Appendix A

RESEARCH INSTRUMENTS

Dear Sir/Ma’am Respondent,

We, Mozart Jello O. Olario, Brafiel Claire C. Libay, Rijayah Jane T. Obedencio,
Justine Krystyl O. Iñido, and Hemael Bon F. Puebla, taking Bachelor of Science in Nursing at
Christ the King College.

Several research studies and articles exist that sought to investigate the most pressing
factor that determines whether the level of awareness on the COVID-19 vaccine does, or does
not, impact the level of acceptance. The research we wish to conduct for our course completion
is entitled, “Level of Awareness and Acceptance of COVID-19 Vaccine in Gingoog City.”

We are undertaking the aforementioned research study as part of the Course Requirement,
and I am requesting you to join; however, it is entirely up to you whether or not to do so. It's
entirely up to you. Please complete the following research instruments if you choose to
participate willingly. If there are any terminology or concepts in this study that you don't
understand, they will be explained to you, and you can ask questions at any time.

The questionnaires that you are about to respond to will be used by the researcher to
measure the level of awareness and acceptance of the COVID-19 vaccine amongst the selected
vaccinated and unvaccinated residents of Gingoog City. You will have the opportunity to share
your opinions on a wide range of problems relating to your present conditions as a result of your
involvement. Please keep in mind that there are no correct or incorrect responses.

The researchers guarantee that no one will be identified as a result of their responses, and
the questionnaire contains no requests for sensitive information. The researcher will utilize the
results of the analysis for research reasons only.

The questionnaire comprises one part:

1. Level of Awareness and Acceptance Questionnaire (Kumari et. al, 2021)

Researchers:

MOZART JELLO O. OLARIO

BRAFIEL CLAIRE C. LIBAY
RIJAYAH JANE T. OBEDENCIO
JUSTINE KRYSTYL O. IÑIDO
HEMAEL BON F. PUEBLA
 Survey Questionnaire

This questionnaire is part of a study, which seeks to determine the level of awareness and

acceptance of the COVID-19 vaccine in Gingoog City. You are requested to answer the questions

sincerely. 

Please be assured that your responses will be dealt with the utmost confidentiality and

will be solely used as part of the data needed to realize the objective of this study. 

Thank you very much.

Level of Awareness and Acceptance of COVID-19 Vaccine

Instructions:
The following items may be answered using the following responses made below. Please
check which corresponds to your answer.
The following descriptions have the corresponding point value scale:
Strongly agree      =  4
Agree                    =  3
Disagree                =  2 
Strongly Disagree =  1

Domain 1: The level of awareness of COVID-19 vaccine amongst vaccinated and

unvaccinated individuals in Gingoog City.
I am aware that: Strongly Disagree Agree Strongly
Disagree Agree

1 2 3 4

1. COVID-19 vaccine is free of cost.

2. COVID-19 vaccine is accessible in Gingoog City.

3. You can select your preferred COVID-19 vaccine
brand as long as it is available on the selected
vaccination site.

4. I may experience side effects (pain, redness,

swelling
tiredness, headache, muscle pain, chills, fever,
nausea) after getting the COVID-19 vaccine.

5. I can still get infected by the virus after getting

the COVID-19 vaccine.

6. I am free to decide to get vaccinated with the

COVID-19 vaccine.

7. I will be given a vaccination card after getting the

COVID-19 vaccine or the first dose.

8. Health care workers will check my vital signs

before and after the COVID-19 vaccination.

9. I am aware that well-trained professionals will be

the one to administer the COVID-19 vaccine.

10. I can still infect others, if I am COVID-19

positive, after I get the COVID-19 vaccine.
Domain 2: The level of acceptance of COVID-19 vaccine amongst vaccinated and
unvaccinated individuals in Gingoog City.
I accept that: Strongly Disagree Agree Strongly
Disagree Agree

1 2 3 4

2. There is no harm in taking COVID-19 vaccine.

3. COVID-19 vaccine can protect me from having

severe symptoms

4. The benefits of taking the COVID-19 vaccine

outweighs the risks involved.

5. I trust the experts on the COVID-19 vaccines.

6. There will be no immediate serious side effects

after taking the COVID-19 vaccine.

7. General side effects of the COVID-19 vaccine are

mild to moderate.

8. COVID-19 vaccine will lessen the spread of

COVID-19 virus.

9. COVID 19 vaccine can lower the risk of getting

COVID-19 virus.

10. Many people are getting vaccinated with the

COVID-19 vaccine.

11. I will recommend my family and friends to get

vaccinated against COVID-19.

12. I am willing to update my vaccination status

(second dose and/or booster shot), if necessary.