Nursing Program

Butuan City

FACTORS ASSOCIATED WITH COVID-19 VACCINE HESITANCY AMONG

PARENTS WITH ADOLESCENT CHILDREN IN BUTUAN CITY: AN

EXPLORATORY SEQUENTIAL MIXED-METHOD DESIGN

An Undergraduate Thesis Presented to

The Faculty of the Nursing Program

Father Saturnino Urios University

Butuan City

In Partial Fulfillment of the Requirements for the Degree of

Bachelor of Science in Nursing

By:

Janella Jene G. Asis

Khent Glecier J. Bonghanoy

Sienna Carmela T. Cleofas

Khate Coleen P. Goma

Jether Neal L. Moscatiles

Gella Alyssa B. Sinangote

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Butuan City

APPROVAL SHEET

This thesis called “FACTORS ASSOCIATED WITH COVID-19

VACCINE HESITANCY AMONG PARENTS WITH ADOLESCENT CHILDREN IN
BUTUAN CITY: AN EXPLORATORY SEQUENTIAL MIXED-METHOD DESIGN”
prepared and submitted by Group 6 of N 31 Janella Jene G.
Asis, Khent Glecier J. Bonghanoy, Sienna Carmela T.
Cleofas, Khate Coleen P. Goma, Jether Neal L. Moscatiles,
and Gella Alyssa B. Sinangote in partial fulfillment of the
requirements for the degree, Bachelor of Science in Nursing,
has been examined and recommended for Oral Examination.

MOSES REGGIE S. CABALLERO, RN, MAN

Adviser

Approved in partial fulfillment of the requirement for

the degree, Bachelor of Science in Nursing, by the Oral
Examination on _____________ with a grade of _____________.

TARCISIO B. CANDOG, RN, MAN

Chairperson

TINA JOY G. MANTE, RN MAN MA. KATRINA L. COSTINIANO, RN MAN

Member Member

Accepted in partial fulfillment of the requirements for

the degree of Bachelors of Science in Nursing.

TARCISIO B. CANDOG JR., RN, MAN

Dean, Nursing Program
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Butuan City

TABLE OF CONTENTS

PAGE

TITLE PAGE i

APPROVAL SHEET ii

TABLE OF CONTENTS iii

CHAPTER

1 THE PROBLEM AND REVIEW OF RELATED LITERATURE

Background of the Study 1

Review of Related Literature 5

Theoretical Framework 11

Conceptual Framework 15

Statement of the Problem 16

Hypotheses 17

Significance of the Study 18

Scope and Limitations 20

Definition of Terms 22

2 METHODOLOGY

Research Design 24
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Butuan City

Environment, Population, And Sample 26

Sampling Technique 27

Ethical Considerations 28

Research Instrument 32

Data Gathering Procedure 33

Data Analysis 36

BIBLIOGRAPHY 38
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Butuan City
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Butuan City

Chapter 1

THE PROBLEM AND REVIEW OF RELATED LITERATURE

Background of the Study

Since the development of coronavirus illness (COVID-

19), vaccination has been strongly urged around the world in

order to achieve faster herd immunity and aid in the

containment of the pandemic. Kaplan & Milstein (2021) have

stated that vaccination is the best method in alleviating

COVID-19 pandemic since immunity can be gained through it.

Despite the tremendous health advantages and extensive

scientific efforts in lobbying for vaccine effectiveness and

safety, vaccination hesitancy continues to represent a

significant barrier to reaching global herd immunity.

Vaccine hesitancy is defined by the World Health

Organization's (WHO) Strategic Advisory Group of Experts

(2015) Working Group as "delay in accepting or refusing

vaccines despite the availability of vaccine services."

According to MacDonald (2015), vaccine hesitancy is

influenced by factors such as complacency, inconvenience in

accessing vaccines, and lack of confidence. However, poor or

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Butuan City

inadequate communication and its negative impact is closely

associated with this, especially during crises.

Initially, a survey conducted by Pulse Asia on January

7, 2021 revealed that more Filipinos (47 percent) would

refuse to take the vaccination even if it was easily

available. However, Reuters (2021) stated that the

Philippines has provided at least 111,908,830 doses of COVID

vaccination. Considering that each individual requires two

doses, it would be enough to vaccinate around 51.8% of the

country's population (28.7 million). Dr. Tony Leachon

claimed in a report that the Philippines will likely achieve

herd immunity between 85% and 90% in two years' time, or

about 2023 (Javier, 2021).

As immunizations proceeded in numerous regions and

provinces, the Caraga Region presently has a total of

1,029,921 people fully vaccinated against COVID-19 as of

December 31, 2021. According to a recent report released by

the Caraga Department of Health (DOH), a total of 2,315,160

doses of the vaccine had already been distributed throughout

the province. They also reported that the ongoing

immunization campaigns had reached 52.88% of the target

population in the region.

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Butuan City

Despite a greater readiness to be vaccinated, the

Social Weather Stations (SWS) discovered that 19 percent

were still hesitant and 18 percent were unwilling to be

vaccinated. 14 percent of those who were unsure stated they

would "certainly not" get vaccinated, while 4% said they

would "probably" not get vaccinated (SWS, 2021).

Numerous determinants that promote parental vaccine

decision-making have been highlighted throughout the

previous decade (Bianco et al., 2019 & Charron et al.,

2020). This included parents' alternative health beliefs and

their mistrust of vaccine-related institutions, low

perceived vaccine safety and efficacy, and low perceived

vulnerability to vaccine-preventable diseases (Diaz et al.,

2020; Forster et al., 2016; Majid et al., 2020; & Salmon et

al., 2005). In the Philippines, relative to these

determinants are fears from major side effects and the

dangers of long-term health implications such as sickness or

disability, perceived lack of information and trust of

government, religious or cultural pronouncements that

discourage vaccination, a non-essential view of vaccines,

and competing time constraints (Caudal et al., 2020;

Landicho-Guevarra et al., 2021; Salmon et al., 2005; &

Yufika et al., 2020). Moreover, due to the controversy

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Butuan City

surrounding Dengvaxia in 2017, Sanofi's dengue vaccine, some

parents have refused to vaccinate their children even

against vaccine-preventable diseases (Smith, 2018).

The goal of this study is to explore and measure the

factors that contribute to parents' COVID-19 vaccine

hesitancy for their adolescent children in Butuan City to

determine their primary concerns or barriers, as well as

which of the identified factors is the highest reason of

parental vaccine hesitancy, in order for the researchers to

develop an intervention program. The study may also help the

government and healthcare system, future research studies,

and other initiatives to create relevant behavior change

communication campaigns, implement actions and other

measures to combat the hesitancy problems, and increase the

adoption of the COVID-19 vaccines and vaccination rate

within the region to prevent further complications and

intensification of the infection rate from recurring.

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Butuan City

Review of Related Literature

The review of related literature denotes a systematic

search and critical analysis of integrated information from

various sources. This includes an overview of relevant

literature and studies that have been evaluated in order to

investigate the research problem, which may take into

account existing gaps in previous studies and the need for

additional research. To deepen the study, a variety of

similar references have been reviewed to obtain perspectives

that were used in contextualizing the research.

Parental COVID-19 Vaccine Hesitancy

Vaccine hesitancy is defined by WHO (2013) as a

behavior that is driven by a range of factors such as issues

of confidence (lack of trust in vaccine or the provider),

complacency (do not recognize a need for a vaccine, do not

value the vaccine), and convenience (access). Individuals

who are vaccine-hesitant are a heterogeneous group with

varying degrees of uncertainty regarding specific vaccines

or vaccination in general. They may also accept all vaccines

while remaining concerned about vaccines; others may refuse

or postpone certain vaccinations while accepting others,

while some may refuse all vaccines.

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Butuan City

It has been stated by Tomacruz (2021) that a nationwide

Social Weather Station (SWS) survey conducted in June 2021

found how one out of every four respondents was unsure

whether to get vaccinated or not, while almost 20% of those

saying outright no to the vaccines. However, the latest

survey from SWS on September 27-30, 2021 showed that there

has been an increase in vaccination willingness as 64% of

adult Filipinos stated they would "surely" or "probably" get

vaccinated if they "had a chance to be provided a free

vaccine that can prevent COVID-19 that has been authorized

by the Food and Drug Administration (FDA).”

According to Reuters (2021), young people aged 10 to 19

account for 7.8% of the 2.7 million verified COVID-19 cases.

However, deaths in that age range are uncommon, accounting

for only 0.6 percent of the country's over 40,000 deaths.

COVID-19 immunization for children aged 12 to 17 years old

began countrywide on November 3, 2021, with the help of

Moderna and Pfizer (DOH, 2021). There are 12,722,070

Filipinos aged 12 to 17 years old, according to the

Philippine Statistics Authority's Philippine Projected

Population figures for 2021. More than seven million of the

12.7 million Filipino youngsters have received at least one

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Butuan City

dose of vaccine, while 2.1 million have been fully immunized

(Kabagani, 2021).

The study of Simonson et al. (2021) revealed that

despite all socioeconomic and demographic groups studied,

parents are more vaccine-hesitant and resistant than non-

parents (in terms of willingness to vaccinate themselves).

However, the age of a child does not appear to be an

associated factor in parents' vaccination hesitancy since

parents of children who are either younger (1 to 12 years

old) and older (13–17 years old) exhibit almost the same

amount of hesitancy, which is estimated at around 20% when

it comes to vaccinating them.

A study conducted in two highly urbanized areas in

Manila, Philippines, discovered factors that contribute to

around one-third of respondents having vaccine hesitancy.

Parents were reported to be rejecting at least one

vaccination for their children due to negative media

information and worries about vaccine safety and adverse

effects; the predominant negative media information reported

by respondents was connected to the Dengavaxia vaccine

controversy (Migriño et al., 2020). Interpersonal and

community barriers, health system barriers, and

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superstructural barriers were also found to be related

factors (Caudal et al., 2020).

In this regard, the majority of parents in Bulacan,

Philippines are hesitant to vaccinate their child, due to

the scientific evidence of the risks and advantages of

vaccination being the most prevalent factor influencing

their decision (Wee et al., 2021). Then again, Bautista et

al. (2021) reported that a high percentage of respondents

have preferred brands in mind, which may have an impact on

the government's immunization program.

Sociodemographic Profile

Due to the ongoing COVID-19 pandemic, it is still

regarded as a major global public health threat that affects

people of all ages and socioeconomic backgrounds. As such,

the public’s acceptance of COVID-19 vaccines is associated

with the individuals’ sociodemographic profile. Marriage and

a higher educational level were discovered to be socio-

demographic factors associated with vaccine acceptance.

Higher risk perception and trust in the healthcare system

were discovered to be related to significant predictors in

explaining respondents’ vaccination intentions (AL-Mohaithef

et al., 2021).
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Butuan City

According to a similar study conducted in Arkansas by

MacElfish et al. (2021), it has been noted that COVID-19

vaccine hesitancy and trust greatly varies across

sociodemographic groups. COVID-19 and general vaccine

attitudes were found to be consistently related to age,

gender, race, and education, with younger respondents and

those with lower education and income reporting more

hesitancy.

The SWS survey has found that willingness to be

vaccinated improves across education levels. College

graduates were the most willing to be vaccinated (83%),

followed by junior high school graduates (68%), and

elementary graduates (59%), and non-elementary graduates

(59%). However, non-elementary graduates had the highest

overall hesitancy to get vaccinated, accounting for one-

third (37%) of those surveyed (SWS, 2021).

Santibanez et al., (2020) were one of the first to

report on vaccine hesitancy among parents of children during

the COVID outbreak, especially investigating why fewer

children took the flu vaccination in 2019 in time of the

pandemic. It was shown that children with vaccine-hesitant

parents were 26% less likely to obtain a flu vaccination

than children whose parents had no reservations. Despite

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this, not every parent with reservations avoided the vaccine

— 34% to 47% of those children were subsequently vaccinated,

despite their parents' reservations (Santibanez et al.,

2020).

Several studies have also reported the association of

educational background with vaccine hesitancy and

willingness. Consistently, a study based on multivariable

models stated that a higher educational level (compared to a

medium level) and stronger confidence in one's knowledge of

prevention measures were associated with a higher intention

to get vaccinated and have the child vaccinated

(Brandstetter et al., 2021).

Gender was also proved to be statistically significant

related to various factors for vaccination hesitancy as

well. Based on a study conducted in New Zealand, women were

more likely than men to identify potential risks to their

personal health, such as unknown future vaccine effects or

potential side effects, which contributed to their hesitancy

in receiving the vaccine (Pricket et al., 2021).

This correlates with the findings of the study in the

Philippines, where vaccines are regarded to be protective by

the majority of 20–39-year-old mothers (95.5%), although

vaccine hesitancy rates among respondents reached 36.4%. The

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contributing factors for this were negative media coverage

and worries about vaccine safety, particularly in relation

to Dengvaxia (Migrio et al., 2020).

On the other hand, a study in Bulacan, Philippines

discovered a weak negative correlation between the economic

status of the parents and their vaccine hesitancy

considering the cost of the vaccine. Additionally, the

correlation analysis between the parents' educational level

and their vaccination apprehension was also interpreted as a

negligible correlation, indicating that vaccine hesitancy

has no association with the two mentioned factors (Wee et

al., 2021).

Theoretical Framework

Figure 1. Icek Ajzen Model

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Butuan City

The study is anchored on the theory of planned behavior

by Icek Ajzen in 1991. This theory aims to predict an

individual's intention to engage in a behavior and was

intended to explain all behaviors over which people have the

ability to exert control. A person’s control over their

behavior is collectively represented by six constructs in

this theory. These six constructs are the following:

attitudes, behavioral intention, subjective norms, social

norms, perceived power, and actual and perceived behavioral

control of the individual.

According to the TPB, intentions precede behavior,

which in turn are also determined by attitudes, subjective

norms, and perceived behavioral control. In this theory, the

individuals' cognitive and affective evaluations of a

particular activity as positive or negative are referred to

as attitudes. The subjective norms are the social pressure

an individual perceives which may lead to them performing

the behavior. This is composed of injunctive norms

(describing how people should act) and descriptive norms

(describing how people actually act).

The perceived behavioral control refers to the

individual’s personal belief about whether they are able to

perform the behavior. The respondent’s particular behavior

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towards vaccination can be analyzed through the six

constructs of this theory. Furthermore, the theoretical

framework will aid in recognizing the presence of vaccine

hesitancy by examining the belief structure of the

respondents’ in the study, which includes attitudes toward

COVID-19 vaccines, social norms, subjective norms, and

perceived behavioral control.

Subjective norms are often categorized as either

descriptive norms that entail individuals’ perceptions of

others’ behavior, or injunctive norms that involve

perceptions of others’ attitudes or opinions towards a

behavior - a factor positively associated with vaccination

intentions (Winter et al., 2021). A study concluded that

perceiving greater support for HPV vaccination from a peer

or doctor was also related to greater HPV vaccine self-

efficacy in college students, which, in turn, was related to

increased vaccine intentions (Stout et al., 2020). As such,

subjective norms may be an important antecedent when

determining intentions to receive a COVID vaccine.

In TPB, a person’s attitude is determined by their

understanding of the benefits and drawbacks of an action.

Attitude is comprised of behavioral beliefs and outcome

evaluations. Results of a study showed that positive

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attitudes related to the COVID-19 vaccine were negatively

associated with vaccine hesitancy while higher efficacy

beliefs would also lead to higher intentions of getting

COVID-19 vaccine (Thaker & Ganchoudhuri, 2021). Therefore,

this construct can be used to determine the presence of

positive and negative attitudes that may positively or

negatively affect the intention of acquiring the vaccine

among the respondents.

Perceived behavioral control is determined by the

number of resources an individual has and their ability to

control the barriers of the behavior. If an individual is

abundant in resources and has fewer perceived barriers, then

they are more likely to have a stronger intention to perform

behaviors (Azjen, I., & Madden, T., 1986). This construct

may be represented through an individual’s fear of

vaccination, its symptoms, or the lack of resources which

can lead to vaccine hesitant behavior.

Overall, these three constructs within the Theory of

Planned Behavior are important to explaining the intention

of an individual to perform a behavior, including vaccine

hesitancy. The researchers will utilize the three constructs

in this theory by setting themes for each questions which

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will help in determining the dominant factor that affects

vaccine hesitancy among the participants.

Conceptual Framework

Vaccine Hesitancy

Health Status

Social Factor Intervention

Factors associated Program

Sociodemographic
with COVID-19 Factor

Environmental Factor

COVID-19 vaccine-
related information

Independent Variables Dependent Variables

Age
Sex
Educational Attainment
Occupation

Intervening Variables

Figure 2. Research Paradigm

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This present study would like to investigate whether

the respondents identified for this study who are parents

that are hesitant towards COVID-19 vaccinations in their

children in selected barangays in Butuan City. This is to

measure and determine the factors associated with vaccine

hesitancy.

The Conceptual Framework of the study showcases the

relationship between the factors associated with COVID-19

(independent variables) and vaccine hesitancy (dependent

variables). As for the age, sex, educational attainment and

occupation (intervening variables), they are intertwined

with the independent and dependent variables as the study

also aims to examine if there are significant differences

when the respondents are grouped according to their profile.

Hence, with the research findings, the researchers will

formulate an appropriate intervention program for the

respondents.
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Statement of the Problem

The study aims to identify the factors associated with

COVID-19 vaccine hesitancy among parents with adolescent

children in Butuan City.

Specifically, it sought to answer the following

questions:

1. What are the factors associated with parents’ vaccine

hesitancy towards COVID-19 vaccination in their

children?

2. What is the profile of the respondents regarding the

following?

2.1. Age

2.2. Sex

2.3. Educational Attainment

2.4. Occupation

3. What is the extent of the factors associated with

vaccine hesitancy among parents with adolescent

children?

4. Is there a significant difference on the factors

associated with COVID-19 vaccine hesitancy when grouped

according to their profile?

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5. Based on the findings of the study, what intervention

program can be developed?

Hypotheses

Based on the problem presented, the following null

hypothesis will be tested at a 0.05 level of significance:

Ho1: There is no significant difference between the

factors associated with COVID-19 when grouped according to

their profile.

Ho2: There is no significant difference between vaccine

hesitancy of the respondents when grouped according to their

profile.

Ho3: There is no significant relationship between the

factors associated with COVID-19 of respondents and vaccine

hesitancy.
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Butuan City

Significance of the Study

The outcomes of the study are significant to the

following sectors:

Parents. The study will highlight the concerns of the

parents towards the vaccination of their children which can

be addressed by local government units and other health

sectors based on the results of the study.

Children. The study will benefit children by improving

awareness and addressing concerns related to vaccine

hesitancy in their families.

Community. The study will benefit the community as the

results of this study can be used by local government unit’s

to promote vaccination towards hesitant families increasing

the chance of attaining herd immunity and decrease

likelihood of acquiring COVID-19 and its symptoms within the

community.

Department of Health (DOH). The outcomes of the study

will provide information on the current situation on the

causes of vaccine hesitancy which may serve as a basis for

planning of programs, advocacies, and guidelines which focus

on the problem. This may also serve as a basis to improve

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existing guidelines and to identify areas that were not

primarily focused on previous programs and policies.

Local Government Unit (LGU). The outcomes of the study

will provide information that may be used in creating

appropriate programs and public awareness campaigns that are

focused on dealing with vaccine hesitancy.

Student Nurses. The results of the study will provide

student nurses with the knowledge they will need when

providing health teaching and health education to

individuals who are vaccine-hesitant.

Future Researchers. This study will serve as the basis

of literature for future researchers when conducting studies

related to this field.

Scope and Limitations

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Butuan City

The study covers the factors associated with COVID-19

vaccine hesitancy among parents with adolescent children

wherein the data collection will be conducted within

barangays in Butuan City.

The respondents of the study are parents that are

hesitant to vaccinate their adolescent child against COVID-

19 within the said city. Moreover, the researchers only aim

to identify the factors associated with COVID-19 vaccine

hesitancy and determine what would be the highest reason for

the parents’ hesitancy.

The researchers will determine the sampling through the

use of convenience sampling with randomly selected

respondents for the study to have a readily available sample

given that the researchers have easy access to elements,

making it simple to gather respondents for the sample

because the data would be collected virtually where

gathering will be limited.

The respondents will be selected in accordance with the

inclusion criteria which include (a) COVID-19 vaccine-

hesitant parents in their adolescent children regardless of

whether the parent is vaccinated or not, (b) residing within

Butuan City, (c) with a child ages 12 to 17 years old who is

not yet vaccinated, (d) the child stays with his or her
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parent, and (e) willing to participate in the study. On the

other hand, exclusion criteria include (a) parents who are

not hesitant to vaccinate their children against COVID-19,

(b) those who do not reside within Butuan City, (c) does not

have a child ages 12-17 years old who is not yet vaccinated,

(d) the child do not stay with his or her parent, and (e)

not willing to participate in the study.

Due to the situation of the COVID-19 pandemic,

adjustments will be made for the data collection. The one-

on-one interview utilizing the formulated questionnaire

would only be conducted through a phone call, virtual

communication, or other means of remote interview that is

convenient for the respondents. As for the survey, it will

be conducted through an online platform as well with the use

of Google forms that will be disseminated through the

messenger medium, a social media application. The major

limitation of the study is the medium for conducting the

interview and survey as these will be solely based on the

internet connectivity of whether it will be available or

not, and the security of the connection which might affect

the gathering of data.

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Definition of Terms

The following are terms used in the study which are

operationally defined for clarity:

Herd Immunity. The indirect protection of infectious

diseases, viruses, and etc. Through vaccinations or previous

experience of the host of a disease or infections. This

occurs when a large portion of the community has an immunity

to a certain type of disease which in this study is pointing

to the COVID-19 disease.

Parents. A male or a female with a child/children ages

12 to 17 years old, who are specifically not yet vaccinated

with the COVID-19 vaccine.

Vaccine Hesitancy. It is the refusal of getting

vaccinated despite the availability of the vaccines due to

determining factors.
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Chapter 2

Methodology

The methods and procedures to be applied by the

researchers will be discussed in this part of the research

study. It includes the location, population, and how the

researchers chose the subjects. In addition, this section

will; display the research instruments, sampling and

statistical techniques to be used in the data collection

process.

Research Design

The exploratory sequential mixed method design was used

in this study. A mixed method approach involves the

integration of qualitative and quantitative approaches

within a single study to investigate a phenomenon (Leech N.

& Onwuegbuzie, A., 2009). This is done sequentially,

following a first phase of qualitative data gathering and

analysis, a second phase of quantitative data gathering and

analysis and a third phase of integration and comparison

between both findings (Guest, G. & Fleming, P., 2015).

The researchers chose this method for this study to be

able to explore and determine the factors involving vaccine

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hesitancy prior to measuring them. This is done through the

initial quantitative phase involving one on one interviews

with the respondents. The data gathered from this phase will

be used in making survey questionnaires for the quantitative

phase of the study, wherein each variable will be measured

to determine the most prevalent factor.

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Environment, Population, and Sample

The study will be conducted in Butuan City, which

consists of 86 barangays. Butuan City is a highly urbanized

coastal city in Agusan del Norte province and the regional

center of Caraga (Region XIII). It is located in the Agusan

Valley's northeastern portion, across the Agusan River.

Agusan del Norte borders it to the north, west, and south,

Agusan del Sur to the east, and Butuan Bay to the northwest.

Figure 3. The Map of Butuan City

The respondents of the research study will be composed

of parents from the selected barangays in Butuan City, who

are chosen based on the inclusion criteria. For the first

phase of the study, ten (10) respondents will be selected

through purposive sampling, a non-probability sampling

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method wherein researchers use their own discernment in

selecting from the population to participate in the

interview.

The second phase of the phase of the study will require

a larger population to be tested in which fifty (50)

respondents will be purposively selected to participate in

the survey.

Sampling Technique

The study utilizes non-probability sampling technique

specifically with the use of the purposive convenience

sampling. By means of this sampling method, the researchers

will choose the ten (10) participants and fifty (50)

respondents which will fit with the criteria wherein the

selection involves gathering of the respondents from the

targeted population who are convenient to the researchers.

In this sampling technique, the researchers will be able to

easily and conveniently gather the study’s respondents

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accordingly. Each potential candidate will be screened first

by the researchers. The respondent who is fitted with the

inclusion criteria will then be included for the conduct of

the study.

For the initial phase of the study, a qualitative

method design will be utilized in which ten (10)

participants from varying selected barangays in Butuan City

will be chosen to participate for an interview.

Subsequently, the second phase is a quantitative method

design in which fifty (50) respondents will be selected to

participate in the survey. For this phase, the respondents

will still be gathered from selected barangays in Butuan

City conveniently. Overall, a total of sixty (60)

respondents will be gathered from the sample population.

With this type of sampling technique, the researchers

will guarantee that the respondents that fit the criteria

from each selected barangays in Butuan City are included in

the final sample as the respondents of the study.

Ethical Considerations
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In conducting this study, the researchers considered

principles that include autonomy, beneficence, non-

maleficence, justice, privacy and confidentiality, fidelity,

and human dignity. Considering that the researchers aim to

prevent deception, bias, and unintended harm to the

respondents and scientific community, taking these ethical

issues into account and consideration will serve as a guide

to propose an objective study.

Autonomy. This applies to the study as a state of being

self-governing. Each of the respondents will be given the

chance to decide whether or not to participate in the study.

The respondents will be provided with a consent form with

information regarding the study included. After reading the

content of the consent, if the respondents agree, he/she

will then have to sign the form. If the respondent does not

agree, he/she will not be forced to do so. Throughout the

study if the respondents suddenly decided to quit, even

though he/she agreed at first, he/she can still stop without

the need to explain his/her reasons.

Beneficence. This applies to the study as the

researchers’ action is done for the benefit of others. This

also means that having the interests of research respondents

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in mind. The purpose of this study is to discover new

information that is helpful to the society and should never

hurt anyone or find out information at the expense of other

people. Maximize benefits and minimize risks for respondents

means that they may be exposed to harms or risks, and the

researchers are obliged to do their best to minimize

possible risks and maximize the benefits of the respondents.

Justice. This applies to the study as fair treatment of

all respondents regardless of indifferences. To avoid any

biases in data gathering, the researchers utilized the

convenience sampling technique to establish a neutral sample

population. It is guided by research questions

and necessities as to not avoid any group, and to be

as representative of

the generally target population as possible. The researchers

also treated respondents equally regardless of their status.

Privacy and Confidentiality. This applies to the study

as the practice of keeping sensitive information private

unless the owner of the data gives permission to be shared

with another party. Anonymity was practiced in order to keep

personal information such as the name of the respondents

which would lead to their identification. Instead of names

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of respondents, the researchers used numbers to identify

respondents (e.g. respondents 1, 2, 3…). This principle was

used in order to respect the respondents’ personal

integrity, the privacy of their own and their families, and

harm.

Fidelity. This is characterized as a guideline that is

concerned with building trusting relationship between

researcher and inquire about respondents. It is a two-way

process with researchers needing to trust research

respondents as much as respondents need to trust

researchers. In line with this, researchers are open and

honest about possible burdens of the study to make an

informed decision about the study. in view of the fact that

rapport is essential for successful communication, the

principle of fidelity was used by establishing trust and

good rapport towards the respondents to provide information

and data access brought by good relationship between both

researcher and the respondents.

Human Dignity. Individual inviolability is directly

tied to this definition. Individuals have interests and

integrity, which cannot be sacrificed in the pursuit of

greater understanding through research. The researchers will

 Nursing Program
Butuan City

protect the respondents' personal integrity, individual

freedom and self-determination, privacy, and family life,

and shield them from injury and unhelpful strain. When

choosing a topic, interacting with research subjects, and

reporting and publicizing research findings, researchers

must exhibit respect for human dignity.

Research Instrument

In the first phase of the study, the researchers will

utilize a semi-structured one-on-one interview consisting of

approved sub-questions and follow-up questions based on the

constructs of the Theory of Planned Behavior by Icek Azjen

(2006), allowing respondents to answer anything however they

prefer without being limited to predefined answers.

The interview will examine two parts: profile and

factors associated with vaccine hesitancy. This will be

recorded with the agreement of the respondents in order to

capture the interview data more efficiently. The recording

 Nursing Program
Butuan City

of the interview will allow the researcher to focus on the

interview topic and subjective cues, allowing the

transcriptionist to construct a "verbatim transcript" of the

interview, which will then be extracted as research

variables.

In the second phase of the study, a survey

questionnaire, which the researchers made out of the

published standardized questionnaire, will be utilized. This

will be composed of the identified variables where responses

will be measured by the Likert Scale (e.g. always, often,

sometimes, seldom, or never). A 5-point Likert scale is a

common tool for assessing attitudes, knowledge, perceptions,

values, and behavioral changes. This usually consists of a

set of statements from which respondents can select to rate

their answers to evaluative questions (Vogt & Johnson,

2011).

Data Gathering Procedure

The prepared research instrument and formulated

questionnaire will be reviewed by the research adviser and

panelists for it to undergo reliability and validity tests

to check for its coherence and accuracy before conducting

 Nursing Program
Butuan City

the actual interview and survey. After the approval, the

selection of respondents from selected cities or provinces

within Butuan City will then be conducted to gather

potential study respondents according to the study’s

criterion wherein convenience sampling, a type of non-

probability sampling, will be utilized by the researchers.

Following the selection of the respondents who are

fitted in accordance with the study’s criteria, the

researchers will submit a formal letter to the Dean of the

Nursing Program for approval. Moreover, in order to conduct

the study, the researchers will issue a letter of informed

consent to the respondents from the thesis adviser and

research teacher which has been approved, for the purpose of

adhering to the principles of research ethics, enabling the

rights, safety, and privacy of the respondents to engage

oneself in the study voluntarily, with full knowledge of

what it entails for them to participate, and to provide

their agreement before doing so.

For the gathering of data, it will be conducted in

adherence to the health and safety protocols due to the

situation of the COVID-19 pandemic. Given that the study

utilizes an exploratory sequential mixed-method design, it

will consist of two phases: Qualitative and Quantitative.

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Butuan City

In the qualitative phase, ten (10) participants will be

gathered from selected barangays in Butuan City. The

researchers will formulate a questionnaire based on the

constructs of the Theory of Planned Behavior by Icek Azjen

(2006). The questions for the interview encompasses the

exploration of the participants’ perspectives and

experiences with the use of open-ended questions to

determine the factors associated with COVID-19 vaccine

hesitancy among parents with adolescent children. The

interview will be done virtually utilizing the formulated

questionnaire through a phone call, virtual communication,

or other means of remote interview depending on what is

available and convenient for the respondents. The

researchers will inform and thoroughly explain to the

respondents that the interview is going to be recorded for

the purposes of documentation and transcription.

In the quantitative phase, the researchers will be

gathering a total of fifty (50) respondents from selected

barangays in Butuan City. The survey questionnaire will be

made out of the standardized questionnaire with precisely

the same set of questions and identical format for the

responses to be recorded uniformly. This was published which

composed of the identified variables (e.g. always, often,

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Butuan City

sometimes, seldom, or never). The survey will be conducted

on an online platform and will be distributed through the

messenger medium, a social media application, using Google

forms.

Data Analysis

Due to the nature of the research design being an

exploratory sequential mixed method, the data analysis to be

performed by the researcher will be split into qualitative

and quantitative phases respectively.

Qualitative Phase

The researchers will utilize thematic analysis

following Braun & Clarke’s (2006) 6-step framework in

analyzing the qualitative data during the first phase. The

purpose of thematic analysis is to identify themes and

patterns present in the qualitative data which are relevant

to the research question. The steps to be performed by the

researchers are the following respectively: (i) the

researchers will become familiar with the data through re-

listening to audio recording and reading transcripts; (ii)

the researchers will begin analyzing the data and generating

codes which will help separate relevant from irrelevant

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Butuan City

data; (iii) the researchers will search for themes or

patterns that arise from the data and assign the codes to

the appropriate themes; (iv) themes will be reviewed,

modified and developed by the researcher to ensure that data

assigned is relevant to each theme; (v) themes will be

defined in relation to the research question; (vi)

researchers will then write a report summarizing the

analyzed data.

Quantitative Phase

For the second phase involving quantitative data, the

researchers will use the information from the first phase to

formulate questionnaires that will allow them to identify

the common factors affecting vaccine hesitancy in the target

sample. Data gathered will be analyzed through chi square

test of independence that will help identify the relation of

the factors to the behavior which is vaccine hesitancy. The

researchers will consult a statistician to check the data to

determine validity of the results. Data will then be

compared between both phases and the researchers will give

their interpretation of the results.

Statistical Analysis

*to be inserted
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Butuan City

Statistical Treatment

*to be inserted

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