CHINESE GENERAL HOSPITAL COLLEGES

S.Y. 2020- 2021

CASE STUDY: COVID-19 in the Philippines

Submitted by:
GROUP 9
Auxtero, Kathreen Rose Q.
Briva, Gellyne Anne O.
Calma, David Andrei D.C.
Canuto, Alona Mae B.
Gatan, Lyca Mae B.
Hidalgo, Danica Marie F.
Israel, Bless R.
Nepomuceno, Albert Clark A.
Sazon, Le Anne Nickole M.
Tesoro, Marc Cano L.
Villalon, Hannah S.

BSN 3C

Submitted to:
Ms. Vilma Albo

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Knowledge, attitudes and practices of COVID-19 among income-poor households
in the Philippines: A cross-sectional study
INTRODUCTION
The presence of COVID-19 across countries around the globe have devastated
the lives of thousands of people. It has affected every nation and does not choose any
individual to hinge on. And with that being said, it is clear enough that even the most
powerful, affluent, or influential people have greatly suffered this infectious plague. If the
wealthy people or nations were affected, how much more are those living in the poverty-
stricken areas or the low- and middle- income countries (LMICs). The presence of this
disease in the LMICs is raising significant concerns about the country’s preparedness to
control the spread of the virus. With the existing overburdened health care institutions
before this pandemic, the feasibility of adopting the employed measures of high-income
countries to LMICs is unsure. The current recommended hospital-based interventions
focused heavily on the resources or equipment to facilitate health care provision with
infected cases of patients. In addition to that, LMICs need to supply or provide emergency
support to vulnerable populations, including individuals and households living in poverty.
In the context of technological advancement and the privilege to access devices,
gadgets, and the internet, there’s an increasing concern about disseminating
misinformation that surrounds the current matter of the COVID-19 virus. WHO Director-
General Dr. Tedros Adhanom Ghebreyesus has even stated, “We’re not just fighting an
epidemic, we’re fighting an infodemic.” If technology paves the way to a myriad of
dissemination of factual information through mass and social media, which has rapidly
become widespread, then false or misinformation can also easily be transmitted with the
same channels. Thus, the spread of the variety of this incorrect knowledge can fuel panic
or a false sense of security among the general public. Confusions to which among this
necessary information about the virus and reducing exposure and transmission puts more
people at even greater risk of acquiring the infection. In the LMICs, households who lack
resources and access to a regular and reliable source of information about disease
etiology are ill-equipped to minimize risk amid disease outbreaks.
Although the transmission speed was initially limited in the Philippines, public
health measures were not sufficient to contain the spread of the virus. The Philippines
government attempted to control further transmission when they enforced preventive
measures like; Enhanced Community Quarantine (ECQ) in regions with a significant
number of COVID-19 cases. However, new cases of COVID-19 have been confirmed to
increase exponentially. The caseload in Metro Manila and the likelihood of spreading in
the surrounding regions threaten communities with limited health system capacity. The
objective of this study was to understand the knowledge, attitudes, and practices (KAP)
of COVID-19 among families living in extreme poverty in the Philippines. Numerous
studies have been conducted on examining KAPs on COVID-19, but there’s also a need
to understand the KAPs among vulnerable and low-income communities. It is essential
that the people from the lower socioeconomic positions in the community be equitably
included in the guidelines and strategies that were developed to address COVID-19 in
LMICs.

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 BACKGROUND INFORMATION
COVID-19 is a noble infectious disease that emerged before the end of the year
2019. It originated in Wuhan, China, which has brought unprecedented challenges
globally. Until now, it continues to escalate extensively and affects every aspect of
society. Since COVID-19 is highly transmittable, it has brought extreme measures by
implementing restrictions and social distancing to terminate the transmission. The
government's strict health protocols restrain people from proceeding outside their
residences without rational objectives such as buying groceries and necessary essential
utilities. However, according to Lau with his corresponding co-researchers (2020), low-
and middle-income countries (LMICs) such as the Philippines are immensely affected by
the pandemic attributable to the insufficiency in knowledge, attitude, and practices (KAP)
regarding COVID-19. People who are considered impoverished reside in a community
are the members of the society with insufficient or none-at-all opportunity access to health
care where most of these people are incapable of going through a health consultation
due to complicated processes and appointments. Because of the inadequate
preparedness of the health system in the Philippines, there is a shortage of worker
storage, and hospitals are congested, which results in difficulty of admission to the
hospital among low- and middle-income individuals. Moreover, the strict implementation
of health protocols by the government modifies the economy, where some of the
businesses are ordered to cease operation temporarily. Prodigious companies are forced
to reduce employees because of the risk of bankruptcy. These situations result in
occupation loss and no income source, which substantially affects the low- and middle
individuals.
Every individual must comprehend basic knowledge and information concerning
COVID-19 such as the etiology, transmission, common symptoms, and preventions to
decrease or impede the chain of transmission of the infectious disease. However, there
is an insufficiency of distributing information in the LMICs, which may affect people who
possess minimal sources of information and/or no daily updates about the COVID-19
situation, newly implemented health protocols, and preventive measures against the
disease. Low- and middle-income countries usually have inadequate access to television
news and the internet, which are essential in this time of pandemic to acquire updates
regarding the COVID-19 situation. However, one of the consequences of getting access
to the internet is the risk of obtaining forged details and information, which may extend to
every individual and cause unnecessary circumstances. According to a research study,
misinformation regarding COVID-19 proliferates quickly, which causes deleterious
consequences on individuals' well-being (Barua, 2020), and the personal and religious
beliefs and conspiracies that are distinctly inaccurate may result in unnecessarily altered
healthiness.
Attitude, cooperation, and participation of every individual during this crisis are very
relevant to impede the continuous occurrence and transmission of infectious disease.
However, it is relatively challenging for the government and health workers to seek
participation and cooperation among the community because of insufficient health
information and false health beliefs. Numerous individuals objectified vaccination and
opposed the wearing of masks due to their personal beliefs. According to Chan (2020),
limited clinical evidence of wearing a facemask, implementing hand hygiene practice, and

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social distancing causes doubtless to the effectiveness of these indicated health
protocols. Furthermore, every individual with low- and middle-income do not possess
adequate accounts to allot to buy newly added essentials such as face shields and face
masks for protection and preventive measures because of occupational loss. The
congested community area is also a dilemma to effectively implement the protective and
preventive measures since social distancing is comparatively challenging to execute.
COVID-19 practices are preventions and interventions to obstruct the unceasing
incidents of infectious disease. Hence, the Philippines' government implemented various
preventive measures such as community quarantine and lockdown, social distancing,
travel restriction, the mandatory wearing of face mask and face shield, handwashing, and
the right strategy of coughing. However, despite implementing these preventive
measures, the COVID-19 cases are interminably and exponentially increasing,
particularly in congested regions such as the National Capital Region (NCR).
Several studies have already been conducted regarding the knowledge, attitude,
and practices regarding COVID-19 with underlying factors that exceedingly influence the
contemporary situation of the affected individuals. However, it is relevant to accord a more
extensive comprehension concerning the vulnerable experiences of the low- and middle-
income countries due to the insufficient preparedness and awareness from the emerging
catastrophe.

ALTERNATIVES
The group came up with several alternative solutions to the study’s problem. The
constraints and most practical action for the study were also discussed.

Distribution of easy to understand leaflets containing significant information

relevant to COVID-19, its transmission routes, and preventive measures

Leaflets are visually appealing and contain useful information that can help the
public, especially extreme low-income households. Distribution of leaflets can be
immensely useful in presenting important information relevant to COVID-19, its status,
transmission routes, and preventive measures. The leaflets are easy to produce and do
not even cost much to distribute to the public, making it quicker and more efficient to
disseminate information. However, leaflets of low quality are quickly discarded and do not
appeal to the target audience. Moreover, there are some instances where people often
discard them despite the appealing appearance of such material. They do so because
they may lack sufficient understanding of its contents, inability to read due to reasonable
conditions is also a factor, or simply unmotivated to read that they lack the interest to read
diligently.

Most importantly, safety is a concern for distribution. Touching and interacting with
leaflets might bring about exposure to COVID-19. For instance, if the leaflets have been
in contact with a person declared positive for COVID-19 before distribution, the public has
a higher chance of acquiring the virus. Therefore, safety measures should be
implemented on handling leaflets from printing to distribution. All social distancing laws
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should be practiced by workers who handle leaflets and avoid working in big groups. They
should avoid physical contact with members of the team and members of the public.
Before beginning work, staff should wash their hands well and not handle leaflets if they
display any symptoms, even mild ones.

Health teachings done through traditional media regarding meaningful contexts

about COVID-19.

Health teachings done through traditional media includes putting or flashing

information in newspapers, magazines, or even televisions. This way, the client will learn
and be educated on their premises without going to health teachings that include having
contact with a crowd. Presentation of illustrations and pictures that are easy to understand
or acting out the things that should be done for preventive measures that are flash on
television is a good way of informing the people about some significant contexts about
COVID-19. However, in conducting this kind of health teaching, we should also consider
the people's economic status that will be included in the learning. Some of the people
included in the study do not have televisions; some of them have but are not working.
This significantly affects the effectiveness of this intervention. Unfortunately, the
information will not reach those that has no or broken televisions.

Moreover, the level of education of the community can also affect this action. For
instance, some of the respondents have not attained any educational level, and most are
only elementary graduates. Thus, the interpretation of the information in newspapers and
magazines will vary based on the educational attainment of the people reading it. Some
will have trouble understanding or even reading the text on the health teaching materials.
Similar to the problem regarding leaflets, newspapers, and magazines can also carry a
risk for getting the virus due to touching and interactions upon distributing these materials.
Therefore, this alternative was rejected due to economic status, availability of television
in the respondents' houses, educational attainment, and the risk of having the virus upon
distribution of the materials.

Public announcements through a crier and illustrations posted on common places

regarding COVID-19 status and preventive measures

Patrolling around the community to share public announcements, usually done

with a vehicle and speakers, is an effective way to inform the people about what COVID-
19 is, its status, and preventive measures. This doesn’t only prevent overcrowding or any
physical contact with the people; it also gives an advantage to those who struggle to
understand information because these announcements are usually spoken in our mother
tongue. Reading is also not an issue for this; those who don’t have any educational
attainment will easily understand the information that will be told. In addition to that,
posting of illustrations on places that are commonly visited while the public announcers
are patrolling around can also add up to the effectiveness of this intervention. Since the
people cannot remember all the information that will be stated in the public

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announcement, it is a good move to leave some reminders via posters or illustrations that
will remind the people about the things they should know about COVID-19.

SOLUTION
Coronavirus (COVID-19) is a disease caused by a new coronavirus that can
spread from person to person (CDC, 2020), which is considered to be the third pandemic
in the 21st century (Perlman, 2020). In recognition of the severe threats posed by COVID-
19 and the absence of a vaccine, proper preventive measures play an essential role in
reducing the rate of infection and managing the spread of the disease. This demonstrates
the need for a public commitment to preventive and control measures influenced by their
knowledge, attitudes, and practices. Since the outbreak of COVID-19 in the Philippines,
there have been several issues posed by people from countries with low and medium
incomes. First is providing misinformation that could cause panic, a false sense of security
among the public, and confusion over necessary information about how to minimize
transmission and exposure to the virus, which puts individuals at risk of infection. Second
is a lack of knowledge on proper preventive measures such as social distancing, avoiding
large crowds, wearing a face mask, and taking vitamins. These concerns need to be
solved to gain awareness and knowledge about the precautionary measures against
COVID-19 by providing education and outreach materials to increase public
understanding of the disease and influence behavioral change.
Since disseminating pertinent information regarding preventive measures against
COVID 19 is the primary concern of low- and middle-income families, the group, proposes
to have a public announcement through a crier and provide illustrations containing reliable
information on how the community can protect themselves from the deadly disease. Brief
information about COVID 19, proper preventive measures, and emergency procedures
that one must take if they exhibit symptoms of COVID 19 will be included in an
announcement and illustration that will be posted in their respective areas. In addition to
that, announcements shall be made by an assigned Community Health Worker on that
particular barangay and disperse the information through a Public Address System
vehicle.
To further improve the public health knowledge about COVID 19, a public
announcement will be made at least once a week. Rest assured that the community will
adapt the information they learned from the public announcement and illustration
provided. Given that most information about COVID 19 is announced on television or
through social media, this proposal will serve as a solution to the lack of mediums for
information propagation within the low-and middle-income families since most of them
don’t have access to technology. This will also clarify the misconceptions about the
COVID 19 and appropriate preventive measures known by the community.
In addition to that, the objective of this proposal is further explained by the Theory
of Change developed by Kurt Lewin. Since the researchers were able to recognize the
particular aspect in the community where change is needed, which includes the low-and-
middle-income families, they were able to analyze their current situation and identify some
methods where one can spark a change to improve the problems in the low-and-middle-
income communities. According to the research, public health messaging has positively
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influenced the way people learn about COVID-19 and adapt to specific preventive
measures that they learn from some community members. However, they were unsure
whether the information is accurate as this information's rationales were not well-
communicated and explained to them. Therefore, our goal is to provide the information
that they perceive as liable for them to properly rely on the knowledge we will share with
them through this proposal. Rigorous methods that need the cooperation of officials who
have knowledge about their community as well as how to gather all relevant and factual
information to the public should be established. This will cause a shift in the behavior
toward a new and more healthful pattern that will help the people from the depressed
area of the community to initiate change and be prepared to combat the pandemic. And
even if the plague will be over, the people, especially the families in each household, need
to have a long-term solidification of the new behavior pattern towards achieving optimum
health. Proper allocation of health care, education, maintenance, and the prevention and
control of diseases, including the funds and budget for community health projects, should
be implemented and established. The aforementioned details about how the community
will be helped to survive the fight against the plague were outlined according to Kurt
Lewin's Change theory.
In conclusion, indigent families are among the most heavily-affected individuals
during this pandemic in terms of their livelihood and health. Whereas, most of the
members of this group are economically unstable and live in highly congested areas,
which leads to compromised health. Despite these factors, economic standing must not
take place during this pandemic. Thus, no one must be left behind in this fight against
COVID-19. The proposed solution encompasses ensuring that families under the lower
and middle-class category will be equipped with relevant information, new knowledge,
and skills to use in their daily lives during the COVID-19 pandemic. Since the near-end of
this battle is still unknown, it is essential that each citizen of our country must be guided
and instructed regarding the proper precautionary measures to prevent the spread of this
disease.
Furthermore, both the government and health sector must need to step-up their
game to achieve the goal of this proposed solution. Other resources, such as workforce
and financial assistance, must also be provided for the smooth implementation of this
program. Moreover, in this program, the community health team is also a key player to
achieve the potential benefits and success of this proposed program. Therefore,
members of the health team must be equipped with enough knowledge and competency
to render this program among indigent families. Lastly, the audience's participation and
engagement is a must; therefore, the community health team must ensure that all family
members, which is classified under the lower/middle-range income groups, will participate
in this program. Given the fact that the goal of this program was to enhance their
knowledge and guide them towards the adaptation of evidence-based practices
necessary for the prevention of acquiring COVID-19, leading to a healthy and "COVID
FREE" community.

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 RECOMMENDATION

To accomplish the proposed solution, a proper implementation should be done.

Barangay councils such as the Barangay Captain and Kagawad, along with the
Community Health Workers from Health Center, should collaborate and conduct a
meeting or seminar regarding the status and preventive measures of COVID- 19. The
team should identify critical points that are important to be disseminated to people. This
includes the number of cases in the community and preventive measures that the people
are not familiar with. After that, materials that will be needed for the public announcement,
such as speakers, microphone, vehicle, and the poster or illustration with the content
about COVID-19, should be gathered. A timeline should also be considered to complete
the plan. Since COVID- 19 is still prevalent, it is essential to make the announcement
weekly or bi-weekly. In announcing the information, the Councilor on Health should be
the one to take charge and provide the information on the targeted audience, which is the
people of the community. Afterward, with the help of other Kagawads or Barangay
Tanods, the posting of illustrations or other visuals in locations where people can see and
view the information easily will take place. Additionally, the Councilor on Health should
advise the people to raise their concerns to them or go to their Health Center if there is
any information which they did not understand during the announcement.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
(BELOW IS A BLUEPRINT OF PLAN ON HOW THE PROPOSED SOLUTION AND
METHODS WILL BE ESTABLISHED AND IMPLEMENTED)

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ACTIVITY/PLAN HOW?- STEP BY WHO? TARGET RESOURCES REQUIRED TIME SPAN
STEP AUDIENCE
Public 1. Collaboration of the
Announcement Barangay Council Barangay 1. Expert knowledge of Every month (weekly or bi-
through a crier and Health Captain, People or hygiene and sanitation weekly)
and illustrations Workers. Barangay families of procedures for
regarding COVID- 2. Conducting a Kagawad, the preventive measures.
19 meeting, while still Health Community 2. Factual knowledge or
following the health Workers, information regarding
protocols (physical Local COVID-19
distancing). Physician, 3. Budget available for the
3. Identify key points Local Nurse Illustration/Poster as
important for the well as the other
announcement: materials needed
- Number of 4. Materials Needed:
Cases - Microphone
- Preventive - Speakers
Measures - Vehicle
- Common
clinical
manifestations
of the disease;
the signs and
symptoms
- Facts and
Misinformation
comparison
4. Gathering of
materials:
- Microphone
- Speakers
- Vehicle

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 - Illustration/
poster
5. Schedule time of
the announcement.
6. Active and full force
participation,
contribution and
action of the
manpower which
are the members of
the Community
Health Team from
the decision-
making process to
the implementation

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References:

Barua, Z., Barua, S., Aktar, S., Kabir, N., & Li, M. (2020). Effects of misinformation on
COVID-19 individual responses and recommendations for resilience of disastrous
consequences of misinformation. Progress in Disaster Science, 8, 100119.
https://doi.org/10.1016/j.pdisas.2020.100119

CDC. (2020). What you should know about COVID-19 to protect yourself and others.
Retrieved from
https://www.cdc.gov/coronavirus/2019-ncov/downloads/2019-ncov-factsheet.pdf

Chan T. K. (2020). Universal masking for COVID-19: evidence, ethics and

recommendations. BMJ global health, 5(5), e002819.
https://doi.org/10.1136/bmjgh-2020-002819

Lau, L., Hung, N., Go, DJ., Ferma, J., Choi, M., Dodd, W. & Wei, X (2020). Knowledge,
attitudes and practices of COVID-19 among income-poor households in the
Philippines: A cross sectional study. Journal of Global Health, 10 (1): 011007.

Perlman, S. (2020). Another decade, another coronavirus. The New England Journal of
Medicine, 10.1056/nejme2001126

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