzinger, 2008). These stakeholders at

community level (e.g. households, primary health care workers) need to interact

with technical officers at the local government level (e.g. sanitation inspectors) in

order to create positive effects.

In the province of Tarlac, a reported cases of 2989 individuals are

contacted with the disease last July 2, 2018 and 1,629 individuals for the same

period last year. Most of the victims are school children based on the report of

the Provincial Epidemiology and Surveillance Unit (PESU). This quarter alone a

total eleven deaths were reported by the PESU, six of which came from the town

of Paniqui, three from Gerona, one each from Concepcion and Mayantoc. This

alarming state needs not only prevention but an increased awareness regarding

the disease.

The researcher, therefore, aims to describe the level of aware and levl of

compliance of different healthcare stakeholders to the Department of Health’s

 6

implemented measures in controlling and combating the dengue disease. The

researcher also aims to determine the interrelatedness of the respondents’ level

of awareness and level of compliance to the DOH’s dengue preventive measures

A framework for a more intensive dengue awareness program will then be

proposed by the researcher as an output of this study.

Statement of the Problem

This study aims to determine and describe the level of awareness and the

level of compliance of different healthcare stakeholders to the Department of

Health’s implemented programs for dengue awareness and prevention.

Specifically, it will also seek answers to the following questions:

1. What is the profile of the stakeholders in terms of:

a. type of organization;

b. scope of responsibility;

c. number of officials;

d. number of members; and

e. source of funds?

2. What is the level of awareness of the stakeholders on the DOH dengue

preventive measures?

3. What is the level of compliance of the stakeholders on the DOH dengue

preventive measures?

4. Is there a significant difference between the level of compliance of the

stakeholders when they are grouped according to their profile variables?

 7

5. Is there a significant relationship between the stakeholders’ level of

awareness and compliance to the DOH dengue preventive measures?

6. What plan of action can be proposed to enhance the implementation of the

DOH dengue preventive measure?

Research Hypothesis

Aside from the aforementioned questions, the research will also test the

following hypotheses using appropriate statistical test with a 0.05 level of

significance:

1. There is a significant difference between the level of compliance of the

stakeholders when they are grouped according to their profiles.

2. There is a significant relationship between the stakeholders’ level of

awareness and compliance to the DOH dengue preventive measures.

Scope and Delimitation of the Study

The study is quantitative in nature and will focus on the difference

stakeholders in the municipality of Pura, Tarlac. Stakeholders were limited public

and private healthcare stakeholders such as those in the education sector, local

government sectors, local community/barangay sectors, private business

sectors, health and safety sectors and others that are within the scope of the

Department of Health’s policies on dengue awareness and prevention.

The study is also limited to the responses of the respondents to the

questionnaires intended for the study. The items in the survey questionnaires are

limited to the DOH’s dengue prevention and control program, specifically the
 8

Enhanced 4S (Search and Destroy, Seek Early Consultation, Self-Protection

Measures, and Systematic Fogging During Outbreaks) Strategy.

Significance of the Study

Dengue imposes significant economic and societal burdens on countries

where the disease is endemic and, as such, estimating the associated disease

impact can help inform policymakers and assist them in setting priorities for

disease control and management strategies (Martelli, et al 2015; Ibarra, et al,

2014). The effects of dengue on health and preventive care, its economic burden

and social impact on populations have not been clearly studied. Understanding

dengue burden from societal and socio-economic perspectives is crucial for

allocation of limited scarce public health resources among competing health

threats, as well as ensuring cost-effectiveness of integrated dengue prevention

and control methods. Thus, effective coordination with schools and different

stakeholders will broaden the network in combating dengue.

The findings of the study will therefore be beneficial to the following

groups.

Lawmakers. The findings of this study will help lawmakers in

promulgating law regarding the importance of linkages between public and

private sectors regarding dengue. They may be able to write laws that will

oversee these linkages so that abuses may not developed in the duration of such

linkages.
 9

Stakeholders. This study will provide relevant data regarding the

importance of stakeholder awareness and compliance to the DOH’s dengue

preventive measures. With enhanced awareness and compliance, stakeholders

will be able to identify and internalize their part in keeping their community

dengue free.

Local Health Officers. The findings of this study will provide relevant data

regarding the importance of imparting the knowledge of the stakeholders

regarding dengue prevention and control. They may use the information gathered

from this study as a baseline in conducting health awareness protocol in their

respective communities.

Other researchers. This study will also benefit researchers that will

undertake projects similar to the present study by providing them with valid data

and information that they can utilize.

Definition of Terms

For a clearer understanding of the study, the following terms are defined

conceptually and operationally. The definitions shall provide a cleared

understanding of the variables that will be used in the study.

Awareness. Chalmers (1997) defined awareness as the state of being

conscious of something. More specifically, is the ability to directly know and

perceive, to feel, or to be cognizant of events. In this study, awareness is defined

as the ability of an individual belonging to a particular group to recognize dengue

preventive measures laid upon by the Department of Health.

 10

Compliance. This term is defined as the act or process of complying to a

desire, demand, proposal, or regimen or to coercion or the conformity in fulfilling

official requirements (Merriam-Webster, n.d.). In this study, compliance is defined

as the act to which an individual belonging to a particular group in conforming to

the dengue preventive measures laid upon by the Department of Health.

Level of Awareness. Level of consciousness in which sense data can be

confirmed by an observer without necessarily implying understanding. More

broadly, it is the state or quality of being aware of something (Definition.net, n.d.).

Level of Compliance. This term indicates the degree of compliance that

an individual has achieved for a program or a requirement.

Stakeholders. In the health care sector, stakeholders typically refers to

those entities that are integrally involved in the healthcare system and would be

substantially affected by reforms to the system.

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Chapter 2

REVIEW OF RELATED LITERATURE

This chapter focuses on related literature regarding dengue, stakeholder

participation and compliance to the healthcare system and community linkages

which will be used to develop the research theoretical and conceptual framework.

Also related foreign and local studies parallel to the current study will also be

presented to further the research gap.

RELATED LITERATURE

Epidemiology of Dengue in the Philippines

Dengue is considered by the World Health Organization (WHO) as a

major global public challenge in the tropic and subtropic nations such as the

Philippines (Wilder-Smith & Macary, 2014). The dengue virus, a member of the

Flavivirus of the family Flaviviridae, is an arthropode-borne virus that includes

four different serotypes: dengue virus (DENV) -1, DENV-2, DENV-3 and DENV-4

(Halstead, 2007; Moi & Kurane, 2013). These four viruses are called serotypes

because each has different interactions with the antibodies in human blood

serum. The four dengue viruses are similar — they share approximately 65% of

their genomes — but even within a single serotype, there is some genetic

variation. Despite these variations, infection with each of the dengue serotypes

results in the same disease and range of clinical symptoms. The acute viral

illness spread by Aedes mosquitoes.

Due to increased population growth rate, global warming, unplanned

urbanization, inefficient mosquito control, frequent air travel, and lack of health
 12

care facilities, dengue has seen a 30-fold upsurge worldwide between 1960 and

2010 (Gubler, 2002; WHO, 2009; Guzman, et al., 2010). Two and a half billion

people reside in dengue-endemic regions (Guzman, et al., 2010) and roughly

400 million infections occuring per year, with a mortality rate surpassing 5–20%

in some areas (Linares, Panuti & Kubota, 2013). Dengue infection affects more

than 100 countries, including Europe and the United States (San Martín,

Brathwaite, Zambrano, Solórzano, Bouckenooghe, Dayan, & Guzman, 2010).

In the Philippines, outbreaks reported in1926 (Siler, Hall & Hitchens, 1926;

Simmons, St John & Reynolds, 1931), and the first recorded epidemic in

Southeast Asia occurred in Manila in 1954 (Ooi & Gubler, 2009; Gubler, 1997).

Further epidemics occurred in 1966, 1983, and 1998, with increasing reported

cases of dengue disease (DOH Report, 2010; WHO-Western Pacific Region,

2008; Songco, Leus & Manaloto, 1987; Venzon, Rudnick, Marchette, Fabie &

Dukellis, 1972). The 1998 epidemic had the highest recorded incidence rate

(60.9 cases per 100,000 population) and case fatality rate (CFR; 2.6%) (DOH

Report, 2010). The rising incidence of dengue disease can be explained by

several factors. Dengue is caused by one of four dengue viruses (DENV-1, -2, -3,

or -4) transmitted primarily by the Aedes aegypti (Linnaeus) mosquito, which

breeds in open water containers, and can survive year round in tropical and

subtropical climates. During World War II, the movement of people and

equipment expanded the geographic distribution of Ae. Aegypti and dengue

disease in Southeast Asia (Ooi & Gubler, 2009). Since then, virus propagation in

the region has been facilitated by rapid urbanization, environmental degradation,

 13

the lack of a reliable water supply, and improper management and disposal of

solid waste (Ooi & Gubler, 2009; HSLP, 2009). In the Philippines, the percentage

of the population living in urban areas increased from 27.1% in 1950 to 58.5% in

2000 (UN DESA Population Division, 2008).

Current Status of Dengue Disease in the Philippines

According to the United Nations Office for the Coordination of

Humanitarian Affairs office (OCHA) in the Philippines more than 77,000

suspected cases of dengue and 300 deaths were reported in the first 20 weeks

of 2019 in the Philippines. This is almost double the number of reported cases

during the same time period last year. Dengue cases remain high as the rainy

season approaches, with the Department of Health declaring a dengue outbreak

in four villages in the province of Negros Oriental in the Central Visayas region.

City and municipal health officials, working with local authorities, have launched

information campaigns in the affected provinces. They are conducting house-to-

house visits and distributing treated mosquito nets (OCHA, 2019).

According to the latest report of the DOH Epidemiology Bureau, there

were 3,610 dengue cases reported from June 16 to 22. This number brings the

cases recorded, from all over the country since January 1 to June 22, to a

cumulative total of 98,179, with 428 deaths. The reported cases for June 16 to 22

alone is eight percent (8%) higher compared to the same period last year (3,330

cases). Since January, the highest number of cases came from Western Visayas

(11,285), CaLaBaRZon (10,313), Central Visayas (8,773), SOCCSKSARGEN

(8,297), and Southern Mindanao (8,289). Meanwhile, the DOH clarified that the
 14

alleged outbreak in the Ilocos province were confined to specific barangays only

and not the whole province. The DOH Center for Health Development Office in

Region 1, Northern Luzon, reported a total of 353 dengue cases from Ilocos

Norte from January 1 to June 29, this is 47.7% higher than the number of cases

reported for the same period in 2018. Most of the cases came from Laoag City

(94), Badoc (43), Batac City (29), Pagudpud (21), and Dingras (20). There were

no deaths reported (DOH, 2019).

With 106,630 dengue cases reported through the Philippines Integrated

Disease Surveillance and Response (PIDSR) system from 1 January to 29 June

2019, including 456 deaths, the current dengue incidence is 85% higher than in

2018, in spite of a delayed rainy season. Whereas the Case Fatality Rate (CFR)

of 0.43% as of 29 June 2019 is lower than in the same time period in 2018

(0.55%), this is still significantly higher than the regional average of 0.22% in the

Western Pacific. The Philippines Department of Health (DOH) declared a

National Dengue Alert on 15 July 2019, urging regional DOH offices to step up

dengue surveillance, case management and outbreak response in primary health

facilities and hospitals, as well as through community and school-based health

education campaigns, clean-up drives, surveillance activities, case

investigations, vector control, and logistics support for dengue control. The

National Disaster Risk Reduction Management Council (NDRRMC), raised the

code blue alert, activating the national Health Cluster, led by DOH (WHO, 16

July, 2019). Between 1 January to 6 July, 115,986 dengue cases including 456

deaths were reported through the DOH routine surveillance system, with a CFR
 15

of 0.42%. With a median age of 12 years, the most affected age group among

dengue cases is 5-9 years (30%). Similarly, the most affected age group among

dengue deaths is 5-9 years (40%). The majority of dengue cases are male

(55%), whereas the majority of dengue deaths are female (53%). CFR is highest

in regions V (1%), BARMM (1%), VI (0.6%), and VII (0.7%), whereas incidence is

highest in regions IX, CARAGA, VI, XII, X, and II (WHO, 25 July, 2019)

The Department of Health (DOH) declared a national dengue epidemic to

enable the local government units to use their Quick Response Fund to address

the epidemic situation. Based on the DOH Dengue Surveillance Report, there are

146,062 cases recorded from January to July 20 this year, 98% higher than the

same period in 2018. There were 622 deaths (Government of the Philippines, 6

August, 2019). During 1 January to 27 July, there are 167,607 dengue cases

reported, including 720 deaths. The number of cases reported is 97% higher than

in 2018, in spite of a delayed rainy season. Case Fatality Rate (CFR) as of 27

July is 0.43%, which is lower than in the same time period in 2018 (0.54%), but

still significantly higher than the regional average of 0.22% in the Western

Pacific. The most affected age group among dengue cases is 5-9 years (23%),

with a median age of 12 years. Similarly, the most affected age group among

dengue deaths is 5-9 years (42%). The majority of dengue cases are male

(52%), whereas the majority of dengue deaths are female (54%). CFR is highest

in regions XI (.58%), BARMM (.87%), and V (0.57%), whereas incidence is

highest in regions VI, IV-A, XIII, IX, X. (WHO, 13 Aug 2019)

 16

As dengue cases continue to rise in Eastern Visayas, the Department of

Health's blue alert in Region 8 remains in effect. Based on the data released by

DOH-8, a total of 16,526 dengue cases with 50 deaths were reported from

January 1 to August 23, 2019. The majority of the cases are from the province of

Leyte with 4,262 cases and 13 deaths. Ages ranged from one-month old to 88

years old. The DOH noted a clustering of cases in 95 municipalities and 585

barangays in Eastern Visayas. (DOH, 2019)

Between 1 January and 17 August, 229,736 dengue cases including 958

deaths were reported through the DOH routine surveillance system, with a CFR

of 0.42%. With a median age of 12 years, the most affected age group among

dengue cases is 5-9 years (23%). Similarly, the most affected age group among

dengue deaths is 5-9 years (40%). The majority of dengue cases are male

(52%), whereas the majority of dengue deaths are female (54%). Between 11

and 17 August, 13,327 cases and 40 deaths were reported, compared to 17,137

cases and 36 deaths in the preceding week, but still 40% higher than in 2018

(WHO, 2 Sep 2019). Between 1 January and 31 August 2019, 271,480 dengue

cases including 1,107 deaths were reported through the DOH routine

surveillance system, with a CFR of 0.41%. With a median age of 12 years, the

most affected age group among dengue cases is 5-9 years (23%). Similarly, the

most affected age group among dengue deaths is 5-9 years (39%). The majority

of dengue cases are male (52%), whereas the majority of dengue deaths are

female (53%). Between 25 and 31 August, 12,526 cases and 41 deaths were

reported, compared to 13,192 cases and 38 deaths in the preceding week, but
 17

still 52% higher than in 2018. Similarly, the weekly CFR of 0.33% in

epidemiological week 35 is lower than in the same time period in 2018 (0.40%)

(WHO, 2019).

During week 36, 2019, a total of 13,059 dengue cases were reported

nationwide. As of 31 August 2019, the cumulative number of cases was 292,076

with 1,184 deaths. This is higher compared to 135,490 cases with 690 deaths

reported during the same period in 2018 (WHO, 26 Sep 2019). Between 1

January and 21 September 2019, there were 322,693 dengue cases including

1,272 deaths reported through the DOH routine surveillance system, with a CFR

of 0.39%. During week 38, 8,856 cases and 15 deaths were reported, compared

to 9,815 cases and 37 deaths in the preceding week, but still 25% higher than in

2018. Similarly, the weekly CFR of 0.17% in epidemiological week 38 is lower

than in the same time period in 2018 (0.45%) (WHO, 4 Oct 2019). As of 24

October, approximately 350,000 dengue cases were recorded and 1,342 deaths,

the current dengue epidemic is the largest in the last ten years, or since the

disease has been monitored in the Philippines (OCHA, 2019).

This year, most countries in Asia and South-East Asia are reporting a

large increase in the number of detected dengue cases. The Philippines is

among the highest of these, and have reported over 371,500 cases as of

November 2019 (ECHO, 25 Nov 2019). 371,717 cases were recorded between

January to October 2019 compared to 180,072 for the same period last year (106

per cent increase). With 1,407 deaths recorded compared to 927 for the same

period last year (62 percent increase). The case fatality rate (CFR) is 0.38 per
 18

cent, lower than 0.51 per cent in the same period last year. There are 16

provinces which have declared state of calamity due to dengue: Aklan, Albay,

Cavite, Capiz, Catanduanes, Eastern Samar, Guimaras, Iloilo, Leyte, Mountain

Province, North Cotabato, Paranaque, South Cotabato, Southern Leyte, Western

Samar and Zamboanga Sibugay (IFRC, 2019).

Department of Health’s Dengue Prevention and Control Policies

The dengue problem in the Philippines has been confronting the country

since 1953 when hemorrhagic fever was reported for the first time in this part of

Asia. From then on, sporadic cases of dengue have been reported in several

parts of the country and control measures were instituted as necessary.

It was in 1993 when the Communicable Disease Control Service, as

mandated by Executive Order 119, formulated the National Dengue Prevention

and Control Programme for the control of DF/DHF (Dengue Fever/Dengue

Hemorrhagic Fever). Being a low budget program – US$16 million in 1993;

US$1.6 million in 1997 – it was implemented in only two regions of the country,

namely, Region 7 and the National Capital Region (NCR) which were high

incidence regions.

The program aims at reducing the morbidity and mortality rates of dengue

infection to a level wherein it will no longer be a public health problem. Its general

objective is to prevent and control the transmission of dengue virus and obtain

reduction by 90% by the end of a 15-year period. It also have the following

specific objectives: (1) to create a dengue technical working group; (2) to develop

an integrated vector control approach for prevention and control; (3) to develop
 19

capability on diagnosis and management; (4) to intensify health education/IEC

activities, and (5) to operationalize an effective surveillance system and to

develop a dengue epidemic contingency plan for emergency response.

The current National Dengue Prevention and Control Program (NDPCP)

of the Department of Health has the following program components: (1)

Surveillance; (2) Case Management and Diagnosis; (3) Integrated Vector

Management (IVM); (4) Outbreak Response; (5) Health Promotion and

Advocacy; and Research. Dengue Case Surveillance was being conducted by

the Philippine Integrated Disease Surveillance and Response (PIDSR) and

laboratory-based surveillance/ virus surveillance through Research Institute for

Tropical Medicine (RITM) Department of Virology, as national reference

laboratory, and sub-national reference laboratories. On the other hand, Vector

Surveillance was through DOH Regional Offices and RITM Department of

Entomology.

For the Case Management and Diagnosis, Dengue Clinical Management

Guidelines training was being conducted to all hospitals in the Philippines. The

Dengue non-structural protein 1 Rapid Diagnostic Test (Dengue NS1 RDT) was

also established as the forefront diagnosis at the health center/Rural Health Unit

level. Molecular testing or polymerase chain reaction (PCR) as dengue

confirmatory test available was also made available at the sub-national and

national reference laboratories. Also, the Nucleic Acid Amplification Test-Loop

Mediated Isothermal Amplification Assay (NAAT-LAMP) as one of confirmatory

 20

tests will be available at district hospitals, provincial hospitals and DOH retained

hospitals.

Training on Vector Management, Basic Entomology for Sanitary Inspector,

and Integrated Vector Management (IVM) were facilitate to national health

workers in order to support the IVM thrust of the NDPCP. Insecticide Treated

Screens (ITS) as dengue control strategy in schools was also introduced.

For Outbreak Response, continuous augmentation of insectides, such as

adulticides and larvicides, to LGUs for outbreak response was enriched by the

department. In addition to this, to promote health and Dengue Awareness

advocacy, the county adopted the celebration of ASEAN Dengue Day every June

15.

As of this date, the Department of Health is conducting its strategic policy

program in combating the dengue disease. The program is entitled Enhance 4S.

These 4S strategy consists of: Search and destroy mosquito breeding places,

Secure self-protection, Seek early consultation and Support fogging/ spraying

only in hotspot areas where increase in cases is registered for two consecutive

weeks to prevent impending outbreak.

Stakeholders in the Healthcare Sector

Stakeholder involvement can help to ensure a guideline’s acceptability

and feasibility to the end users. They can also ensure that equity and human

rights issues are taken into consideration and support the adoption of its

recommendations into policy and practice. There are many stakeholder groups

equally affected by recommendations in guidelines, for example, patients,

 21

consumers, providers, general public, researchers, and policymakers. However,

engagement with patients/public/community stakeholder groups dominates the

literature, and guidance of the engagement with patient/public stakeholders is the

most prominent (Armstron & Bloom, 2017; Lavis, Paulsen, Oxman & Moynihan,

2008; van de Bovenkamp, 2015).

In a review of guideline methodologies conducted by Armstrong and

Bloom (2017), patients/public stakeholders were consulted by 101 different

guideline developers. Many guideline groups that have sought to involve

stakeholders have utilized limited numbers of participants or utilized slow and

labor-intensive processes for example, time and resources needed to administer,

collate, and respond to over 200 stakeholder views and comments (Cluzeau F,

Wedzicha, Kelson, Corn, Kunz, Walsh, et al, 2012).

It is recognized that successful guideline development and implementation

requires the engagement of multiple stakeholders (Dunston, Lee, Boud, Brodie &

Chiarella, 2009) and “shared solutions” (input from patients, clinicians, and

policymakers) improve health outcomes (Suman, Dikkers, Schaafsma, van

Tulder & Anema, 2016; Dunston, Lee, Boud, Brodie, Chiarella, 2009;

Kumarasamy & Sanfilippo, 2015). Patient/public stakeholders may potentially feel

intimidated to contribute if they are only one voice among many. Keeping patient

and public stakeholder voices separate from other stakeholder groups potentially

shortchanges the input and influence that this group may offer. Equitable

engagement of multiple stakeholder groups can help to ensure that guidelines

contribute to reducing health disparities [27, 28].

 22

However, there is a lack of consensus on how to identify and recruit

relevant stakeholders, how they should be engaged, what their roles and

responsibilities should be, how to evaluate the impact of their engagement in

guideline development, and how to best collect and manage conflicts of interest

as part of the engagement and guideline development process.

Engaging the stakeholders in policy formation for healthcare situation like

dengue awareness empower the community in guided decision-making and

policy engagement. The more stakeholder knew or are engage in policy

formation the more they will engage in the implementation of the policy (Suman,

Dikkers & Schaafsma, et al, 2016).

Stakeholder Engagement Framework of the Department of Health outlines

the models for engagement, key actions, capability improvement agenda,

approach to risk oversight and management, and performance framework,

drawing each back to the department’s strategic priorities: (1) better health

outcomes and reduced inequality through greater stakeholder engagement; (2)

affordable, accessible, efficient, and high quality health system through

collaborating and partnering with others, and (3) better sport outcomes.

The framework sets out a strategic approach to stakeholder engagement

that includes, principles to guide our engagement approach, a five-step model for

conducting engagement activities, a matrix to support tailoring the level of

engagement to the task, recognizing that tools and strategies must be fit-for-

purpose, and appropriate to the issues on which we are seeking to engage,

challenges to consider, and strategies for success.

 23

The stakeholder engagement framework is supported by detailed

guidance, tools and templates, together with learning and development and a

stakeholder management system to support staff throughout the department in

planning, designing, undertaking and evaluating stakeholder engagement

activities.

The Department of Health has adopted five-key principles to guide

stakeholder engagement activities. The principles set the standards to which we

aspire in building consistent, open and respectful working relationships and were

agreed to following extensive consultation within the department.

Role of Stakeholders in Dengue Prevention

As public participation becomes increasingly embedded in national and

international public health policy, it becomes ever more crucial for decision-

makers to understand who is affected by the decisions and actions they take,

and who has the power to influence their outcome: the stakeholders. The

stakeholder concept has achieved widespread popularity among academics,

policy-makers, the media and corporate managers. Within the field of strategic

management the stakeholder concept has become firmly embedded (Friedman &

Miles, 2016).

References to stakeholders are commonplace and the requirement to

engage stakeholders in public sector organizational strategy and project design

is a key priority in current government policy both within the local government

sectors. Many of these organizations recognize that stakeholder engagement is

not about giving the public a list of options to choose from – it’s about drawing
 24

them in right from the start, so that their views, needs and ideas shape those

options and the services that flow from them (Markwell, 2010).

Literature regarding stakeholders’ participation in dengue prevention,

particularly in education, is limited though there are various literature written

regarding stakeholders’ participation in clinical health care provision.

RELATED STUDIES

The study conducted by Zahir, Ullah, Shah and Mussawar (2016)

determined the role of community participation in prevention of dengue fever in

The Swat district located in the Northern area of Khyber Pakhtunkhwa, Pakistan,

which experienced a dengue fever outbreak in August, 2013. A total number of

8,963 dengue cases with 0.4% case fatality ratio were registered during the

outbreak. Results regarding perception of practices for dengue control with

community participation showed that: practices for control had significant

association with organization of people to eradicate dengue mosquitoes (p =

0.00), community leaders (p = 0.04), community efforts (p ≤ 0.01), use of

insecticides by community people (p = 0.00) and involvement of community

people in awareness campaign (p=0.00). Similarly, significant associations were

found between practices for control and community shared information during

dengue outbreak (p = 0.00), community link with health department, NGO, Other

agencies (p = 0.02). It was concluded that the spread of dengue epidemic was

aided by the ignorance, laziness of the community people and government

agencies. However, the people, religious scholars, leaders and government

agencies were not organized to participate in dengue prevention and eradication,

 25

hence, the chances of dengue infection increased in community. The study

recommends mobilizing local communities and activating local leadership with

active participation of Government and non-government organizations for

initiation of preventive strategies.

Chacon & Peraza (2013) examined the people’s perception of community

participation, the priorities and the problems related to Aedes aegypti control, as

well as the existing organizational structures and the main training needs. The

findings helped determine the participatory strategy that was not appropriate for

controlling the proliferation of Aedes aegypti in the research locale. The

researcher used a series of quantitative and qualitative methods: interviews with

key informants and a general survey. The study was conducted in the District of

La Playa in the neighborhood of Mariano, located in the northwest part of Havana

City, Cuba. The findings of the study showed that community participation was

very high, and that at least 90% of the community leaders (elected or appointed

community members) attended intersectoral meetings with the health council.

Leaders encouraged members of the community, especially children and elder

people, to participate in social mobilization activities such as cultural and artistic

presentations that focused on messages that motivated people in eliminated

unused containers or cover up water-holding recipients.

The study of Ayala, Perez, Rigau, Clark and Barrera (2015) aimed at

developing Aedes aegypti Aedes aegypti a novel approach to community

participation by developing a model that involves the active participation of

community residents in the planning and conduction of activities to reduce Aedes

 26

aegypti infestations. Initial steps in project development included identification of

intervention and control communities with similar community environment and

organizational level capable of supporting a community participation project,

entomologic inspections of 20% of the houses (comparable baseline Breteau

Index ≥ 50 was required), and determination of community characteristics. To

promote community participation we also required a community inventory,

partnership identification, and in-depth and informal interviews with gatekeepers

and community leaders in the intervention community to determine project

viability. The researcher evaluated communities in 22 of the 78 municipalities of

Puerto Rico. Thirteen communities were selected for further evaluation. From

these, two communities (≈200 houses in each) with similar organizational level

and comparable larval indices (house index 67.5% and 75%, respectively; p-

value = 0.46) were chosen. Three informal and 7 in-depth interviews were

conducted during December 2013. Content analysis of these interviews indicated

that interviewees viewed dengue as a disease of interest but only when there

were cases in the community. Correct dengue knowledge was mixed with

misconceptions and the community had a well-organized health committee.

Tapia-Conyer, Mendez-Galvan and Burciaga-Zuñiga (2013) determined

the effectiveness of the patio limpo (clean backyard) method as a community

participation strategy in the prevention and control of dengue in Mexico. Through

the patio limpio campaign, the concept of community participation has been

employed in Mexico to raise awareness of the consequences of dengue. Patio

limpio consists of training local people to identify, eliminate, monitor and evaluate
 27

vector breeding sites systematically in households under their supervision. A

community participation programme in Guerrero State found that approximately

54% were clean and free of breeding sites. Households that were not visited and

assessed had a 2·4-times higher risk of developing dengue than those that were.

However, after a year, only 30% of trained households had a clean backyard.

This emphasises the need for a sustainable process to encourage individuals to

maintain efforts in keeping their environment free of dengue.

Rakseenil and Phatisena (2018) conducted a study with the objective of

developing the participation of the community in the prevention and control of

dengue hemorrhagic fever by the theory of social marketing in Wichianburi Buri

Municipality, Phetchaboon Apply the social marketing of Philip Kotle (1984),

using the 4P's (Products, Pricing, Place and Promotion) in order to build the

audience participation and behavior modification to prevent and control dengue

hemorrhagic fever. It was conducted during July-September 2018, the sample

was applied health of 35 people, community leaders, one person community

committee, two headmen first person staff for Disease Control Hospital. Data

collection is divided into three phases, (1) study in the urban context, (2)

developed process with the participation of the community in the application of

the theory of social marketing, and (3) results of the development process. The

content analysis compared the results before and after the test developed by the

researcher. The results showed that the development of community participation

in prevention and control of dengue fever, the sample had an average score in

terms of awareness and participation in the implementation of activities to

 28

prevent and control the disease in the community. It was higher than before the

development of statistical significance (p <.05) and the index of the prevalence of

mosquito larvae in homes fell 50 percent after conducted the research.

Therefore, the development of community participation on the prevention and

control of dengue fever can reduce the incidence of the disease can be

sustainable.

The study of Carandang, Valones, Valderama, Cotoco and Asis (2015)

determined the knowledge, attitudes and preventive behaviors (KAP) of adults in

relation to dengue vector control measures in the communities of Sta. Cruz,

Laguna. A total of 207 respondents were actively participated in the cross-

sectional descriptive study in 2015. Representatives of households were

interviewed face-to-face by six trained interviewers using a structured

questionnaire. KAP reliabilities of 0.89, 0.91 and 0.95 were reported in the pilot

sample of 30 cases. The associations between each independent variable and

prevention behavior were tested with chi-square tests. Multiple logistic regression

was used to determine the factors that were significantly associated with

preventive behavior while controlling for the other variables. The results revealed

that 51.69% of the respondents had a high level of knowledge. More than 94% of

the respondents knew that dengue fever is a dangerous communicable disease

and that dengue fever is transmitted from person to person via mosquitoes. More

than half (56.52%) of the participants had positive attitudes toward vector control

measures, and 52.17% exhibited a high level of preventive behavior in terms of

dengue vector control measures. Preventive behaviors were significantly

 29

associated with information provided from sources that included health personnel

(p = 0.038) and heads of villages (p = 0.031) and with knowledge levels (p <

0.001). This study suggests that proactive health education through appropriated

mass media and community clean-up campaigns should strengthen and

encourage community participation, particularly in terms of addressing mosquito

larvae in overlooked places, such as the participants’ own homes, for example, in

flower vases and ant traps.

Prior to community involvement in averting the spread of the dengue

disease, members of the society must be first educated and must acquire

pertinent knowledge in dengue prevention. Yboa and Labrigue (2013) evaluate

the knowledge and practices regarding dengue infections among rural residents

in Samar Province, Philippines. A cross sectional design was adopted for this

investigation. Convenience samples of six hundred forty six (646) residents who

were visiting the rural health units in different municipalities of Samar, Philippines

were taken as participants in study. More than half of the respondents had good

knowledge (61.45%) on causes, signs and symptoms, mode of transmission, and

preventive measures about dengue. More than half of the respondents used

dengue preventive measures such as fans (n = 340, 52.63%), mosquito coil (n =

458, 70.90%), and bed nets (n = 387, 59.91%) to reduce mosquitoes while only

about one third utilized insecticides sprays (n = 204, 31.58%) and screen

windows (n = 233, 36.07%) and a little portion used professional pest control (n =

146, 22.60%). There was no correlation between knowledge about dengue and

preventive practices (p=0.75). Television/Radio was cited as the main source of

 30

information on dengue infections. Findings suggest that better knowledge does

not necessarily lead to better practice of dengue measures. Educational

campaigns should give more emphasis dengue transmissions and on cost

effective ways of reducing mosquito and preventing dengue such as

environmental measures and control. Furthermore, wide range of information,

skills and support must be provided by the government to increase dengue

awareness among residents.

Theoretical Framework

This study is based on the following theories: transformational leadership

theory (Burns, 1978), Joyce Epstein’s (1987, 1996) theory of overlapping

spheres, and Kania and Kramer’s (2011) theory of collective impact outlines the

conditions for effective collaboration for positive, community change.

Among the theories that have significantly changed thinking about

organizational behavior are those that build on the concepts of transformational

leadership. The transformational leader assesses the needs, values and

aspirations of his/her followers, is clear about his/her own values, needs, and

vision, and acts in a manner that promotes the needs of both (Burns, 1978).

There is a recognition of the relationship between the well-being of the individual,

the work group, and the larger organization. Recognizing the social context of

behavior, this type of leadership supports intellectual stimulation by attending to

individual styles and needs for development, while creating a culture in which

employees enhance their own satisfaction while working to promote the good of

the organization. Consequently, workers are likely to invest more energy and
 31

time in the organization than they initially intended. Support for creative problem-

solving takes place in an atmosphere in which mistakes are accepted in the

context of team involvement, commitment and support. Leadership reinforces

activities that contribute to the vitality of the work community by actively

participating followers (workers). The leadership creates an organizational culture

based on openness, trust, and respect, and inspires team spirit (Bass and Avolio,

1993, Bass, 1985). Transformational leadership is empowering and participatory

as it promotes input into decision-making, delegation of tasks and responsibility,

and fosters local leadership. The context of the leadership and followership is

seen as indispensable to understanding organizational problems and building on

individual and group strengths. The acknowledgment of "followership" as a

significant and reciprocal role in relation to "leadership" provides a unique

organizational insight. Leaders cannot be studied in isolation from followers,

constituents, or group members. The leader is a product of group history, culture,

and interactions, and is shaped by such. The organization is envisioned as a

system of interacting members with shared goals, values, and beliefs working

together in a common effort toward mutually agreed on outcomes. The

organization as functional community resounds.

Though community-building takes time, its impact is long-lasting. In order

to implement change in a school environment, creating a common vision is

paramount. The biggest challenge for school leadership is handling different

kinds of people, with various goals and interests. A school leader has to ensure

that students are following curricula, excelling academically, and becoming

 32

outstanding members of society. In comparison, teachers are focused on

meeting curricula deadlines and ensuring that students keep up with class work.

The leader must confront student deviance, as well as teachers’ possible

cynicism and lack of motivation.

Collective Impact (CI) theory posited on the commitment of a group of

actors from different sectors to a common agenda for solving a specific social

problem, using a structured form of collaboration. The concept of collective

impact was first articulated in the 2011 by John Kania and Mark Kramer. The

concept of collective impact hinges on the idea that in order for organizations to

create lasting solutions to social problems on a large-scale, they need to

coordinate their efforts and work together around a clearly defined goal (Kania &

Kramer, 2011). The approach of collective impact is placed in contrast to

“isolated impact,” where organizations primarily work alone to solve social

problems (Schmitz, 2012) and draws on earlier works on collaborative

leadership, focused on collective goals, strategic partnerships, collective and

independent action aligned with those goals, shared accountability, and a

backbone "institutional worrier" (Hank, 2009). Collective impact is based on

organizations forming cross-sector coalitions to make meaningful and

sustainable progress on social issues (Bornstein, 2011). Within the realm of

education, the collective impact strategy has shown persuasive promise.

Conceptual Framework
 33

This study was premised from the concept of the participation of the

community stakeholders on the directives of the Department of Health with

respect to its policy on dengue prevention and control.

The variables of the study are the profiles of the stakeholders in terms of

type of organization, scope of responsibility, number of officials, number of

members and source of funds. Another variable is the respondents’ level of

awareness and compliance to the Department of Health’s dengue preventive

measures. These variables will be gathered through the use of a researcher-

made questionnaire.

Input Process Output

Profile of the Statistical Analysis

respondents in term and Interpretation of
of: Data.
a. type of
organization; Significant difference
b. number of on the level of
officials; compliance to DOH’s
c. number of dengue preventive Proposed Plan of
members, and measures according Action to enhance
d. source of funds. to profile variables. the implementation
of the DOH’s
Level of Awareness Significant Dengue Preventive
on the DOH’s dengue relationship between Measures
preventive measures. the level of
awareness and
Level of Compliance compliance to DOH’s
to the DOH’s dengue dengue preventive
preventive measures. measure.

Figure 1. Paradigm of the Study

 34

Chapter 3

RESEARCH METHODOLOGY

This chapter presents the research design, the respondents of the study,

the sampling technique, the instrument to be used, the validation of the

instrument, the administration of the instrument and the statistical treatment of

the data.

Research Design

To be able to answer the problems stated in this research the researcher

made used the quantitative research design. Quantitative research is mostly

conducted in the social sciences using the statistical methods used above to

collect quantitative data from the research study. In this research method,

researchers and statisticians deployed mathematical frameworks and theories

that pertain to the quantity under question. The researcher used the quantitative

approach to describe the level of awareness of the respondents and their level of

compliance to the Department of Health’s dengue preventive measures.

Moreover, the researcher also utilized the causal-comparative method to

compare the significant differences the level of compliance to the DOHs dengue

preventive measure when the respondents were grouped according to their

profile variables. Also, the researcher utilized the correlational design. A

correlational study is a type of research design where a researcher seeks to

understand what kind of relationships naturally occurring variables have with one

another. In simple terms, correlational research was used to figure out if two or

more variables are related and, if so, in what way. This design was used to
 35

determine the between the stakeholders’ level of awareness and level of

compliance to the DOH’s dengue preventive measures.

Respondents and the Locale of the Study

The research was conducted at Pura, Tarlac and the research population

was all the stakeholders of the said locale. The stakeholders were classified

according to the type of stakeholder group they belong to. The groups are (1)

school administrators, (2) teachers, (3) school nurses, (4) medical practitioners,

(5) DSWD 4Ps, (6) barangay local government unit, (7) barangay health workers,

(8) municipal local government unit, (9) municipal health workers, (10) local

business groups, (11) law enforcement, (12) social safety and others. Purposive

convenient sampling was facilitated to determine the samples that will be

considered in the study.

Research Instrument

To gather pertinent data needed to answer the problems of the study, the

researcher developed a self-made instrument. The instrument has three parts.

The first part of the instrument is a checklist which will gather relevant information

regarding the demography of the stakeholders such as type of stakeholder group

they belong, the numbers of officers and members of the group as well as the

group funding.

The second part of the questionnaire is a 5-point Likert scale while will

gather information regarding the stakeholders’ level of awareness to the DOH’s

dengue preventive measure. The third part is also a 5-point Likert scale which
 36

will determine the level of compliance of the stakeholders to the DOH’s dengue

preventive measures. This part of the questionnaire was developed in cognizant

with the existing DOH Policies on dengue prevention.

Validation of the Instrument

After the instruments were constructed, it was submitted for content

validation by five (5) validators that are in the medical field using Bolarinwa’s

pooled-judgment validation. Comments and suggestions will be considered for

the final draft. It was evaluated and approved by the adviser and critic reader

before it was be administered to the respondents. They were provided with a

copy of the instruments and score card for them to rate each question item with

reference to the criteria stipulated in the score card. This activity was done in five

(5) working days. With reference to the score cards accomplished by the

evaluators, the instruments were improved by incorporating their suggestions

and corrections.

Data Gathering Procedure

Prior to data gathering, the researcher first asked permission from the

Schools’ Division Superintendent of the Schools’ Division of Tarlac Province for

the conduct of the study. Upon approval the researcher encoded the

questionnaire into an online survey form using Google Forms. The form was then

sent to target respondents for them to accomplish. The researcher also posted

the link of the online survey form the Municipality of Pura social media page on
 37

Facebook to facilitate data gathering. Raw survey responses were automatically

coded in Google sheet and was then processed and encoded to Microsoft Excel.

Statistical Treatment of Data

Data obtained from the respondent was analyzed using suitable statistical

methods. For the first problem, the researcher will use frequency counts and

percentage distribution for the profile of the respondents according to stakeholder

type, internal funding, distance of office from school and intent of participation.

The researcher used weighted mean to describe the level of awareness

and compliance of the stakeholders to the DOH’s dengue preventive measures.

The Likert Scale below was used for the verbal interpretation

Description Description
Limits of Scales
(Level of Awareness) (Level of Awareness)
4.51 – 5.00 Very Aware Highly Complied
3.51 – 4.50 Aware Complied
2.51 – 3.50 Somewhat Aware Moderately Complied
1.51 – 2.50 Unaware Slightly Complied
1.00 – 1.50 Very Unaware Did Not Complied

To determine the significant difference between the level of participation

when the stakeholders are groups according to type, internal funding, distance of

office from school and intent of participation, the research will use the multiple

analysis of variance (MANOVA).

The Pearson product-moment correlation coefficient (Pearson’s r) was

also utilized to determine the relationship between the stakeholders’ level of

awareness and level of compliance to the DOH’s dengue preventive measures.

 38

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 45

Appendix A
Research Instrument

PART 1: Respondent’s Demography

Name (Optional): ________________________________________________

What type of Stakeholder group are you incorporated (Check one that applies to
you):

____ School Administrators

____ Teacher
____ School Nurse
____ Medical Practitioners
____ DSWD 4P’s Recipient
____ Barangay LGU
____ Barangay Health Worker Group
____ Municipal LGU
____ Municipal Health Worker
____ Local Business
____ Law Enforcement
____ Social Safety (Fire Protection, Road Safety, Security Agency, etc.)
Others : ____________________

What is the scope of your responsibility in your group?

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

How many officials/officers do your group have?

____ Less than 5

____ 6 to 10
____ 10 to 15
____ More than 15
 46

How many members do your group have?

____ less than 10

____ 11 to 20
____ 21 to 30
____ 32 to 40
____ 41 to 50
____ more than 50

How is your group being funded?

____ Government Fund

____ Private Corporation
____ Member Initiative
____ Solicited fund

PART 2: Level of Awareness of the DOH’s Dengue Control and Prevention

Policy

Each item in this questionnaire will determine your level of awareness regarding
the DOH dengue preventive measures following the Enhanced 4s Strategy. Put a
check (✔) on the box that is true to you using the scale given below:

5 Very Aware
4 Aware
3 Somewhat Aware
2 Unaware
1 Very Unaware

I am aware of. . . 5 4 3 2 1
1. The DOH’s enhanced 4S program
2. The DOH’s 4’o clock habit
3. The implementation of the “Search and Seek”
program.
4. The importance of checking and eliminating
mosquito breeding grounds in my house and in
the community.
5. The DOH’s Policy regarding self-protection
measures.
6. The importance of using organic and non-
chemical mosquito repellent.
 47

7. Dengue prevention through the use of

implements such as mosquito nets, long
sleeves clothing and the like.
8. The importance of seeking medical attention on
the onset of fever with possible dengue
symptoms.
9. The importance of sustained hydration when
having a fever for more than 2 days.
10. The DOH’s policy of fogging, spraying and
misting areas which are identified as dengue
hotspot.

PART 3: Level of Compliance to the DOH’s Dengue Control and Prevention

Policy

Each item in this questionnaire will determine the level on which you comply on
the DOH’s Policy to control and prevent dengue. Put a check (✔) on the box that
is true to you using the scale given below:

5 Highly Complied
4 Complied
3 Moderately Complied
2 Slightly Complied
1 Did Not Complied

Search and Seek 5 4 3 2 1

1. I comply with the DOH 4’o clock habit.
2. I search for containers and other possible
mosquito breeding sites.
3. I change the water in plant pots or jars every
week.
4. I clean the drain for blockages every 7 days.
5. I always convince others to always put all
garbage into closed bins.
Self-Protection Measures 5 4 3 2 1
1. I wear long pants and long sleeves shirt early in
the morning and late in the afternoon.
2. I use organic, non-chemical mosquito repellant.
3. I Use mosquito nets while sleeping.
4. I clean the surroundings of my house to
eliminate mosquitoes breeding grounds.
5. I don’t usually go to places that are identified as
dengue hotspot.
Seek Early Consultation 5 4 3 2 1
 48

1. I immediately bring family members who have

fever and symptoms of dengue to the nearest
health station.
2. If a family member has a fever, I usually
recommend sustained hydration.
3. I educate my household and neighbors about
the early symptoms of dengue fever.
4. If a household has a fever for two to three days
already, I bring him/her immediately to the
health center or hospital for a rapid test to know
if it is dengue or not.
5. If diagnosed with dengue, I follow the
recommendations of doctors to prevent further
complications.
Support Fogging, Spraying and Misting
1. I support fogging, spraying and misting in
designated dengue hotspot areas.
2. I allow health authority to inspect and fog my
house anytime.
3. I support the information campaign of the DOH
regarding the importance of fogging, spraying
and misting.
4. I support the local health unit’s method of
identifying places that are in need of fogging,
spraying or misting.
5. I report immediately to the local health unit
areas that are in need of fogging, spraying or
misting.

THANK YOU VERY MUCH

 49

Appendix B
Electronic Form of the Research Questionnaire

Appendix C
Sample Questionnaire Validation Tool

Republic of the Philippines

PANGASINAN STATE UNIVERSITY
School of Advanced Studies
Urdaneta City, Pangasinan

June 25, 2020

NAME
Designation

Sir/Ma’am

Greetings!

The undersigned is a graduating student of Master’s in Education at the

University of Pangasinan undertaking her research entitled “Stakeholders’
Compliance on the Department of Health’s Dengue Preventive Measures”.

With your expertise, I am humbly asking your permission to validate the attached
survey questionnaire for the research using the prescribed rating tool.

I am looking forward that my request would merit your positive response.

Thank you and more power.

Respectfully Your,

ANTONETTE T. MELEGRITO
Researcher
 50

Noted by:

HONELLY MAE S. CASCOLAN, PhD

Adviser
POOLED-JUDGMENT QUESTIONAIRE VALIDATION

The questionnaire is divided into two parts (1) a set of question to determine the
respondents’ level of awareness regarding the DOH’s dengue preventive
measures following the Enhanced 4s Strategy and (2) will determine the level on
which you comply on the DOH’s Policy to control and prevent dengue. Please
rate the following items in a scale of 1 to 5 (1 being the lowest and 5, the highest)
based on the given criteria. Thank you very much for your time and effort.

PART 1: Level of Awareness of the DOH’s Dengue Control and Prevention

Policy

Items Criteria
I am aware of. . . Objectivity Clarity Readability Comprehensiveness
11. The DOH’s enhanced 4S
program
12. The DOH’s 4’o clock habit
13. The implementation of the
“Search and Seek” program.
14. The importance of checking
and eliminating mosquito
breeding grounds in my
house and in the community.
15. The DOH’s Policy regarding
self-protection measures.
16. The importance of using
organic and non-chemical
mosquito repellent.
17. Dengue prevention through
the use of implements such
as mosquito nets, long
sleeves clothing and the like.
18. The importance of seeking
medical attention on the
onset of fever with possible
dengue symptoms.
19. The importance of sustained
hydration when having a
fever for more than 2 days.
20. The DOH’s policy of fogging,
 51

spraying and misting areas

which are identified as
dengue hotspot.

Part 2: Level of Compliance to the DOH’s Dengue Control and Prevention Policy

Items Criteria
Search and Seek Objectivity Clarity Readability Comprehensiveness
1. I comply with the DOH 4’o
clock habit.
2. I search for containers and
other possible mosquito
breeding sites.
3. I change the water in plant
pots or jars every week.
4. I clean the drain for
blockages every 7 days.
5. I always convince others to
always put all garbage into
closed bins.
Self-Protection Measures Objectivity Clarity Readability Comprehensiveness

1. I wear long pants and long

sleeves shirt early in the
morning and late in the
afternoon.
2. I use organic, non-chemical
mosquito repellant.
3. I Use mosquito nets while
sleeping.
4. I clean the surroundings of
my house to eliminate
mosquitoes breeding
grounds.
5. I don’t usually go to places
that are identified as dengue
hotspot.
Seek Early Consultation Objectivity Clarity Readability Comprehensiveness

1. I immediately bring family

members who have fever and
symptoms of dengue to the
nearest health station.
2. If a family member has a
fever, I usually recommend
sustained hydration.
 52

3. I educate my household and

neighbors about the early
symptoms of dengue fever.
4. If a household has a fever for
two to three days already, I
bring him/her immediately to
the health center or hospital
for a rapid test to know if it is
dengue or not.
5. If diagnosed with dengue, I
follow the recommendations
of doctors to prevent further
complications.
Support Fogging, Spraying Objectivity Clarity Readability Comprehensiveness

and Misting
1. I support fogging, spraying
and misting in designated
dengue hotspot areas.
2. I allow health authority to
inspect and fog my house
anytime.
3. I support the information
campaign of the DOH
regarding the importance of
fogging, spraying and
misting.
4. I support the local health
unit’s method of identifying
places that are in need of
fogging, spraying or misting.
5. I report immediately to the
local health unit areas that
are in need of fogging,
spraying or misting.

COMMENT:
________________________________________________________________
________________________________________________________________
________________________________________________________________

SUGGESTIONS:
________________________________________________________________
________________________________________________________________
________________________________________________________________
 53

Adapted from:

Bolarinwa, OA (2015). Principles and methods of validity and reliability testing of questionnaires
used in social and health science researches. Niger Postgrad Med J [serial online] 2015
[cited 2020 Jun 25];22:195-201. Available from: http://www.npmj.org/text.asp?
2015/22/4/195/173959
 54

CURRICULUM VITAE