Research Title: Factors Affecting Acceptability of COVID-19 Vaccine among Pregnant Women in a

Tertiary Hospital in Baguio City

Researcher:
Andrienne E. Boado-Angiwan, RN, MD
Medical Officer III
Department of Obstetrics and Gynecology
Baguio General Hospital and Medical Center

Purpose and Conduct of the Study

Good day!

I am Dr. Andrienne E. Boado-Angiwan, a 3 rd year resident in training under the Department of

Obstetrics and Gynecology and I would like to invite you to participate in this research study which aims
to determine the factors affecting the acceptability of COVID-19 vaccines among pregnant women in our
locality. Data generated from this study may be utilized as basis for health information campaigns for
pregnant women, and may also serve as basis for future health policy development.

Your participation in this study is entirely voluntary. The services you will receive in our
institution will continue and nothing will change whether you choose to participate or not. If you choose
to participate in this study, you will be asked to answer a questionnaire for us to determine your
knowledge, attitudes and practices concerning COVID-19.

Thank you so much!

Type of Research Intervention

This is a survey which involves answering a 3-page questionnaire.

Participant Selection

This study involves pregnant adults who reside in Baguio City, with a viable pregnancy of COVID
status.

Confidentiality

There are no risks involved in participating in this study since your personal data and all answers
provided will be kept confidential in compliance with The Data Privacy Act of 2012 (RA 10173).

Voluntary Participation

It is your choice to participate or not in this study. Regardless of your decision to participate or
not, you will still receive all the necessary services in our institution.
Benefits

Your participation will help us recognize areas where there is gap of knowledge concerning
COVID-19 vaccination. In addition, data generated from this study can be useful for health policy
development and information campaigns.

Confidentiality

Your personal information obtained through the conduct of this study will not be shared or
given to anyone. Identity of all participants will remain confidential in case the findings of this study are
presented or published.

Voluntariness

Being part of this study is by your own free will and volition. There will be no penalties in case
you refuse to participate. In the event that you initially signified your desire to participate but you
eventually opt to withdraw your participation, you may do so anytime. Your relationship with the
researcher and all health care workers in this institution will not be affected whether you choose to
participate in this study or not.

Contact Person: For questions or clarifications, pls contact the researcher at 0917-3177-456.

Consent Form

I have read and understood the foregoing information in this form and had been given the
opportunity to ask questions/clarifications. I give my consent to freely and voluntarily participate in this
study.

__________________________________________ Right thumb mark

Patient’s Signature over Printed Name (if patient cannot sign)