Name (Optional) : __________________________________ Age : ________________

Sex : __________________________________

INFORMED CONSENT

This survey questionnaire is for the research study in Research Media Communication Theories
as part of the requirements for the Doctor of Arts in Literature and Communication course. All
information shared in this survey questionnaire will be treated with utmost care and confidentiality.

Thank you very much for your participation and support.

Sincerely yours,

ETHEL LUZ E. MEDADO

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I. REASONS FOR USING FACEBOOK

COMMON REASONS ALWAYS SOMETIMES RARELY NEVER

4 3 2 1
1. Bond with old friends
and family
2. Develop relationships
with others
3. Engage in meaningful
social contact
4. Online shopping
5. Vlogging

II. RISK FACTORS

Strongly Agree Agree Disagree Strongly Disagree

PHYSIOLOGICAL
4 3 2 1

1. Gave me a sense of social

isolation
2. Often causes balance
issues which creates
disturbances in the inner
ear causing spinning and
vertigo
3. Low frequency of social
contacts
4. Low level of physical
 activity

Strongly Agree Agree Disagree Strongly Disagree

PSYCHOLOGICAL
4 3 2 1

1. Develops low self- esteem

due to cyberbullying
2. I became nomophobic
3. I am Internet addiction
4. Neuroticism
5. Fear of missing out
6. Depression and anxiety
7.

III. IMPACT OF SOCIAL MEDIA

IV.
Strongly
CATEGORY Strongly Agree Agree Disagree
Disagree
4 3 2
1
SUPPORT
Provide aid and care in
times of need
COMPANIONSHIP
Participate in enjoyable
POSITIVE
shared activities
CONTROL
Exert influence to deter
health-damaging
behaviors
SUPPORT FAILURES
Fail to provide needed
support or provide
miscalibrated or
grudging support
REJECTION/NEGLECT
Exclude person from
enjoyable shared
NEGATIVE activities or
ignore/neglect person
MISDIRECTED/CONTROL
Exert influence that
undermines sound
health practices or that
encourages initiation of
unsound health
practices