APPENDIX E

Episcopal Diocese of Southern Philippines

BRENT HOSPITAL AND COLLEGES INCORPORATED
R.T. LIM. Boulevard, Zamboanga City
COLLEGE OF NURSING

SCHOOL RESEARCH OFFICE

This is to certify that an

ETHICS REVIEW CLEARANCE
Is permissible

We are hoping for your kind consideration and utmost approval for this letter given for the
implementation of the research proposal with the corresponding details.

STUDY PROTOCOL TITLE: ” ASSESSMENT ON THE CONFIDENCE LEVEL

TOWARDS COVID-19 VACCINE”.

PRINCIPAL INVESTIGATOR DERWENA J. SAKIB, ET AL.

(SIGNATURE OVER PRINTED NAME & DATE)
It is understood that the ETHICS REVIEW COMMITTEE’S approved ethical concerns and
other recommendations will be followed.
This Clearance is valid until completion of the study unless revoked for violations.

Issued this__th June ,2022.

DANTE DUMDUM, MA JOY C. GARCIA, MN

Member, Ethics Review Committee Member, Ethics Review Committee

MARK HERNANDO, MN
Chair, Ethics Review Committee
 APPENDIX F
Episcopal Diocese of Southern Philippines
BRENT HOSPITAL AND COLLEGES INCORPORATED
R.T. LIM. Boulevard, Zamboanga City
COLLEGE OF NURSING

SCHOOL RESEARCH OFFICE

TECHNICAL REVIEW CLEARANCE
This section should e signed by the panel chair/head of the scientific/technical review
committee or department that reviewed the scientific soundness of the research study and issued
the appropriate approval. Alternatively, results of the scientific/technical review disposition
maybe appended to this application, instead of completing this section, provided that the
information required below had been appropriately addressed.

STUDY PROTOCOL TITLE: ” ASSESSMENT ON THE CONFIDENCE LEVEL

TOWARDS COVID-19 VACCINE”.

PRINCIPAL INVESTIGATOR DERWENA J. SAKIB, ET AL.

(SIGNATURE OVER PRINTED NAME & DATE)
I confirm that the BHCI ETHICS AND TECHNICAL COMMITTEE (name of
department/Technician Panel Reviewer) has review and approved the following study protocol
related information; Objectives /Expected output supported by literature review: overall research
design; sampling design; sample size; inclusion/ exclusion/withdrawal criteria; data collection
plan and storage as applicable; data analysis plan including statistical design/frameworks, as
applicable; research plan timetable and research output dissemination..

Issuing Panel of Research Review Committee/Department:

Issuing Head of the Panel:
College Designation:. Signature:
 APPENDIX A; APPROVAL LETTER
Episcopal Diocese of Southern Philippines
BRENT HOSPITAL AND COLLEGES INCORPORATED
R.T. LIM. Boulevard, Zamboanga City
COLLEGE OF NURSING

APPROVAL LETTER
Dear Ma’am
Greetings of Peace!
As part of the final requirements of our research subject, the College of Nursing Level III

students from section H of Brent Hospital and colleges Incorporated will conduct nursing

research entitled “ASSESSMENT ON THE CONFIDENCE LEVEL TOWARDS COVID-19

VACCINE”. The study is under the research advisory of Mr. Walbert Delos Santos , MAN, the

purpose of this study is to determine The level of confidence in taking the COVID – 19 in terms

of; Importance Safetyness, Effectiveness.

We respectfully request your permission to perform the aforementioned study among level III

nursing students in section A through H. The researchers will use a self-made checklist

questionnaire that will be distributed online via Google Forms.

We sincerely hope that you will give this letter you full through and approval.

Respectfully Yours,

Derwena J. Sakib Maria Jessica P. Enriquez

Research Leader Dean of College of Nursing

Approved by;
 Walbert Delos Santos , MAN
Research Adviser

APPENDIX B; REQUEST LETTER

Episcopal Diocese of Southern Philippines
BRENT HOSPITAL AND COLLEGES INCORPORATED
R.T. LIM. Boulevard, Zamboanga City

COLLEGE OF NURSING
ANALYN V. SUENAN, MN
Brent Hospital and College Incorporated
College Registrar
Dear Ma’am
Greeting of peace!

We are Brent Hospital and College Incorporated Level III nursing students who will be
conducting a research study entitled “ASSESSMENT ON THE CONFIDENCE LEVEL
TOWARDS COVID-19 VACCINE”. As part of our academic research requirement.
In light of this, we respectfully request permission from your good office to obtain the names of
the whole population of BSN Level 3 section (A-H). which will serve as a foundation for
selecting respondents for our study. Only the names of the level 3 nursing students will request,
and other information of the students will not be included. Rest assured that the respondents’
personal information will not be misused in any manner, and the researchers will maintain strict
data confidentiality.
We are looking forward for your favorable response. Thank you and God bless.
Respectfully Yours
Approved by;

Derwena J. Sakib ANALYN V. SUENAN, MN

Research Leader School Director

Noted by;
 Walbert Delos Santos, MAN
Research Adviser

APPENDIX C; CONSENT LETTER

Episcopal Diocese of Southern Philippines
BRENT HOSPITAL AND COLLEGES INCORPORATED
R.T. LIM. Boulevard, Zamboanga City

COLLEGE OF NURSING
To whom if may concern
We are currently third-year nursing students from section H at Brent Hospital and Colleges
Incorporated. Presently, we are conducting a study entitled “ASSESSMENT ON THE
CONFIDENCE LEVEL TOWARDS COVID-19 VACCINE”. As part of our requirements
in the research subject.
The aim of this study will assess the level of confidence in taking the COVID – 19 in
terms of; Importance Safetyness, Effectiveness of the level III nursing students of Brent Hospital
and Colleges Incorporated and to determined if there is significant difference between male and
female on the level of confidence when data are group according to importance, safetyness, and
effectiveness of level III nursing students of Brent Hospital College Incorporated.
The respondents will answer the particular question that correspond to their answer. The
study will be conduct through online means and will not provide or allow any harm/danger to the
participants. Will be informing that collected data will be including in the study. The researchers
will ensure at all times. No names or other identifying information will be use when reporting the
data, your cooperation throughout this research will be highly appreciated. Thank you so much!
Sincerely yours,
The Researchers
CONSENT FORM
I Have read and understood the above information and had been given the opportunity to
consider and ask questions on the information regarding the involvement in this study. I
voluntarily agree to participate.
Participant’s Signature

___________________ ___________________
Name of Participant Signature of Participant
Witness or Legal Guardian’s Signature
_________________________
_____________________
Name of Witness/ Guardian
Signature of Guardian/ Date

APPENDIX D; QUESTIONNAIRES
Episcopal Diocese of Southern Philippines
BRENT HOSPITAL AND COLLEGES INCORPORATED
R.T. LIM. Boulevard, Zamboanga City

COLLEGE OF NURSING
Research Title:
“ASSESSMENT ON THE CONFIDENCE LEVEL TOWARDS COVID-19 VACCINE”.
Personal Information
Sample Self-made checklist Questionnaire

Part 1. Respondent’s Profile

Age : __ 16 – 18
__ 19 – 21
__ 22 – 24

Gender:
__ Male

__ Female
Part 2. Are you vaccinated with COVID 19 vaccine? __ YES __ NO
If NO do not proceed in answering in part 3, If YES proceed answering in part 3

Part 3. Query on the confidence level of COVID 19 vaccine.

Kindly choose from 1 to 5 your confidence towards COVID 19 vaccine where;

(5) -Completely Confident (4) – Fairly Confident (3)– Somewhat Confident
(2) – Slightly Confident (1) – Not Confident at all

Item Statement of confidence of vaccine importance 1 2 3 4 5

1 I am ____ that once vaccinated with COVID 19 vaccine I
will be able to live my life with no restrictions
 2 I am ___ that COVID 19 vaccine will help protect and
enhance the health and well-being of everyone and me.
3. I am ___ Covid 19 vaccine will play an important role in
building and sustaining vaccine confidence
4 I am ___ that COVID 19 vaccine will reduces the
probability in contracting the virus.
5 I am ____ that Covid 19 vaccine will help stop the
pandemic

Item Statement of confidence of COVID – 19 vaccine safeness 1 2 3 4 5

1 I am ____ that COVID 19 vaccine is safe and are ensured
by manufacturers to safe and had passed strict clinical
trials
2 I am ____ that COVID 19 vaccine had passed FDA
experts.
3 I am ____ that COVID 19 vaccines of any brand are have
the same effect and safe to use.
4 I am _____ that COVID-19 vaccine is recommended for
people with co-morbidities or underlying health
conditions since they are at a higher risk for severe
COVID-19.
5 I am ____ that COVID vaccine is safe to be used by
children

Item Statement of confidence of COVID – 19 vaccine 1 2 3 4 5

Effectiveness
1 I am ____ that COVID 19 vaccine is effective in people
with pre-existing medical conditions that are associated
with increased risk of severe disease.
2 I am ___ that COVID 19 vaccine of any brand is effective
in pandemic response.
3 I am ___ that COVID 19 vaccine is effective in fighting
against any form of COVID 19 variants.
4 I am ___ that COVID 19 vaccine is effective to let few
people get sick.
5 I am ___ that receiving 3 doses of COVID 19 vaccine is
having a high level of effectiveness
 APPENDIX D; QUESTIONNAIRES
Episcopal Diocese of Southern Philippines
BRENT HOSPITAL AND COLLEGES INCORPORATED
R.T. LIM. Boulevard, Zamboanga City

COLLEGE OF NURSING