Immunity Vs.

Tolerance: Factors Influencing Selected Parents’ Decision on

COVID-19 Vaccination in Lucena City

Quezon National High School

Senior High School

Quantitative Research Paper

In Partial Fulfillment of the Requirements for the Subject Practical Research 2

Under the Academic Track: Science, Technology, Engineering

and Mathematics Strand

by:

Arabella B. Isles

Arabella Q. Lagaya

Sofiah Illyzah G. Marquez

July 2021
 ii

Republic of the Philippines

Department of Education
Division of Quezon
Quezon National High School
Iyam, Lucena City

APPROVAL SHEET

In partial fulfilment for the subject Practical Research 2 under the Academic
Track: Science, Technology, Engineering, and Mathematics strand, this Qualitative
Research Paper entitled, Immunity Vs. Tolerance: Factors Influencing Selected
Parents’ Decision on COVID-19 Vaccination in Lucena City has been prepared and
submitted by Arabella B. Isles, Sofiah Illyzah G. Marquez, and Arabella Q. Lagaya who
are hereby recommended for approval and acceptance.

Ms. Carmela Ana Reforma

Research Adviser

Approved by the Committee on Oral Examination in Quantitative Category.

____________________ ____________________ ____________________

Member Member Member

Accepted in partial fulfilment of the requirements for the subject Practical Research 2
under the Science Technology, Engineering, and Mathematics Strand.

MR. ARIEL R. VIÑAS

SSHT-VI, Science and Technology

 iii

ACKNOWLEDGMENT

The researchers of the study entitled, “Immunity Vs. Tolerance: Factors

Influencing Selected Parents’ Decision on COVID-19 Vaccination in Lucena City” would
like to express their deepest gratitude to everyone who supported them that made this
research study successful. This work would not have materialized had it not been for the
selfless support, understanding and invaluable help of the people, who in one way or
another had contributed much in making this work a reality. Our sincerest gratitude to all
who made this scholastic endeavor possible.

First and foremost, to Almighty God, for giving endless blessings throughout the
process of research study, by providing and granting them the capability to accomplish
this study successfully.

Ms. Carmela Ana Reforma, their research adviser, for giving them trust, for
sharing his expertise, and giving support during the whole period of the study, and
especially for the patience and guidance during the writing process of the study. The
researchers would also like to thank her for the continuous patience, motivation,
enthusiasm and immense knowledge. All of these would not have been done if not for
you.

Respondents of the study for being approachable, cooperative, for allotting

time for the interview, and willingly answered all the questions that the researchers
needed to accomplish the study.

Friends and classmates, for giving the researchers their support and giving
them motivation in the process of making the research study.

Lastly, many thanks to an understanding family of the researchers, for their

endless support and encouragement to the researchers.
 iv

DEDICATION

This study is wholeheartedly dedicated to the people behind the vaccine

development, procurement, and administration who have played an important role in
significantly reducing the global burden of several serious infectious diseases,
specifically the COVID-19 pandemic.

To the researchers’ beloved parents who supported them all throughout the
study by giving them moral, spiritual, emotional and financial support. May all your
support be paid off with this study.

To their class and research adviser, Ms. Carmela Ana Reforma, for giving them
motivation, endless support and guidance to finish this study.

And to their Alma Mater, Quezon National High School, who paved the way in
giving them the opportunity, as a STEM student, to produce and give the best out of their
talents and intelligence through this research. To show the best of Quezon Highers.
 v

TABLE OF CONTENTS

Preliminaries

Title Page i

Approval Sheet ii

Acknowledgements iii

Dedication iv

Table of Contents v

List of Tables viii

List of Figures viii

Abstract ix

Chapter I – Introduction

Background of the Study 1

Objectives of the Study 2

Significance of the Study 3

Scope and Limitations 5

Conceptual Framework 6

Research Paradigm 8

Definition of Terms 9
 vi

Chapter II – Review of Related Literature

Literature Review 13

Chapter III – Methodology

Research Design 25

Research Locale 25

Research Participants 25

Research Instrument 26

Data Gathering Procedure 27

Ethical Considerations 28

Statistical Treatment 28

Chapter IV – Results and Discussions

Part 1: Decision of Parents in Terms of their Child’s COVID-19 30

vaccination

Part 2.1: Vaccination Decision-Making in Terms of 31

Sociodemographic Variables

Part 2.2: Vaccination Decision-Making in Terms of Health- 32

Related Variables
 vii

Part 2.3: Vaccination Decision-Making in Terms of Vaccination 34

Beliefs

Part 2.4: Vaccination Decision-Making in Terms of Political 39

Factors

Part 3: Possible Solutions and Strategies to Address the 41

Problems Toward COVID-19 Vaccination Decision-
making Among the Respondents

Chapter V – Conclusions and Recommendations

Conclusions 45

Recommendations 48

References Cited 49

Appendices

A. Research Instrument 55

B. Curriculum Vitae 63

C. Consent Form 66
 viii

LIST OF TABLES

Table 2.1. Vaccination Decision-Making in Terms of Sociodemographic 31

Variables

Table 2.2. Vaccination Decision-Making in Terms of Health-Related Variables 32

Table 2.3. Vaccination Decision-Making in Terms of Vaccination Beliefs 34

Table 2.4. Vaccination Decision-Making in Terms of Political Factors 39

Table 3. Possible Solutions and Strategies to Address the Problems Toward 41

COVID-19 Vaccination Decision-making Among the Respondents

LIST OF FIGURES

Figure 1. The Health Belief Model (1980) 6

Figure 2. Research paradigm showing the relationship of the factors 8

influencing the selected parents’ decision on COVID-19 vaccination

Figure 3. Percentage of the decision of the parents in terms of their child’s 30

COVID-19 vaccination
 ix

Title : Immunity Vs. Tolerance: Factors

Influencing Selected Parents’ Decision
on COVID-19 Vaccination in Lucena City

Researchers : Arabella B. Isles

: Sofiah Illyzah G. Marquez
: Arabella Q. Lagaya

Name of Institution : Quezon National High School

Ibabang Iyam, Lucena City

Research Adviser : Ms. Carmela Ana Reforma

Year Written : 2020-2021

ABSTRACT

Vaccine has played a significant role in the world as it induces immunity against a
specific disease. In 2020, the World Health Organization announced the COVID-19
outbreak as a pandemic that triggered the immediate vaccine development. However, a
substantial part of the population exhibits vaccine refusal and delay. This study aims to
assess and examine the different factors considered by the respondents regarding their
child’s COVID-19 vaccination. Descriptive-qualitative design was utilized whereas 50
parents of senior high school students from Lucena City were selected through quota
sampling to answer an online questionnaire. Only 44% of the samples reported that they
would definitely have their child vaccinated. Internal factors such as sociodemographic
variables, health-related variables and vaccination beliefs, and external elements -
specifically political factors - were considered by the respondents in making their
decisions. To encourage the remaining population to accept vaccine shots,
communication and evidence-based strategies, healthcare workers’ intensive training,
and proactive encouragement of vaccine uptake from vaccination personnels and
advocates were found to be the most effective. However, there are potential limitations
to the generalizability of the findings that should be addressed in future studies. Tailored
vaccine promotion messages should address specific concerns among the refusal and
hesitancy groups. The findings of this study will provide an overview of vaccination
decision-making and determinants of delay and refusal to help the government and
medical teams to understand why some individuals are hesitant in the context of COVID-
19 vaccines. Moreover, it will help in addressing the concerns of individuals to increase
the confidence in, and uptake of, vaccines.

Keywords: COVID-19, vaccination, vaccine hesitancy, vaccine acceptance

 1

INTRODUCTION

Vaccine hesitancy is attributed to the delay in acceptance or refusal of vaccines

despite the availability of vaccine services (World Health Organization [WHO], 2014). It
was identified as a global threat by the World Health Organization in 2019 as rising anti-
vaccination movements resulted in the increase of presumably vaccine-preventable
diseases. They added that the key reasons underlying refusal and delay are
complacency, inconvenience in accessing vaccines, and lack of confidence in vaccines
(WHO, 2019). Existing literature has also associated trends in vaccination intentions to
sociodemographic variables, vaccine-related attributes, political considerations, personal
beliefs and attitudes toward health prevention, and knowledge and access to information
(Kreps et al., 2020; Shmueli, 2020; Tam & Qiao, 2020; WHO, 2014).

The world is currently in the grip of the pandemic as coronavirus disease 2019
(COVID-19), a highly infectious illness, marks its territory on every continent except
Antarctica. Globally, as of 23 April 2021, there have been 3, 066, 113 deaths reported to
WHO, including 144, 358, 956 confirmed cases of COVID-19 (WHO, 2021). The
casualties caused by this unprecedented virus consequently aroused the public’s need
for a feasible vaccine. On March 11, 2020, WHO declared the virus’ outbreak a
pandemic, and since then, researchers and scientists have been racing to develop an
effective and safe vaccine to boost herd immunity against the virus. As of 18 February
2021, several vaccines have been developed and various countries have initiated mass
vaccination programs against COVID-19 (WHO, 2021). Nonetheless, Karlsson et al.
2020 and Kreps et al. 2020 argue that apart from vaccine availability and production, the
effectiveness of these immunization programs is dependent ultimately on vaccine
acceptance and coverage. However, according to the report of an ongoing survey
conducted by YouGov (2021), an international research and analytics group, the
Philippines is among the countries with the lowest COVID-19 vaccine willingness out of
21 nations, with only 56 percent of Filipino respondents saying they will or have already
received the vaccine. Additionally, a national study conducted by Pulse Asia (2021) from
February 22 to March 3, showed 61 percent of Filipinos would refuse to be immunized,
while another 23 percent are uncertain whether they would get inoculated, mostly due to
vaccine safety and efficacy concerns. Similar surveys indicating higher levels of vaccine
refusals and delays pose a threat to the success of immunization programs and
campaigns in the country. On a positive note, according to a press release issued on
 2

March 19, 2021, Lucena City has the highest vaccination coverage against COVID-19 at
36.3 percent (1,387 out of 3,821 health care workers) since the vaccine roll-out began
on 1 March 2021 (Janairo, 2021).

Upon review, the researchers discovered that recent studies lacked specificity
regarding the anticipated risks and benefits of COVID-19 vaccination. Furthermore,
related literature and studies have mostly concentrated on internal factors influencing
vaccination intention, with little study focusing on the external factors. Finally, only a few
clinical trials have developed strategies for addressing these internal and external
factors that reduce COVID-19 vaccine uptake. To meet the challenges of the twenty-first
century, the United Nations established 17 Sustainable Development Goals (United
Nations [UN], 2015). The third goal is aimed at promoting good health and well-being.
Hence, this study entitled “Immunity Vs. Tolerance: Factors Influencing Selected
Parents’ Decision on COVID-19 Vaccination in Lucena City'' has been created to provide
healthcare professionals with a better understanding of the key factors that affect
parents' intentions to vaccinate their children against COVID-19. The findings of the
study will prove to be beneficial in aiding government and public health officials in
developing successful vaccine acceptance messaging to curb the pandemic.

STATEMENT OF THE PROBLEM

The researchers generally aim to examine the vaccine-related beliefs, behaviors,

and factors associated with vaccination decision-making against COVID-19 among
selected parents of senior high school students in Lucena City. Specifically, the
researchers intend to answer the following:

1. What percentage of the respondents will

1.1. definitely have their child vaccinated?

1.2. probably have their child vaccinated?

1.3. probably not have their child vaccinated?

1.4. definitely not have their child vaccinated?

 3

2. What are the factors that affect the decision of the parents regarding COVID-19
vaccination in terms of:
2.1. sociodemographic variables?
2.1.1. age
2.1.2. gender
2.1.3. education
2.1.4. socioeconomic status
2.2. health-related variables?
2.2.1. perceived health status
2.2.2. past diseases or illnesses
2.3. vaccination beliefs?
2.3.1. perceived susceptibility
2.3.2. perceived severity
2.3.3. perceived benefits
2.3.4. perceived barriers
2.3.5. cues to action
2.3.6. health motivation
2.3.7. attitude
2.3.8. subjective norms
2.3.9. self-efficacy
2.4. political factors?
2.4.1. FDA approval
2.4.2. origin of the vaccine
3. What are the possible solutions to address the problems toward vaccination
decision-making among the respondents?

SIGNIFICANCE OF THE STUDY

This study entitled “Immunity vs. Tolerance: Factors Influencing Selected

Parents' Decision on COVID-19 Vaccination in Lucena City” can benefit the following:

Vaccine researchers and developers, since they are the one who are
responsible in taking new antigen or immunogen identified in the research process and
 4

developing this substance into a final vaccine while ensuring the safety and efficacy of
the resultant vaccine. This study will help them achieve the purpose of their profession -
attaining immunization rates in the targeted group.

CaLaBaRZon Center for Health Development, since they are in charge of

implementing and coordinating the vaccine program. This research could aid the
government in formulating a strategy to boost vaccine acceptance and demand. They
will now be able to address trust and acceptance, as well as vaccine demand, and
respond to concerns about vaccine delivery prioritization requirements, such as who will
be vaccinated, how many will be vaccinated, and why.

LGUs in Lucena City, since COVID-19 vaccination is being developed in

response to the coronavirus pandemic, which has affected millions of people worldwide
and resulted in the loss of many lives. This research may aid the LGUs in Lucena City in
identifying the factors that must be considered when accepting the vaccine. The people
will therefore understand and recognize the importance of making decisions particularly
when it comes to the wellness of each individual.

Healthcare workers, since they are the only people who can engage, educate,
and answer people's concerns because they are the only ones who are available. As
more people are vaccinated, healthcare workers' jobs will become easier, and the
number of cases of covid will reduce.

Parents, since they are the main focus of this study. Parents will be more
knowledgeable when it comes to making vaccine choices, such as whether to choose
between immunity and family tolerance.

Senior high school students, once their parents are already equipped with
enough knowledge regarding vaccination, the senior high school students will perhaps
contribute in eliminating the toll on public health. Furthermore, letting the students get
vaccinated will provide an additional protection against the exposure in COVID-19.

Remaining groups in the community, if the large portion of the community -

including the children of the respondents and the remaining individuals - become
immune to the disease through being vaccinated, the spread of the virus from one
person to another is most unlikely to happen. The chain of transmission will be
 5

completely interrupted once herd immunity is already achieved which will benefit the
whole population.

Lastly, the future researchers can benefit from this quantitative study because
this can be a reference for future researchers regarding this topic. Moreover, this study
may help the future researchers to formulate objectives, hypotheses, ideas and
principles that can help them to have a deep understanding about the importance of
decision making on Covid-19 vaccination.

SCOPE AND LIMITATIONS

Lucena City recorded the highest COVID-19 vaccination rate of 36.3% in the
region of CALABARZON since the start of the vaccine roll-out last March 1, 2021
(Janairo, 2021). The city accounts for 3 vaccination sites whereas 1,387 out of 3,821
health care workers who belong in Priority Group A1 were already vaccinated. They
added that deferrals and refusals during health screenings were constantly recorded. In
this particular study, the researchers focused on understanding, assessing, and
analyzing the factors considered by the respondents in terms of the developed hesitancy
towards their child’s COVID-19 vaccination. The respondents will be coming from the
population of senior high school students’ parents in Lucena City. The existence of
vaccine hesitancy and acceptance among the respondents will be thoroughly discussed
in this study. The relationship among different variables such as demographic data;
health status; perception on COVID-19 and vaccination; demonstrated attitude,
practices, and behavior toward COVID-19 and vaccination; and the external barriers and
other influences considered by the respondents in their decision-making. The
researchers will obtain fifty (50) respondents through quota sampling. The researchers
made sure that they are knowledgeable enough about the population so they can
choose the relevant stratification. The samples to be chosen will serve as the
representative of the corresponding population of interest. The study will subject the
particular respondents living within the locale of Lucena City to data gathering that will
last for seven (7) days.

As with the majority of studies, the design of the current study is subject to
limitations. The results reported herein should be considered in the light of some
 6

limitations because a sampling error may occur. The respondents chosen in this study
may not reflect the general or appropriate population concerned. Thus, the researchers
maximized their ability to gain access to the geographic scope of the participants. The
findings in this study are only relevant to the parents of senior high school students and
do not reflect the perspective of other individuals in the community. Moreover, the
instrument or method used to collect necessary data from the respondents may also limit
the researchers’ ability to conduct a thorough analysis of the results. Consequently, the
future researchers may acknowledge or address the deficiency by revising the specific
method or instrument that will include the missing elements. The findings of this study
are only applicable to the parent population of Lucena City regarding their child’s
vaccination against COVID-19.

Generally, the researchers aim to analyze the vaccine-related beliefs, behaviors

and factors associated with vaccination hesitancy of parents in Lucena City toward the
COVID-19 vaccination. An online survey questionnaire will be administered to the
sample size and the obtained data will undergo statistical treatments in order to obtain
useful information that could be used for the interpretation of the results.

CONCEPTUAL FRAMEWORK

Figure 1. The Health Belief Model (1980)

 7

There has been a lot of studies on vaccine uptake and its behavioral influences in
recent years. Although the evidence is still developing, these results contribute to a
clearer understanding of the challenges and enablers to vaccination, especially for
children. Parents have become more anti-vaccination in their children. Various studies
demonstrate the reasons why they are skeptical and often refuse vaccination. This
includes the different vaccine-related beliefs, behaviors and factors affecting the parents’
decision in regards to vaccination.

The use of a framework derived from the Health Belief Model (HBM) is essential for
understanding the behaviour-related factors that influence the decision-making among
parents regarding the uptake of COVID-19 vaccination. This model is designed to use
those belief patterns to explain and predict health-related behaviour. Participant’s role in
this study can be interpreted by their beliefs and the variables relevant to the HBM
about COVID-19 vaccine, including perceived susceptibility (the subjective risk
assessment of contracting COVID-19); perceived severity (severity and consequences
of getting COVID-19); perceived benefits (importance or effectiveness of receiving
COVID-19 vaccine); perceived barriers (hurdles to accessing COVID-19 vaccine); cues
to action (triggers for receiving COVID-19 vaccination, such as recommendations by the
local government, physicians and family members, respectively); and self-efficacy
(respondents’ belief on their capacity to make decisions about COVID-19 vaccination).

This quantitative research will use focus group discussions to obtain a better
understanding of parents’ experiences, the variables that affect their vaccination
decisions against COVID-19, and their knowledge needs.
 8

RESEARCH PARADIGM

Figure 2. Research paradigm showing the relationship of the factors influencing the
selected parents’ decision on COVID-19 vaccination

Figure 1 shows the relationship of the factors that may affect the decision-making
of the respondents regarding the uptake of COVID-19 vaccine.

Vaccine related beliefs, behaviors, and factors associated with vaccine hesitancy
against COVID-19 is important to determine that may help in understanding the parental
perception as they are in the process of making the vaccine decision for their children. In
the same way, different variables also play a vital role in decision making, including
demographic variables, socio-psychological variables, structural variables , and health
status of children before taking the COVID-19 vaccine. In related to this, cues to action
including the encouragement from healthcare workers, information from news and other
social media platforms, and scientific researches may also influence the parents’
decision that may lead to vaccine hesitancy. Vaccine-hesitant parents, on the other
 9

hand, have a different perspective on the perceived benefits of the vaccination and
perceived barriers to the vaccination. Similarly, perceived barriers can be linked to
vaccine hesitancy, and can play a role in parents’ actual decision on their children's
vaccination against COVID-19.

Furthermore, all of this will be identified and accomplished by online survey, such
as google forms that will be sent to the selected parents containing the structured
questionnaires in order to answer the objectives of the study accurately and
systematically that the researchers will be done after discussing the related literature
and studies.

DEFINITION OF TERMS

This section defines the important terms used in the study. The terms are as
follows:

Attitude refers to the degree to which an individual has a favorable or unfavorable

assessment of the behavior of interest (LaMorte, 2019). In the study, attitude
towards COVID-19 vaccines was used to determine COVID-19 vaccination
intention among the respondents.

Barriers refers to a person's feelings on the obstacles to performing a recommended

health action (LaMorte, 2019). In the study, the respondents’ perceived barriers
to COVID-19 vaccination, such as physical availability, affordability and
willingness-to-pay, geographical accessibility, and ability to understand and
appeal of immunization services, were used as a determinant of COVID-19
vaccination intention.

Benefits refers to a person's perception of the effectiveness of various actions available

to reduce the threat of illness or disease (LaMorte, 2019). In the study perceived
benefits from uptaking COVID-19 vaccines were used as determinants of the
respondents’ COVID-19 vaccination decisions.

Coronavirus Disease 2019 (COVID-19) is a highly contagious respiratory disease

caused by the SARS-CoV-2 virus that can spread from person to person via
 10

droplets released when an infected person coughs, sneezes, or speaks (National

Cancer Institute [NCI], 2021). In the study, the researchers are identifying the
factors affecting vaccination intention of the respondents towards this particular
disease.

Cues to Action is the stimulus needed to trigger the decision-making process to accept
a recommended health action (LaMorte, 2019). In the study, this is an
independent variable intended to determine COVID-19 vaccination intention.

Demographic Variables are independent variables, which can either be categorical

(e.g., gender, race, marital status, psychiatric diagnosis) or continuous (e.g., age,
years of education, income, family size) (. In the study, a defined set of
demographic variables were used to determine COVID-19 vaccination intention
among the respondents.

Health Status refers to the medical conditions, claims experience, receipt of health care,
medical history, genetic information, evidence of insurability, and disability of a
person (HealthCare.gov, 2021). In the study, this information about the
respondents was used as a determinant of COVID-19 vaccination intention.

Health Motivation encourages people to engage in health-oriented behaviors (Cherry,

2020). In the study, health motivations are specified health-oriented behaviors
that were used as determinants of COVID-19 vaccination intention.

Herd Immunity, or community immunity, happens when a large portion of a population

gains immunity or resistance to a specific disease (Yu, 2020). In the study, this is
the variable that the researchers are trying to achieve by creating strategies
against vaccine hesitancy.

Self-efficacy refers to the level of a person's confidence in his or her ability to

successfully perform a behavior (LaMorte, 2019). In the study, this is an
independent variable intended to determine COVID-19 vaccination intention.

Severity refers to a person's feelings on the seriousness of contracting an illness or

disease (LaMorte, 2019). In the study, the respondents' perceived severity of
COVID-19 was used as a determinant of COVID-19 vaccination intention.
 11

Subjective Norms refers to the belief about whether most people approve or
disapprove of the behavior (LaMorte, 2019). In the study, this is an independent
variable intended to determine COVID-19 vaccination intention.

Susceptibility refers to a person's subjective perception of the risk of acquiring an

illness or disease (LaMorte, 2019). In the study, the respondents' perceived
susceptibility to COVID-19 was used as a determinant of COVID-19 vaccination
intention.

Vaccination is the process of injecting a vaccine into the body in order to produce
immunity against a specific disease (CDC, 2018). In the study, the term was
referred to as a health behavior by which the respondents would reveal their
intentions or attitude towards.

Vaccine Acceptance is defined as a decision to accept or refuse vaccines, when

presented with an opportunity to vaccinate (Dubé, 2021). In the study, the
researchers aim to determine this vaccination attitude among the respondents.

Vaccine Attitude can be seen on a continuum, ranging from total acceptance to

complete refusal (WHO, 2014). In the study, the term was used to generalize the
respondents' appraisal of vaccines, which are acceptance, delay, and refusal.

Vaccine Hesitancy is characterized as the delay in accepting or refusing vaccination

despite the availability of vaccination services (MacDonald, 2015). In the study,
this term is referred to as a vaccine attitude in situations where people have
doubts and concerns toward vaccinations, without referring to actual vaccine
receipt.

Vaccine Hesitant Individuals are characterized as a heterogeneous group who may

reject certain vaccines but consent to others, delay vaccination, or accept
vaccines but are unsure of doing so (WHO, 2014). In the study, the term was
used to refer to individuals who have doubts and concerns towards vaccination,
but may still choose to vaccinate.

Vaccine Uptake is defined as the proportion of the eligible population who received a
vaccine during a specific time period (Buque et al., 2016). In the study, the term
 12

was used to describe the action of undergoing vaccination, while vaccine

hesitancy among the individuals still exists.

Vaccine-Associated Risk refers to the probability of an adverse outcome occurring as

a result of vaccination, as well as the severity of the perceived harm to health of
vaccinated individuals (WHO, 2013). In the study, the term is used as a
determinant of COVID-19 vaccination intention of the respondents.
 13

LITERATURE REVIEW
COVID-19
Coronavirus disease (COVID-19) is a disease caused by a new coronavirus
named SARS-CoV-2. The World Health Organization first learned of this new virus back
on 31st of December 2019, and the first cases of the virus were found in Wuhan, China.
The disease can attack the human bodies, mostly those bodies which have low
immunity. As the virus spreads, the infected people could have mild to moderate
illnesses and recover without hospitalizations (WHO, 2020). The Department of Health
announced that more people were diagnosed with the coronavirus disease, pushing the
nationwide tally to more than 400,000 confirmed cases (Magsambol, 2020). The
National Taskforce on COVID-19 (NTF) alongside with the Department of Health
revealed the national COVID-19 vaccine from evaluation and acquisition to distribution.
Information dissemination to public is an important factor in the time of pandemic and
deploying the information of the progress of the country’s proactive plan in collecting and
distributing vaccines as soon as the vaccine are safe and available for the public
(Department of Health [DOH], 2020)
Coronavirus disease had a big impact on the lives of humans. In order to avoid
the transmission of the disease, the government decided to have a lockdown on the
whole country for months now and the community are starting to adapt to the new
normal instead of waiting for the vaccine. The public were informed to maintain at least
one meter distance between themselves and others when going out to avoid physical
contact and the usage of face mask as well as face shield is required for everyone to
cover the nose, mouth and chin, which are the possible passageway of the virus. The
disease poses much danger and risks to the lives of different people, mostly on the
bodies with low immunodeficiency. Everyone can be infected by the virus but the
vulnerable individuals are the people with pre-existing medical conditions like asthma,
obesity, diabetes or cancer (WHO, 2020).
On March 25, the Philippine Congress passed the Republic Act 11469, also
known as the Bayanihan (United Efforts) to Heal As One Act gives the President’s
emergency power which is effective for three months unless extended or terminated
earlier by the Congress before the first month that the disease came into the country. As
the holidays are coming, the Department of health is pusher awareness and preventive
measures for a COVID-free holiday. The department released Department Circular (DC)
No. 2020-0355 or the Reiteration of the Minimum Public Health Standards for COVID-
 14

19 Mitigation during the Holidays to give information on the public health standards that
must be observed during the holidays to have a COVID free celebration and activities for
the community (DOH, 2020).

In a study conducted by Fridman et al. (2021) entitled “COVID-19 and vaccine

hesitancy: A longitudinal study”, the researchers primarily aimed to analyze the
participants’ stated intention to get the COVID-19 vaccine once it becomes available in
the region. Moreover, they are also interested in their COVID-19 threat, general
vaccination attitudes and intention to get the vaccine shot. A sample size of 1,018 were
recruited from the panel of U.S. residents on Amazon’s Mechanical Turk platform to
respond to multiple survey waves. The data obtained from the participants were
subjected to data analysis using the concept of linear trends. The findings revealed three
different vaccination-related measures: attitudes toward a COVID-19 vaccine, general
vaccination attitudes, and flu shot intentions. Equipped with this knowledge, the present
researchers can publish additional findings and more accurate data that will help the
researchers in understanding the underlying factors that influence attitudes and
behaviors. Furthermore, the findings could also be used by the current researchers in
designing effective communication strategies and intervention to address vaccine
hesitancy.

Herd Immunity

Herd immunity, also known as population or community immunity, is defined by

WHO (2020) as the indirect protection against an infectious disease that is achieved
when a large proportion of immune individuals exist in a population. This can be
successfully achieved either through vaccination or by immunity acquired through
previous infection. However, WHO (2020) contends that herd immunity against COVID-
19 should be achieved by vaccination rather than through exposing a population to the
disease, as this would result in unnecessary cases and deaths.

Ashby and Best (2021) discussed the most basic elements of herd immunity in
their Primer article entitled “Herd Immunity.” Here they explained that if a sufficient
proportion of the population acquired immunity from a disease, then transmission
generally cannot be sustained. Therefore, achieving herd immunity is critical for long
term disease control as it decreases the risk of diseases and saves lives.
 15

Other researchers, Randolph and Barriero (2020), explain in their own primer
article entitled “Herd Immunity: Understanding COVID-19” that herd immunity threshold
is the point at which the proportion of susceptible individuals falls below the threshold
needed for transmission, meaning that herd immunity is at effect and susceptible
individuals are experiencing indirect protection from the infection. Ashby and Best (2021)
further illustrates the concept of achieving herd immunity and explained that when there
is no immunity in the population, an infected individual can easily spread the disease to
its contacts who are susceptible. Given another situation, when some individuals are
immune but the population is below the herd immunity threshold, a large outbreak is still
likely to happen. Lastly, when the population is above threshold, large outbreaks are
prevented while small or community-based outbreaks may still occur among clusters of
susceptible individuals.

This protection, however, is not a permanent state and does not imply low or
zero disease prevalence, Ashby and Best (2021) clarified. It reduces cases and the
likelihood of having contact with the virus, but susceptible individuals remain at risk of
contracting the disease. A population that has achieved herd immunity may revert into
having high transmission rates, the reason why WHO (2021) encourages the
continuance of adhering to health protocols such as wearing of face masks and face
shields, social distancing, and regular hand sanitation even if vaccines for COVID-19 are
currently available.

Vaccines help our immune systems create proteins that fight or make us immune
to a particular disease, without making us sick (WHO, 2020). However, it is not the
vaccine that would curb a pandemic, it’s vaccination. Likewise, Karlsson et al. (2020)
argued that apart from vaccine availability and production, the effectiveness of
immunization programs is dependent ultimately on vaccine acceptance and coverage.
Similarly, Kreps et al. (2020) noted that a sufficient share of the population must be
vaccinated to reach herd immunity and prevent higher rates of transmission in a
community. In relation to the given information, vaccination for a variety of infectious
diseases has resulted in herd immunity, leading in the global eradication of smallpox and
rinderpest, and the near eradication of polio (Ashby & Best, 2021).

Randolph and Barriero (2020) hypothesized that, assuming the reproduction

number of COVID 19 is 3, meaning that an infected individual gives rise to 3 other
 16

infections, the herd immunity threshold of COVID-19 is approximately 67 percent. This

means that the incidence of infection will decline once a population consists of 67
percent immunized individuals, and consequently, the remaining 37 percent will be
indirectly protected by the fact that COVID-19 will not spread among those who are
vaccinated or immune to the disease. Comparably, it was stated in an article that
most estimates had placed the herd immunity threshold for COVID-19 at 60-70
percent of the population gaining immunity (Aschwanden, 2021).

The study of Kreps et al. (2020) entitled “Factors Associated with US Adults’
Likelihood of Accepting COVID-19 Vaccination” surveyed 2000 adults from the United
States to examine the factors associated with their self-reported likelihood of selecting
and receiving a COVID-19 vaccine. The significant findings of the study imply that the
respondents’ preferences and acceptance of a COVID-19 vaccine were influenced by
vaccine-related attributes including vaccine efficacy, vaccine-associated risk, and
duration of protection. In addition, political considerations such as FDA approval
process, national origin of vaccine, and vaccine endorsements or acceptance messaging
from influential leaders were also important in influencing the respondents to vaccinate.

On the other hand, Schwarzinger et al. (2021) in their study entitled “COVID-19
Vaccine Hesitancy in a Representative Working-Age Population in France: A Survey
Experiment Based on Vaccine Characteristics” surveyed a representative sample of
2000 adults in France to assess and discuss the effects of vaccine characteristics,
information on herd immunity, and general practitioner recommendation on prompting a
vaccine hesitant attitude. The findings of the study suggest that outright vaccination
refusal and vaccine hesitancy were both significantly associated with female gender,
age, lower educational level, poor compliance with recommended vaccinations in the
past, and no report of chronic conditions. Low perception of COVID-19 severity also
underlie negative attitudes towards vaccination, while anti-vaccination intentions lowered
when herd immunity benefits and information were communicated with the participants.

The related literature and studies focusing on herd immunity discussed how it is
achieved namely through vaccination or by immunity acquired through previous infection
(WHO, 2014). Additionally, the mechanics of herd immunity show that if a sufficient
proportion of the population acquired immunity from a disease, then transmission
generally cannot be sustained (Ashby & Best, 2021; Karlsson et al., 2020; Kreps et al.,
 17

2020). Consequently, this was supported by Randolph and Barriero (2020) explaining
the concept of herd immunity threshold as the point at which the proportion of
susceptible individuals falls below the threshold needed for transmission. Furthermore,
the results of the study of Kreps et al. (2020) imply that the respondents’ preferences
and acceptance of a COVID-19 vaccine were influenced by vaccine-related attributes
and political factors. While the study of Schwarzinger et al. (2021) delved on the factors
influencing vaccine refusal and hesitancy, which include demographic variables,
influence from others, health status, and low perception of severity of COVID-19.
However, it also found that education on herd immunity significantly lowers vaccine
hesitancy. In the present study, the substantial amount of literature on herd immunity, as
well as the vaccine attitudes that affect its attainment, will help the researchers explore
optimal strategies in successfully achieving it.

Vaccines
Researchers all over the world are seeking for the development of vaccine which
will provide immunity for the people against the virus. The Philippine government started
to take action and acquire the approved vaccine once it is accessible to the public.
Seventeen vaccine manufacturers from different countries are in negotiation with the
government for providing a potential vaccine. United States drugmaker Pfizer in
collaboration with Germany’s BioNTech has offered the vaccine to the ambassador and
the vaccine has a 90 percent rate of effectiveness during the early trials (Lopez, 2020).
On the other hand, Britain’s AstraZeneca talks about the vaccine that they produced
within a few months with 90 percent rate of effectiveness (Lema et al, 2020). The
companies have been working for the vaccine and the three companies namely Pfizer,
Moderna and AstraZeneca have released the possible price for the vaccine. Moderna
can cost from 10 dollars to 50 dollars per dose but the price still vary from the amount of
vaccine that a country will acquire, which makes Pfizer possibly cheaper with 20 dollars
per dose and AstraZeneca with under 4 dollars per dose – making it the cheapest
vaccine among the indicated companies (Cao, 2020).

The Philippine government along with several local private companies are to sign
COVID-19 vaccine deal with AstraZeneca on Friday (Esguerra, 2020). The vaccine was
called AZD1222 and was found effective after being tested in about 12,000 participants.
 18

It associated no serious side effects among the participants, suggesting that it is safe to
be administered and distributed to the public. However, “the AZ vaccine is morally
controversial, because it was developed using human cells called HEK293 that were
obtained from the body of an aborted female fetus from the Netherlands” (Austriaco,
2020). This has raised concerns regarding the efficacy, safety, and morality of the
vaccines by a growing number of parents. Due to this, lowered vaccine acceptance rates
have been implicated alongside with the increase in the vaccine-preventable disease
outbreaks and epidemics (Dubé, 2014).

Governments worldwide are keenly securing deals to access advanced doses

with the developers of COVID-19 vaccines (Dodd et al., 2020). However, access is not
the only issue that needs to be dealt with by officials because the willingness to accept a
COVID-19 vaccine once it is already available has varied considerably across countries
over the course of the pandemic. Concerns have been raised since vaccine
development usually takes 10-15 years to be completed but with the urgency and
unprecedented challenges brought by the COVID-19 pandemic, developers were able to
produce vaccines in a matter of year with their claim being effective and safe for roll-out.

Lazarus et al. (2020) conducted a study on the likelihood of vaccine acceptance

from a sample of 13,426 respondents in 19 countries through surveys. Of these, 71.5%
would definitely take a vaccine shot if it were proven safe and effective for public
distribution, and 48.1% responded that they would get vaccinated if their employer
recommended it. However, the researchers observed that the far-from-universal
willingness to accept a COVID-19 vaccine is still a cause for concern. They also added
that reporting one’s willingness to get vaccinated might not be necessarily a good
predictor of acceptance, as vaccine decisions are multifactorial and can change over
time. This study could be of big help to the present researchers as they will be dealing
with the same vaccination phenomenon. In addition to this, the present researchers can
also base their research instrument in the past study to give emphasis on the
relationship of numerous variables and vaccine uptake.

Factors Affecting Vaccination Decision-Making

Vaccine hesitancy is a vaccine attitude or behavior that is the product of a

complex decision-making process and is influenced by a constellation of factors. It is
 19

outlined by WHO (2014) as the delay in acceptance or refusal of vaccines despite

availability of vaccine services. They added that vaccine hesitancy is a vaccine attitude
that lies on the continuum, ranging from high vaccine demand to complete vaccine
refusal. Individuals who have this attitude toward vaccines are known as vaccine
hesitant individuals. They are characterized as a heterogeneous group who hold varying
degrees of indecision towards vaccination. Likewise, a vaccine hesitant community is
one that fails to accept vaccines at an expected rate, given that vaccine services are
widely available. Collectively, at both the individual and community level, vaccine
hesitancy undermines the responsibility for immunization. This is a growing challenge for
many countries, as people who delay vaccines for themselves or their children risk the
outbreak of presumably vaccine preventable diseases. In fact, according to WHO
(2019), 2-3 million deaths each year are prevented by routine life-saving immunizations,
and an additional 1.5 million could be avoided if global coverage of vaccinations
improved. For this reason, WHO (2019) identified vaccine hesitancy as one of the top
ten threats to global health.

The report of SAGE Working Group on vaccine hesitancy included their

discussion of the determinants of vaccine attitudes, which can be found under their
Complacency, Confidence, and Convenience Model (“3 Cs”) (WHO, 2014). They defined
the concept of confidence in vaccines as trust in vaccine effectiveness and safety and in
the system that delivers them, which affects vaccine acceptance, including trust in the
motivations of the policymakers who decide on the needed vaccines. Second, vaccine
complacency exists when vaccination is not deemed a necessary preventive action due
to low perception of the risks of vaccine-preventable diseases. This is influenced by
underappreciation of the value of vaccines (low perception of vaccine efficacy, safety,
and benefits) and lack of knowledge, which, in turn, can prompt the failure of
immunization programs as complacency may ultimately lead to hesitancy. And third,
convenience in receiving vaccines is determined by the extent to which the quality and
delivery of vaccination services such as affordability, physical availability,
understandability (language and health literacy), and appeal of the services, influence
uptake.

A systematic review of related literature from 1999 to 2017 done by McClure et

al., (2017) entitled “Vaccine Hesitancy: Where We Are and Where We Are Going”
discussed the effects of vaccine hesitancy. The study cites numerous studies
 20

demonstrating that states and communities with higher rates of vaccine exemptions are
more susceptible to outbreaks of vaccine preventable diseases such as measles,
mumps, and pertussis. In addition, parental refusal or delay of childhood vaccines is the
greatest contributor to the persistence of these diseases, resulting in higher inpatient
admission and emergency department utilization rates, increased morbidity, and death.

Today, researchers are focused on studying the factors associated with COVID-
19 vaccination decision-making. The study of Tam and Qiao (2020) entitled “Factors
Associated With Decision Making on COVID-19 Vaccine Acceptance Among College
Students in South Carolina” surveyed 1062 college students in South Carolina regarding
their intention to vaccinate against COVID-19. According to the online survey, 60.6
percent of respondents were willing to vaccinate, with a variety of vaccine-related
attributes underlying their decision. Specifically, the study found factors including
duration of vaccine protection, vaccine accessibility, and authoritative advice (i.e.
recommendations given by school, government, or doctors) important in influencing
vaccine acceptance. While, perceived risk or negative consequences from the
vaccination and vaccine-related attributes such as quality of vaccine services and the
country the vaccine originated from, were considerations that affected vaccine refusal.
Lastly, the identified vaccine-hesitant individuals in their study considered the same
factors that influence acceptance and refusal.

Karlsson et al. (2021) in their study entitled “Fearing the Disease or the Vaccine:
The Case of COVID-19” explored the role of two of the most common factors affecting
vaccination acceptance, which are perceived risk of disease and perceived vaccine
safety. They surveyed 825 Finnish parents of small children, 205 individuals residing in
areas with inadequate vaccination coverage, and 1325 Facebook users nationwide.
Their study showed that the strongest predictor of intentions to accept a COVID-19
vaccine was the degree to which respondents trusted the vaccine to be safe.
Consequently, it was shown that the individuals who perceive the disease as severe
might still choose not to vaccinate if they consider the vaccine unsafe. Therefore,
contrary to expectations, their study proved that the perceived risk of COVID-19 to
personal health was not strongly associated with the intention to vaccinate.

Upon review, several studies focusing on the concept of vaccination have widely
used the Health Belief Model (HBM) created by social scientists at the U.S. Public
 21

Health Service in 1950. The model theorizes that an individual's course of action is often
influenced by their perception of the benefits and barriers associated with health
behavior (LaMorte, 2018). Specifically, the study of Shmueli (2020) entitled “Predicting
Intention to Receive COVID-19 Vaccine Among the General Population Using the Health
Belief Model and the Theory of Planned Behavior Model” surveyed 398 adults from
Israel aged 18 years and older. The study found perceived vaccine benefits, cues to
action such as influence and advice from peers and authorities, and perceived severity
of the disease as the most significant predictors of the intention to receive a COVID-19
vaccine. Their findings regarding disease severity also indicate that those willing to
vaccinate view themselves as being at high risk of significant suffering or experiencing
complications if they were infected by COVID-19, as compared to those who are hesitant
or refuse to vaccinate.

Much of the related literature and studies indicate that vaccine safety, vaccine
effectiveness, and vaccine accessibility significantly affect the attitude to vaccinate
against COVID-19 (Karlsson et al., 2021; Shmueli, 2020; Tam & Qiao, 2020; WHO,
2014; ). Tam and Qiao (2020) also added duration of vaccine protection, and
authoritative advice or cues to action, which is also according to Shmueli (2020), such as
recommendation given by school, government, or doctors as factors influencing vaccine
acceptance. In addition to the quality of vaccination services and the country origin of the
vaccine (Tam and Qiao, 2020), vaccine-associated risk or a low perception of vaccine
efficacy and safety were important predictors of vaccine hesitancy and refusal (Karlsson
et al., 2020; WHO, 2014). Accordingly, McClure (2017) and WHO (2019) argue that
states and communities with higher rates of vaccine exemptions are more susceptible to
outbreaks of vaccine preventable diseases, resulting in higher inpatient admission and
emergency department utilization rates, increased morbidity, and death. Furthermore,
the study of Karlsson et al., (2020), which claims that perceived risk of disease is not
strongly associated with the intention to vaccinate, is contended by that of Shmueli et al.,
(2020), which argues that perceived disease severity strongly predicts vaccine
acceptance, especially by those who view themselves experiencing severe COVID-19
complications. In the present study, the adequate amount of literature exploring
vaccination decision-making will help the researchers interpret the factors found to
influence vaccine attitudes among the study’s respondents.
 22

Strategies to Address Vaccine Hesitancy

According to an international study that assessed vaccination trust among the

wider public in 67 countries, concerns regarding vaccine safety and fear of health
consequences, as well as the sense of a vaccine's low value, are among the common
explanations for a low immunization rate among children. Furthermore, several doctors
and parents (referred to as vaccine hesitant parents, or VHPs) believe that children have
already been getting too many vaccinations. It will make it more difficult to eradicate life-
threatening communicable diseases, leading to higher rates of morbidity and mortality
and vital complications linked to illnesses, as well as an increase in medical costs. It is
therefore important to address it in order to promote the general population's well being
quality of life (Larson et al., 2016).

Interventions of various content and methods were utilized in various settings

and targeted various communities in related studies. Many of the experiments were
carried out in the United States, with only a handful coming from low- and middle-income
countries. The results with the lower risk of bias were mainly single-component
strategies (often developmental interventions), which are easier to assess than
multicomponent interventions or interventions aimed at changing complicated
determinants, such as social norms (Higgins et al., 2011). Subsequently, few
researchers focused on vaccination coverage or on-time vaccination as an outcome, and
far fewer looked at vaccine-averse people directly. Recalls for patients and health-care
providers are important strategies for increasing vaccine uptake in a variety of settings
and classes (Williams et al., 2011). There is conflicting evidence about the efficacy of
initiatives such as face-to-face contact, health-care professional preparation, community-
based behavior, and mass-media communication. Vaccination guidelines or mandates
for school admission, correct vaccine related-information, and communication with high
levels of endorsement of vaccines are seen as important in rising vaccine uptake
(Murdan et al., 2021). Wigham et al. (2014) explained that strategies in overcoming
vaccination issues, however, fall short of addressing the root causes of vaccine
hesitancy and refusal. Therefore, vaccine hesitancy undermines the effectiveness and
success of immunization programmes.

The role of childhood vaccination attitudes in influencing adult vaccination

acceptance was also explored by the SAGE Working Group on Vaccine Hesitancy.
 23

Since children have not been consistently taught about vaccines in schools in the past,
some adults may be unaware of their health and social benefits for their children and for
themselves. Though there are other ways to learn about vaccines (e.g., from the media,
knowledge booklets, and health-care professionals), many people can overlook them.
Older generations, on the other hand, recognized the importance of vaccinations in the
light of personal experience with vaccine-preventable diseases and/or the disease's
effects on other children, and thus did not have to be informed about the viruses'
dangers and the vaccines' benefits as parents. While more research is required to
assess this strategy in the short and long term, ensuring vaccine education and
awareness in younger individuals (children, teenagers, and young adults), probably
through school-based programs, will provide a good platform to encourage future
vaccine acceptance by parents and adults and minimize the potential for the
development of hesitancy.

As the literature is examined more generally, as Leask et al. (2012) point out, two
significant factors on vaccine hesitancy emerge: the impact of social expectations and
experiences with health-care providers. The function of social norms is shaped by social
networks, which are used by parents to gather information and form vaccination
opinions. It has been discovered that social networks have an effect on parents'
decisions to delay or reject vaccinations. People who are resistant to vaccination, on the
other hand, often take up disproportionately more room in public debates about
vaccination, and the voices of parents who are in favor of vaccination are often ignored.
Healthcare Providers play an important role in immunization through their appropriate
knowledge, positive attitude, and correct information. It is the major factor that is
consistently associated with parents’ acceptance and uptake of vaccinations,
compliance with vaccination schedules and reduction of hesitancy is the attitude and use
of vaccinations by healthcare providers (Verger et al., 2015). Many communication
methods to assist in discussing vaccines with vaccine-hesitant parents have been
released in recent years, but their efficacy has yet to be tested. Despite the fact that
many communication systems recommend addressing vaccines in a participatory and
transparent manner, Opel et al. (2012) found that more firm, presumptive conversation
styles could be more successful in increasing vaccine acceptance.

The SAGE Working Group on Vaccine Hesitancy stresses the importance of

considering the diverse needs of different groups of vaccine-hesitant individuals, since
 24

there is unlikely to be a successful “one size fits all” intervention. Nonetheless,

successful vaccine coverage-increasing measures have been established and should be
implemented (Eskola et al., 2015).Given the scarcity of knowledge on successful
vaccine hesitancy methods, preparing a thorough review of their effects on vaccine
hesitancy/acceptance, as well as sharing lessons learned, is critical whenever initiatives
are introduced.
 25

METHODOLOGY

Research Design

The study adapted a descriptive research design, which according to McCombes

(2019), is a design that aims to describe a population, situation, or phenomenon
accurately and systematically. Congruent with the present study, the researchers'
general objective is to describe the phenomenon of vaccination decision making towards
vaccinating against COVID-19 among parents of senior high school students in Lucena
City; thus, it was determined that a descriptive research design is most suitable for the
study. Additionally, the researchers were able to collect the necessary data for the study
by asking respondents about their attitudes regarding COVID-19 vaccination.

Research Locale

The researchers conducted the study in Lucena City, Quezon Province. The
reason this city is the target locale of the study are twofold: convenience since the
researchers reside here, and because it was identified as the most vulnerable and
susceptible city to COVID-19 in the province of Quezon. In fact, according to data
collected by the Quezon Public Information Office, as of June 6, 2020, Lucena City still
has the most COVID-19 confirmed cases of any city or municipality in the province, with
238 confirmed active cases and a total of 2, 513 COVID-19 cases since the virus
entered the city.

Research Participants

The parents of Senior High School students in Lucena will be the target
population of this study. The researchers aimed to determine the perceptions of the
parents of the students their age who already belong to the population of declared
clinically healthy individuals aging from 18 years old and above to provide a further
understanding and an in-depth knowledge about the vaccination of SHS students (DOH,
2021). Furthermore, limited studies and researchers focused on the perception of
selected parents regarding their child’s COVID-19 vaccination as they only concentrated
on the self-vaccination decision making of individuals aged from 25 to 60 years old.

Fifty (50) respondents will be chosen by the researchers through quota sampling.
Through this technique, the researchers will be able to investigate the characteristics of
 26

a certain subgroup that is of great interest to the study. It will improve the representation
of any particular group within the population thereby ensuring that these groups are not
over-represented. Specifically, uncontrolled quota sampling will be utilized by the
researchers wherein they are free to choose sample group members according to their
own will considering the situation right now and the threats and risks being posed by the
pandemic to both the researchers as well as the respondents. This is to limit the
probability of getting infected by the virus, convenience of data gathering, and
compliance to public health protocols implemented by the national government.

Research Instrument

The researchers will utilize Likert scale to assess by what extent do the
respondents agree or disagree with a particular statement aligned with each of the
research questions of this study. This type of question approach is commonly used in
public health evaluation wherein it measures the respondents’ attitude or opinion toward
a specific question (Losby, 2012). In this study, the researchers will use a 4-point scale
to translate the perspective of the respondents as “strongly disagree, disagree, agree,
and strongly agree”; by 1 being the lowest and 4 being the highest. The research
instrument was divided into 4 sections – the first section for informed consent and ethical
considerations and the remaining three sections designated for the three specific
objectives of this study.

The first section found in the instrument contains the informed consent form to let
the respondents understand why the research is being done and what their participation
will involve. It also contains the general guidelines for all the questions contained in the
instrument. Moreover, it discusses the purpose of the study, participant involvement,
duration, participation, risks, benefits, confidentiality, contact information of the
researchers and research adviser, consent, and the eligibility of the participant to ensure
that the respondents are provided sufficient information in a language which can be
easily understood by them.

The next section concerns the decision of the respondents on their child’s
vaccination against COVID-19. This answers the objective 1 wherein the respondents
are given four (4) choices to choose from: will definitely have their child vaccinated; will
 27

probably have their child vaccinated; will probably not have their child vaccinated; and
will definitely not have their child vaccinated.

Moving on to the third section of the instrument, the researchers divided this into
four sub-parts namely sociodemographic variables, health-related variables, vaccination
beliefs, and political factors. Generally, the third section of the instrument focuses on the
factors considered by the respondents in their child’s vaccination decision-making. For
the first sub-part of this section, the respondents are asked about their age, gender,
educational attainment, and socioeconomic status. For the three remaining sub-parts,
the respondents will be given 4 scales to express their answers on the statements.
Furthermore, these scales will help them to express to what extent they agree or
disagree on the given statement.

The last part of the instrument contains eleven (11) statements intended to
assess the perception and understanding of the respondents regarding the possible
solutions and strategies that can be used to address problems encountered in
vaccination decision-making and how to increase the rate of vaccine acceptance in
Lucena City. This section is designated to answer the objective 3 of this study. The
respondents are also given four scales to express their answers in the given statements
in this section.

Data Gathering Procedures

The researchers asked for permission from their research adviser to start the
data gathering procedures and prepare the questionnaire. Then, respondents were
chosen using a quota sampling method. The researchers sent the informed consent
forms asking for their participation in the research study. After that, is the discussion of
the protocol to the participants wherein it states that there will be no disclosure of any
information for their security and privacy of every respondent. The researchers received
the approvals from the participants and so, the survey officially commenced. The next
step is the sending of google forms process, in which containing the personal
information and structured questionnaires designated to answer the objectives of the
study. Then, the respondents answered the questions in accordance to its arrangement
in the questionnaire including the follow up questions that can come up based on the
respondent’s answers. The researchers did not force the respondents to answer the
 28

certain questions if they did not want to. The researchers made an assurance that the
research participants have an avenue to share their insights and experiences regarding
the study without fear of distortions. After answering the questions provided by the
researchers, the next step was the manifestation of gratitude from the researchers to
their respondents for their kind cooperation. Lastly, the gathered responses form the
respondents were subjected to data analysis and interpretation by the researchers to get
the results.

Ethical Considerations

The researchers asked the selected parents of senior high school students, who
are the respondents of the study, if they are willing to participate in the survey. The
researchers explained the research protocols that the participation of the respondents
will be voluntary which means that they are not forced to answer the questions related to
the study and they can refuse any time if they feel uncomfortable, otherwise respondents
can freely explain their answers through their decisions and opinion about the study they
are involved in. It was also discussed that respondents’ identity will be hidden and the
gathered data will not be disclosed to the public. The researchers ensure that the
personal information will not be revealed and will only use the answers in analyzing the
data of the study to come up with the result. The details gathered from the survey
through google forms must be honestly stated. The researchers only seek to collect data
for the study and not to cause damage to the respondents.

Statistical Treatment

The data that will be gathered by the researchers will be classified as ordinal
data as it is very impossible to measure the difference between each scale (Statistics
How To, 2021). The response choices have a meaningful order but the numbers
themselves are not meaningful. To summarize the general trend and make the vague
definition of the variables clearer, the researchers will be using weighted mean in
analyzing the gathered data. Moreover, this statistical tool will help the researcher in
calculating a theoretically expected outcome where each variable has a different
probability of occurring or responses.

The researchers will use weighted mean to analyze the gathered data with the
formula:
 29

Weighted Mean:

∑𝑛𝑖=1 𝑤𝑖 𝑋𝑖
𝑊=
∑𝑛𝑖=1 𝑤𝑖

Where:

W = weighted mean/average

n = number of terms to be averaged

wi= weights applied to x values

Xi = data values to be averaged

In giving the verbal interpretation and and descriptive analysis based on the
weighted mean, the following scales are used:

Strongly Agree (SA) = 3.51 - 4.0

Agree (A) = 2.51 - 3.50

Disagree (D) = 1.51 - 2.50

Strongly Disagree (SD) = 1.0 - 1.50

 30

RESULTS AND DISCUSSION

Decision of parents in terms of their child's COVID-19

vaccination

7 1

22

20

Will definitely have their child vaccinated Will probably have their child vaccinated
Will probably not have their child vaccinated Will definitely not have their child vaccinated

Figure 3. Percentage of the decision of the parents in terms of their child’s COVID-19
vaccination

The figure shows the proportion regarding the selected parents’ decisions in
terms of their child’s COVID-19 vaccination. Based on the responses gathered by the
researchers, out of 50 respondents, only 1 parent (2%) responded to definitely not have
their child vaccinated, 7 parents (14%) responded to probably not have their child
vaccinated, 20 parents (40%) responded to probably have their child vaccinated, and 22
parents (44%) responded to definitely have their child vaccinated. As can be seen, the
majority of the respondents were accepting of a COVID-19 vaccine for their child and
only few parents were hesitant regarding the vaccination.
 31

Table 2.1.

Vaccination Decision-Making in Terms of Sociodemographic Variables

Socio-demographic Number of
Characteristics Percentage
Variable Responses
Age 41-45 25 50%
46-50 12 24%
51-55 9 18%
56-60 2 4%
61-65 2 4%
66-70 0 0%
70 and up 0 0%
Gender Male 9 18%
Female 38 76%
Rather not say 3 6%
Education No schooling completed 1 2%
Elementary graduate 0 0%
High school graduate 12 24%
College graduate 24 48%
Associate’s degree 0 0%
Bachelor’s degree 9 18%
Master’s degree 3 6%
Professional school degree 0 0%
Doctorate degree 1 2%
Socioeconomic Status Low (PHP 31, 560 and lower) 26 52%
Medium (PHP 31, 560 to PHP 118, 350) 22 44%
High (PHP 118, 350 to PHP 157, 800) 2 4%

Table 2.1 presents the vaccination decision-making of the respondents in terms

of sociodemographic variables. Based on the information collected from the
respondents, 50% of the parents (25/50) were aged between 41 to 45 years, 24%
(12/50) were aged between 46 to 50 years, 18% (9/50) were aged between 51 to 55
years, 4% (2/50) were aged between 56 to 60 years, and the remaining 4% (2/50) were
aged between 61 to 65 years. As for the gender, over half of the respondents’ gender
which is 76% (38/50) were female, 18% (9/50) were male, and the remaining 6% (3/50)
decided to rather not say their gender. The respondents were also asked for their
educational attainment as it may also affect their decision regarding the COVID-19
vaccination of their children. As presented in the table, among the parents, 48% (24/50)
have graduated College, 24% (12/50) have graduated High school, 18% (9/50) have
 32

their Bachelor’s degree, 6% (3/50) have their Master’s degree, 2% (1/50) have Doctorate
degree, and the other 2% (1/50) have no schooling completed. Lastly, as found in the
results regarding the respondents’ socioeconomic status that were also asked by the
researchers, 52% of the parents (26/50) have a low income (PHP 31,560 and lower),
44% (22/50) have medium income (PHP 31,560 to PHP 118,350), and 4% (2/50) have a
high income (PHP 118,350 to PHP 157,800).

Table 2.2.

Vaccination Decision-Making in Terms of Health Related Variables

4 3 2 1 Verbal
No. Health-related Variables Weighted Mean
SA A D SD Interpretation

1 In general, would you say that

30 16 3 1 3.50 Agree
your child’s health is good?

2 My child has no known drug

35 7 6 2 3.50 Agree
allergies or any substance.

3 My child has been denied

6 13 12 19 2.12 Disagree
medical insurance.

4 My child had been linked to

4 5 4 37 1.52 Disagree
alcohol and substance abuse.

5 My child had an anesthetic

complication (e.g., pain, Strongly
2 5 8 35 1.48
nausea and vomiting, fever, et. Disagree
al. after puncture)

6 My child had been diagnosed

with lung or respiratory 4 5 6 35 1.56 Disagree
diseases.

7 My child had a record of Strongly

5 3 2 40 1.46
seizures or convulsions Disagree

General Weighted Mean: 2.16286 Disagree d

Legend: Strongly Agree (SA) = 3.51 – 4.0; Agree (A) = 2.51 – 3.50; Disagree (D) = 1.51 – 2.50; and
Strongly Disagree (SD) = 1.0 – 1.50
 33

Table 2.2 presents the vaccination decision-making of the respondents in terms

of health-related variables computed using a Likert scale. Based on the data gathered by
the researchers, with the weighted mean of 3.50, the respondents agreed that their
child’s health is good and they have no known drug allergies or any substances.
According to the Centers for Disease Control and Prevention (CDC, 2021), all people
who get a COVID-19 vaccine should be monitored on site, especially those who have
had severe allergic reactions or who have had any type of immediate allergic reaction to
a vaccine should be monitored.

However, the respondents disagreed to the three statements regarding the

vaccination decision-making in terms of the health record of their children – with the
weighted mean of 2.12, the respondents disagreed that their child had denied medical
insurance; with the weighted mean of 1.52, the respondents disagreed that their child
had been linked to alcohol and substance abuse; and with the weighted mean of 1.56,
the respondents also disagreed that their child had been diagnosed with lung or
respiratory disease.

Furthermore, with the weighted mean of 1.48, the respondents strongly

disagreed that their child had anesthetic complications, such as pain, fever, nausea and
vomiting. Additionally, for the last statement, with a weighted mean of 1.46, the
respondents strongly disagreed that their child had been diagnosed with lung or
respiratory disease.

To conclude, with the general weighted average mean of 2.16286, the results
presented in the table indicated that the respondents disagreed that their child’s health
status has complications to be considered in deciding for the intake of COVID-19
vaccine.
 34

Table 2.3.

Vaccination Decision-Making in Terms of Vaccination Beliefs

4 3 2 1 Weighted Verbal
No. Vaccination Beliefs
SA A D SD Mean Interpretation

1 I believe that if my child does not

get vaccinated, the likelihood of
21 21 7 1 3.24 Agree
them getting infected with corona
will increase.

2 I believe that if my child does not

get vaccinated, the likelihood of
16 23 10 1 3.08 Agree
my family and relatives getting
infected in Corona will increase.

3 Even if my child will get infected

with COVID-19 I do not think it
7 16 15 12 2.36 Disagree
will cause them significant
suffering or complications.

4 Even if my child gets infected with

COVID-19, the likelihood of them
11 26 10 3 2.90 Agree
recovering from the disease is very
high.

5 I believe that COVID-19 vaccine

will have high efficacy in
17 25 8 0 3.18 Agree
preventing significant suffering
and complications of the disease.

6 I believe that if my child gets

vaccinated against COVID-19 the
risk of getting infected with the 24 23 3 0 3.42 Agree
disease or infecting others will
decrease.

7 Getting vaccinated is expensive,

7 22 15 6 2.60 Agree
requires time and effort.

8 The chances of my child getting

vaccinated against COVID-19 will
increase if opinion leaders on 21 24 4 1 3.30 Agree
social media express support for
the benefit of the vaccine

9 The chances of my child getting

vaccinated against COVID-19 will
increase if friends and family 20 22 5 3 3.18 Agree
express support for the benefit of
the vaccine.
 35

10 The chances of my child getting

vaccinated against COVID-19 will
increase if official guidelines from 25 20 5 0 3.40 Agree
the Department of Health are
published.

11 The chances of my child getting

vaccinated against COVID-19 will
23 23 4 0 3.38 Agree
increase if their general
practitioner recommends them.

12 My child exercises as
18 21 10 1 3.12 Agree
recommended for their age

13 My child makes sure to eat a

26 16 7 1 3.34 Agree
healthy and varied diet

14 Getting vaccinated is a tedious

process that requires time and 13 25 8 4 2.94 Agree
effort

15 Most of my friends will support

14 29 7 0 3.14 Agree
the COVID-19 vaccine

16 If I tell my friends and relatives

that I intend to get my child
vaccinated against COVID-19 17 27 5 1 3.20 Agree
when a vaccine is available, they
will respond positively

17 If my child takes all the necessary

precautions (disinfection of hands,
8 9 21 12 2.26 Disagree
etc.), they do not need to be
vaccinated against corona

General Weighted Mean: 3.06118 Agree c

Legend: Strongly Agree (SA) = 3.51 – 4.0; Agree (A) = 2.51 – 3.50; Disagree (D) = 1.51 – 2.50; and
Strongly Disagree (SD) = 1.0 – 1.50

Table 2.3 presents the vaccination decision-making of the respondents in terms

of their vaccination beliefs computed using a Likert scale. Overall, it had a general
weighted average mean of 3.06118 which corresponds to a verbal interpretation of
“agree.” This communicates that our study found that perceived susceptibility and
severity against the disease, perceived benefits of the vaccine, perceived barriers, cues
to action, health motivation, attitude, subjective norms, and self-efficacy as significant
predictors of intention to receive COVID-19 vaccine.

Two statements concerning perceived susceptibility were agreed upon by the

parents, namely: "I believe that if my child does not get vaccinated, the likelihood of them
 36

getting infected with Coronavirus will increase," which has a weighted mean of 3.24, and
"I believe that if my child does not get vaccinated, the likelihood of my family and
relatives getting infected with Coronavirus will increase," which has a weighted mean of
3.08.

Concerning perceived severity, the parents disagreed with a 2.36 weighted mean
that even if their child will get infected with COVID-19, they do not think it will cause
them significant suffering, meaning they perceive COVID-19 as severely harmful to their
children. Consistent with other related literature, the findings of Shmueli (2020) states
that disease severity also indicate that those willing to vaccinate view themselves as
being at high risk of significant suffering or experiencing complications if they were
infected by COVID-19, as compared to those who are hesitant or refuse to vaccinate.
However, with a weighted mean of 2.90, they agreed that if their child gets infected, the
likelihood of them recovering from the disease is very high, indicating that even though
they believe that COVID-19 will cause their children significant suffering, they still believe
that it is highly recoverable. This response can negatively impact their decision to
vaccinate their children as, according to Schwarzinger et al. (2021), low perception of
COVID-19 severity can underlie negative attitudes towards vaccination.

Furthermore, benefits from receiving COVID-19 vaccination were also found to

positively affect the respondents’ decision making. Having a weighted mean of 3.18, the
parents believe that COVID-19 vaccine will have high efficacy in preventing significant
suffering and complications of the disease. They also believe that if their child gets
vaccinated against COVID-19, the risk of getting infected with the disease or infecting
others will decrease. These findings are similar to the report of Dror et al. (2020), which
implies that vaccination compliance relies on a personal risk-benefit perception.
Correspondingly, according to WHO (2014) individuals who have high perception of the
risks of a disease helps them see vaccination as a necessary preventive action.

Moving on, when asked if getting vaccinated is expensive, and requires time and
effort, the respondents agreed with a weighted mean of 2.60. This shows that the
majority of the respondents will refuse or delay the acceptance of vaccines for their
children due to perceived barriers.
 37

Following this, the parents responded positively to statements determining if

external cues to action will encourage them to vaccinate their children. Having a
weighted mean of 3.40, the majority of the respondents expressed that the chances of
their child getting vaccinated against COVID-19 will increase if official guidelines from
the Department of Health are published. The parents also agreed that the chances of
their child getting vaccinated against COVID-19 will increase if opinion leaders on social
media express support for the benefit of the vaccine, with a weighted mean of 3.30. This
implies that DOH endorsements were associated with more likelihood of vaccination
than political endorsements. These observations are similar to findings reported by
Kreps et al., (2020) who suggested that public outreach campaigns encouraging
vaccination should rely more on advice from health experts. Besides this, the
respondents answered that their willingness to accept vaccines will also increase if
friends and family express support for the benefit of the vaccine (i.e., its efficacy and
safety), and if their general practitioner recommends them, with a weighted mean of 3.18
and 3.38 respectively.

In terms of health motivation, the parents agreed that their child exercises as
recommended for their age and makes sure to eat a healthy varied diet, with a weighted
mean of 3.12 and 3.34 respectively. This finding suggests that having this motivation to
engage in positive health behaviors can also encourage parents to vaccinate their
children in an attempt to uphold their children's health and wellbeing.

In terms of their attitude, or their overall evaluation of vaccination, they see

vaccination as a tedious process that requires time and effort, with a weighted mean of
3.14. This finding is consistent with the WHO (2014) study, which states that if the
quality of service and the extent to which vaccination services are not given at a
convenient and comfortable time and location, parents may develop vaccine hesitancy
and complacency.

In assessing the role of subjective norms, a weighted mean of 3.20 indicates that
parents believe and agree that if they tell their friends and relatives that they intend to
get their child vaccinated against COVID-19 when a vaccine becomes available, they will
respond positively. This means that their beliefs about whether the majority of people
approve or disapprove of their behavior can have a significant impact on their
vaccination compliance.
 38

Finally, parents reported low levels of self-efficacy for their children, with a
weighted mean of 2.26 indicating that they disagree and do not believe that if their child
takes all necessary precautions (i.e. regular hand disinfection, wearing of face masks,
etc…) then they do not need to be vaccinated against coronavirus. This shows that low
perceived self efficacy positively affects parents’ decision to vaccinate their children, as
they think that their children are still significantly susceptible to the virus.

To synthesize all of the above, parents' vaccination belief that their child is
susceptible to the risks of the virus; that their unvaccinated child can adversely affect the
health of others; that the virus will cause significant suffering to their child; and that the
COVID-19 vaccine is safe and effective positively influences their decision to allow their
children to vaccinate. Additionally, the study also found that external cues to action, such
as endorsements, encouragement, and recommendations from other significant people,
help increase the chances of a parent getting their child vaccinated, with endorsements
from health experts such as the DOH receiving the most positive feedback. Furthermore,
health motivation, subjective norms, and having a low perceived self-efficacy were also
found to motivate parents’ vaccine compliance. However, perceived barriers such as
physical availability and affordability continue to prevent parents from fully committing to
vaccinate their children. These findings underscore the necessity of developing
interventions and strategies to deal with parents who have low intentions of allowing
their children to vaccinate in order to achieve herd immunity within the country.
 39

Table 2.4.

Vaccination Decision-Making in Terms of Political Factors

4 3 2 1 Weighted Verbal
No. Political Factors
SA A D DA Mean Interpretation

1 My child will get vaccinated if the

vaccine has received an
emergency use authorization from 20 23 7 0 3.26 Agree
the US Food and Drug
Administration (FDA)

2 My child will get vaccinated if the

vaccine is endorsed by different
administrations that are 21 22 5 2 3.24 Agree
responsible for protecting public
health.

3 My child will get vaccinated if the

vaccine is endorsed by one of my 6 17 13 14 2.30 Disagree
political partisans.

4 My child will get vaccinated if the

country of origin of the vaccine
23 24 3 0 3.40 Agree
has a reported centralized and
developed healthcare system.

5 My child will get vaccinated if the

country of origin of the vaccine
has provided sufficient data about 27 16 7 0 3.40 Agree
the timeliness of vaccine
development and availability.

General Weighted Mean: 3.12 Agree cd

Legend: Strongly Agree (SA) = 3.51 – 4.0; Agree (A) = 2.51 – 3.50; Disagree (D) = 1.51 – 2.50; and
Strongly Disagree (SD) = 1.0 – 1.50

Table 2.4 presents the vaccination decision-making of the respondents in terms

of political factors computed using a Likert scale. As shown in the table, with a weighted
mean of 3.26, most of the parents agreed that their child will get vaccinated if the
vaccine has received an emergency use authorization from US Food and Drug
Administration (FDA). According to the director of the FDA’s Center for Biologics
Evaluation and Research (2021), having a vaccine authorized for a younger population
is a critical step in continuing to lessen the immense public health burden caused by the
COVID-19 pandemic.
 40

The data was subsequently followed by a statement which has a weighted mean
of 3.24 and shows that most of the parents agreed that their child will get vaccinated if
the vaccine is endorsed by different administrations that are responsible for protecting
public health. This indicates that by endorsing and establishing supportive policies and
practices of the administrations can help the increase of parents accepting the uptake of
COVID-19 vaccine for their child.

However, with the weighted mean of 2.30, the respondents disagreed that their
child will get vaccinated if endorsed by one of their political partisans. The result
indicates that the COVID-19 vaccine being endorsed by the politicians will not affect their
decision-making regarding the COVID-19 vaccination.

Furthermore, for the last two statements regarding the political factors affecting
the respondents’ vaccination decision-making, both have a weighted mean of 3.40. The
parents agreed that their child will get vaccinated if the country of origin of the vaccine
has a reported centralized and developed healthcare system. They also agreed that their
child will get vaccinated if the country of the vaccine has provided sufficient data about
the timeliness of vaccine development and availability.

Overall, with a general weighted average mean of 3.12, shows that most of the
statement was agreed by the respondents. The result presented in the table reveals that
different political factors may affect the decision-making of parents on their child’s
COVID-19 vaccination. Government, public health officials and advocacy groups must
be prepared to address hesitancy and build vaccine literacy so that the public will accept
immunization when appropriate.
 41

Table 3.

Possible Solutions and Strategies to Address the Problems Toward COVID-19

Vaccination Decision-making Among the Respondents.

Solutions and Strategies for 4 3 2 1 Weighted Verbal

No.
Problems in Decision-making SA A D SD Mean Interpretation

1 Conduct of seminar or symposium

by professional healthcare to listen
32 15 3 0 3.58 Strongly Agree
and acknowledge the respondents'
concern.

2 Provide enough information in

weighing up the risks versus 38 11 1 0 3.74 Strongly Agree
benefits of being immune.

3 Correcting misinformation,
accepting questions, and 37 11 2 0 3.70 Strongly Agree
explaining.

4 Providing personal examples (e.g.,

pharmacist's own vaccination, fact 33 16 1 0 3.64 Strongly Agree
sheets, and other resources)

5 Communicate the high level of

endorsement of vaccines by 27 21 2 0 3.50 Agree
various communities.

6 Proactively engage in and raise the

33 17 0 0 3.66 Strongly Agree
topic of vaccination.

7 Increase the physical availability,

affordability, willingness-to-pay,
geographical accessibility and 35 14 0 1 3.66 Strongly Agree
ability to understand influence
uptake of the vaccine.

8 Increase the trust and confidence

of the respondents by increasing
the reliability and competence of
healthcare professionals, health 39 11 0 0 3.78 Strongly Agree
services and/or the motivation of
policy makers who make decisions
about vaccines.

9 Social media intervention to

23 24 3 0 3.40 Agree
increase the uptake of all vaccines.

10 Provision of communication tool-

based training for health care 32 17 1 0 3.62 Strongly Agree
workers.

11 The application of mass media to

35 14 1 0 3.68 Strongly Agree
target parents with low levels of
 42

awareness of health services as an

effective intervention.

General Weighted Mean: 3.63273 Strongly Agree c

Legend: Strongly Agree (SA) = 3.51 – 4.0; Agree (A) = 2.51 – 3.50; Disagree (D) = 1.51 – 2.50; and
Strongly Disagree (SD) = 1.0 – 1.50

Table 3 reveals the results of possible solutions and strategies to be utilized to

address the problems that arise in the decision-making of the respondents on their
child’s COVID-19 vaccination. Overall, it had a general weighted average mean of
3.63273 which corresponds to a verbal interpretation of “strongly agree”. This means
that the respondents believe that there is an urgent need to address vaccination
problems such as vaccination hesitancy which reduces vaccine uptake and
compromises herd immunity. Addressing COVID-19-related vaccine hesitancy is
expected to lead to greater numbers of vaccinated individuals, in turn resulting in fewer
COVID-19 cases, reduced infection transmission and fewer deaths (Murdan, et. al.,
2021).

Among the given statements, statement 8 which states that, “Increase the trust
and confidence of the respondents by increasing the reliability and competence of
healthcare professionals, health services and/or the motivation of policy makers who
make decisions about vaccines,” ranks first with the highest weighted mean of 3.78 and
a verbal interpretation of “strongly agree”. The pandemic has generally led to
widespread misinformation that has both damaged research and public policy
knowledge and acceptability, which extends to the problem of vaccination acceptance
(de Figueredo et al., 2020). Thus, the role of healthcare professionals, health services,
and vaccine policy makers is to acknowledge the determinants of vaccine hesitancy.
Health care workers need to be well-trained to tackle false vaccine information shared
amongst ethnic minority communities. Specifically, the core competencies that a
healthcare professional should possess, regardless of their discipline, to meet the needs
of the respondents are providing patient-cared care by identifying, respecting, and
acknowledging the patients’ differences, values, preferences, and expressed needs, and
working in interdisciplinary teams through cooperation, collaboration, communication,
and integration in teams to ensure that their performance is continuous and reliable.
Moreover, employing evidence-based practice, applying quality improvement, and
utilizing informatics to communicate, manage knowledge, mitigate error, and support
 43

decision making can also contribute in increasing the reliability and competence of the
people responsible in the rollout, procurement, and administration of COVID-19
vaccines.

The second strategy that interests the respondents is statement 2, “Provide

enough information in weighing up the risks versus benefits of being immune” with a
weighted average mean of 3.74 and a descriptive analysis of strongly agree. Health
teams must be prepared for conversations with individuals and keep up-to-date in
information regarding vaccine efficacy and components, and severity and frequency of
adverse effects at hand. According to Kumar (2016), information on the safety and
efficacy of vaccines, benefits of vaccination and the potential for non-vaccination have
proved to be a useful strategy for community pharmacists to tackle vaccine hesitancy. A
comprehensive guide on COVID-19 vaccine that highlights information on the excipients,
ingredients and side effects including the mildness of vaccine adverse effects, very low
risk of serious adverse effects, and risks of not immunising will help individuals weigh up
the risks over benefits of acquiring COVID-19 vaccine shots.

The remaining statements all had a verbal interpretation of “strongly agree”

except for statements 5 and 9 which obtained a weighted average mean of 3.50 and
3.40, respectively, and a verbal interpretation of “agree”. The results in the table only
suggest that in order to increase the vaccine confidence and vaccine acceptance in a
given city or community, the government, along with health care professionals and
vaccine personnels, must rapidly develop and deploy nimble and adaptable
communication strategies in real time. They should put forth strategies with emphasis on
tackling the ongoing infodemic of vaccine myths and misinformation, behavioral aspects,
and acutely negative vaccination attitudes of vaccine hesitancy which are mainly
associated with vaccine delays and refusal. The coordinated efforts and works of
physicians, policymakers, health departments, and vaccine manufacturers will be the
key to attaining COVID-19 vaccination goals in Lucena City and might help gain public
trust in the vaccination process against COVID-19.

Putting everything into considerations, the potential strategies and solutions in

addressing the critical gap and improving population adoption of COVID-19 vaccination
are: establishing a strong and reliable health care system response; drawing on
evidence-based strategies with organizational interventions and clinical organizations;
 44

acknowledging negative behaviors and attitudes toward vaccination while emphasizing

the stringent safety and efficacy standards of COVID-19 vaccine development process
and fostering individuals’ self-efficacy through vaccination; tailoring of health messages,
information and advice to at-risk and vulnerable groups and communities; delivering of
compassionate and successful communication with those who are hesitant; and the use
of motivational interviewing among concerned individuals. Parallel results were also
seen in the study conducted by McGee and Suh (2019), whereas the knowledge on
effective communication with the use of presumptive language, persuasion, and
evidence-based strategies of pro-vaccine advocates and health care providers are
considered an effective tool to promote vaccine acceptance and immediately address
those concerns associated with vaccine delays and refusal.
 45

CONCLUSIONS AND RECOMMENDATIONS

The study entitled, “Immunity Vs. Tolerance: Factors Influencing Selected

Parents’ Decision on COVID-19 Vaccination in Lucena City”, generally aimed assess,
examine, and determine the vaccine-related beliefs, behaviors, attitudes and other
factors associated with vaccination decision-making against COVID-19 among the
selected parents of senior high school students in Lucena City.

The research study employed a descriptive-quantitative research design wherein

they used a structured interview questionnaire intended to answer the given objectives
of the study. Fifty (50) respondents were chosen through quota sampling to answer the
research-made questions. The gathered data were analyzed using Weighted Mean
wherein the researchers provided further analysis, explanation, and discussion about the
findings of this study.

Based on the findings of the study, the following conclusions were derived:

1. Parents’ acceptability of COVID-19 vaccination for their children was high in

Lucena City. The percentage of parents who responded to definitely having their
child vaccinated is 44%, 40% responded to probably having their child
vaccinated, 14% responded to probably not having their child vaccinated, and the
remaining 2% responded to definitely having their child vaccinated. The findings
revealed that the majority of the selected parents agreed for their child to take the
COVID-19 vaccine, while there were still some parents who are hesitant in
deciding due to different factors that affect their decision.
2. The findings have revealed that only less than half of the samples have reported
a full willingness for their child to receive vaccination. This suggests that there is
an existence of vaccination refusal and delay among the respondents which
significantly decreases vaccine confidence and trust, and compromises herd
immunity. Several factors were associated with their COVID-19 vaccination
decision-making:
2.1. The sociodemographic variables of the respondents are summarized in
Table 2.1 wherein four demographic factors were significantly associated
with the vaccination decision-making: age, gender, educational
attainment, and socioeconomic status or income level. The results
 46

showed that most of the respondents were female, between the age of 41
to 45 years, have enough knowledge regarding vaccination in which most
of them have graduated college, and have a low income level. Though
respondents have different status and characteristics, the researchers
have concluded that sociodemographic factors do not directly affect the
parents’ decision regarding the COVID-19 vaccination of their child. On
the other hand, having a poor knowledge about the vaccine can cause a
problem and affect their decision.
2.2. Health related factors are generally assumed to be important for the great
majority of people, especially, parents who are in charge of decision-
making for their child's vaccination. When discussing vaccination and
immunization, the emphasis is on its purpose, potential side effects and
efficacy of vaccination. Based on the findings, the researchers have
concluded that most of the parents’ children have good health and don’t
have any health problems to be worried about in accepting the vaccine.
However, health factors should still be considered before making
decisions as it can worsen their child's health and can provide side effects
caused by the COVID-19 vaccines.
2.3. Our results underscore that vaccination beliefs of the parents, whether
real or not, significantly affect their decision to vaccinate their children
against COVID-19. It was found that parents are most likely to vaccinate
their children if official guidelines from the Department of Health are
published, suggesting that public outreach campaigns encouraging
vaccination should rely more on advice from health experts. Likewise,
endorsements from opinion leaders and support from their relatives and
friends highly encourage the parents to open their children to the
possibility of getting vaccinated. Furthermore, when parents perceive that
the vaccine is safe and effective, regardless of if it is a fact or just their
personal belief, it boosts their confidence in the process of vaccination,
which in turn can be beneficial to bolstering future vaccination initiatives.
Additionally, parents are more willing to vaccinate their children if they
view them as being at high risk of significant suffering or experiencing
complications if they were infected by COVID-19, because they see
vaccination as a necessary preventive action. Lastly, parents who see
 47

their children exercising for their recommended age and eating a healthy
varied diet, are inclined to vaccinating them to uphold their health and
wellbeing. Meanwhile, parents show the least support for vaccination and
are likely to delay accepting them for their children when they perceive it
as significantly costly, and require time and effort, and if vaccination
services are inconvenient and not delivered at a comfortable time and
location.
2.4. In terms of political factors, parents in this study reported a need for
vaccine authorization from the US Food and Drug Administration(FDA) to
make sure that COVID-19 vaccines are safe and will not harm their child.
Based on the results, the researchers found that most parents are not
depending their vaccination decision on the political partisans endorsing
the vaccine, but agreed to have their child vaccinated if the endorsers will
be different administrations that are responsible for protecting public
health. Moreover, parents are more focused on the sufficient references
containing COVID-19 vaccine, availability and timeliness of vaccine
development. This may satisfy parents’ information needs and enable
them to make a sufficiently informed choice whether or not to vaccinate
their child.
3. Strategies to address vaccine hesitancy were found to have been evaluated for
impact on vaccination uptake and significant changes in knowledge, awareness,
and attitude regarding COVID-19 vaccination. Most interventions focused on
establishing vaccine confidence by raising knowledge and awareness through
different communication strategies such as conducting seminars or symposium,
correcting misinformations, evaluating the risks and benefits of being immune,
and integrating social media as well as mass media. Focusing on the healthcare
workers’ competence and reliability can also be of great help in increasing the
trust of the respondents. This can be done by emphasizing the core
competencies that they should possess which can be achieved through
evidence-based practice and training. Overall, communication strategies,
evidence-based and dialogue-based interventions were found to be the most
effective. However, the identified strategies should be carefully tailored according
to the target population, their reasons for vaccine refusal and delay, and the
specific context.
 48

Based on the findings and conclusions of this study, the following are hereby
recommended:

1. Larger sample size may be considered to give more reliable results with greater
precision and smaller margin of error.
2. A mixed research design (quantitative and qualitative) may be employed for
future research that will also highlight the opinions, feelings, perception, and
thoughts of the respondents regarding COVID-19 vaccination which can only be
expressed through qualitative data.
3. A different sampling technique may be used in choosing the respondents of the
study to ensure that there is a proportionate number of respondents for each
strand of senior high school. Through this, the future researchers can maximize
the findings to reflect the general or appropriate population concerned.
4. The research instrument can be further improved by including the missing
elements and by acknowledging and addressing the deficiency of the
questionnaire itself.
5. A more accurate and appropriate statistical treatment may be used in analyzing
the data gathered to provide a more comprehensive and a more detailed analysis
and discussion of the findings.
6. Future research studies may also focus on the student’s own vaccination
decision-making. They may also seek to assess and examine the factors
considered by themselves in making decisions regarding vaccination against
COVID-19.
 49

REFERENCES:

Austriaco, N. (2020, November 26). [ANALYSIS] A 3rd COVID-19 vaccine for the
PH: Effective but morally controversial. Rappler.
https://www.rappler.com/voices/thought-leaders/analysis-3rd-covid-19-
vaccine-effective-morally-controversial
Aschwanden, C. (2021). Five reasons why COVID herd immunity is

probably impossible. Nature, 591(7851), 520–522.

https://doi.org/10.1038/d41586-021-00728-2

Cao, S. (2020). COVID-19 vaccine prices revealed from Pfizer, moderna and
astrazeneca. https://observer.com/2020/11/covid19-vaccine-price-pfizer-
moderna-astrazeneca-oxford/
Cherry, K. (2020, April 27). The Psychology of What Motivates Us? Verywell Mind.
verywellmind.com/what-is-motivation-2795378
de Figueredo, A. et al. (2020), “Mapping global trends in vaccine confidence and
investigating barriers to vaccine uptake: a large-scale retrospective temporal
modelling study”, The Lancet, Vol. 396/10255, pp. 898-908,
http://dx.doi.org/10.1016/S0140-6736(20)31558-0.
Department of Health. (2020). DOH, NTF reveal national COVID-19 vaccine
roadmap from evaluation & acquisition to distribution.
https://doh.gov.ph/doh-press-release/DOH-NTF-REVEAL-NATIONAL-
COVID-19-VACCINE-ROADMAP-FROM-EVALUATION-AND-
ACQUISITION-TO-DISTRIBUTION
Department Of Health. (2020). DOH pushes for safe holiday celebrations through
COVID-19 risk-mitigating activities. https://doh.gov.ph/node/25667
Dror et al. (2020, August 12)Vaccine hesitancy: the next challenge in the fight
against COVID- 19. https://doi.org/10.1007/s10654-02 0-00671-y.
Dubé, E., Vivion, M., & MacDonald, N. E. (2015). Vaccine hesitancy, vaccine
refusal and the anti-vaccine movement: influence, impact and implications.
Expert review of vaccines, 14(1), 99-117.
Dubé, È., Ward, J. K., Verger, P., & Macdonald, N. E. (2021). Vaccine Hesitancy ,
Acceptance , and Anti-Vaccination : Trends and Future Prospects for Public
 50

Health. https://www.annualreviews.org/doi/full/10.1146/annurev-publhealth-
090419-102240
Esguerra, D. (2020). PH to sign COVID-19 vaccine deal with AstraZeneca on
Friday. https://newsinfo.inquirer.net/1365099/ph-to-sign-covid-19-vaccine-
deal-with-astrazeneca-on-friday
Eskola, J., Duclos, P., Schuster, M., MacDonald, N.E., & SAGE Working Group on
Vaccine Hesitancy (2015). How to deal with vaccine hesitancy?. Vaccine.
https://doi.org/10.1016/j.vaccine.2015.04.0
Fridman, A., Gershon, R., & Gneezy, A. (2021). COVID-19 and vaccine hesitancy:
A longitudinal study. PloS one, 16(4), e0250123.
Gust, D.A., Kennedy, A., Shui, I., Smith, P.J., Nowak, G., & Pickering, L.K. (2005).
Parent attitudes toward immunizations and healthcare providers the role of
information. American journal of preventive medicine, 28(2), 105-112.
https://doi.org/10.1016/j.amepre.2005.04.0
HealthCare.gov. Health Status. (2021).
https://www.healthcare.gov/glossary/health-
status/#:~:text=Refers%20to%20your%20medical%20conditions,evidence%
20of%20insurability%2C%20and%20disability.
Higgins, J.P.T., & Green, S. (2011). Cochrane handbook for systematic reviews of
interventions version 5.1.0.The Cochrane Collaboration.
https://www.cochranehandbook.org
Karlsson, L. C., Soveri, A., Lewandowsky, S., Karlsson, L., Karlsson, H., Nolvi, S.,
Karukivi, M., Lindfelt, M., & Antfolk, J. (2021). Fearing the disease or the
vaccine: The case of COVID-19. Personality and Individual Differences.
https://doi.org/10.1016/j.paid.2020.110590
Kumar, D. (2016, February 1). Vaccine hesitancy: understanding better to address
better. Israel Journal of Health Policy Research.
https://ijhpr.biomedcentral.com/articles/10.1186/s13584-016-0062-y
LaMorte, W. (2019, September 9). Behavioral Change Models.
https://sphweb.bumc.bu.edu/otlt/mph-
modules/sb/behavioralchangetheories/BehavioralChangeTheories2.html
Larson, H.J., de Figueiredo, A., & Xiahong Z. (2016). The state of vaccine
confidence 2016: Global insights through a 67-country survey.
EbioMedicine, 12, 295-301. https://doi.org/j.ebiom.2016.08
 51

Leask, J., Kinnersley, P., & Rowles, G. (2012). Communicating with parents
vaccination: A framework for health professionals. BMC Pediatr 12, 154.
https://doi.org/10.1186/1471-2431-12-154
Lema, K., Macfie, N. (2020). Philippines in advanced talks with AstraZeneca for
vaccine. https://interaksyon.philstar.com/politics-
issues/2020/11/24/181063/philippines-in-advanced-talks-with-astrazeneca-
for-vaccine/
Lopez, E (2020). Russia, China in lead as Philippines seeks deals for covid-19
vaccines. https://www.scmp.com/week-asia/health-
environment/article/3109729/russi-china-lead-philippines-seeks-deals-covid-
19
Losby, J. (2012). CDC Coffee Break: Using Likert Scales in Evaluation Survey
Work. National Center for Chronic Disease Prevention and Health
Promotion. https://www.cdc.gov/dhdsp/pubs/docs/cb_february_14_2012.pdf
MacDonald NE. (2015). Vaccine hesitancy: Definition, scope and determinants.
Vaccine, 33(34). https://doi.org/10.1016/j.vaccine.2015.04.036
Magsambol B. (2020). PH coronavirus cases jump by 538; total cases now 2,084.
https://www.rappler.com/nation/coronavirus-cases-philippines-march-31-
2020
McClure, C. C., Cataldi, J. R., & O’Leary, S. T. (2017). Vaccine Hesitancy: Where
We Are and Where We Are Going. Clinical Therapeutics, 39(8), 1550–1562.
https://doi.org/10.1016/j.clinthera.2017.07.003
McGee, LIndy U. MD and Suh, Jinny JD (2019) "Communication Strategies to
Address Vaccine Hesitancy in Healthcare Settings and on Social Media,"
Journal of Applied Research on Children: Informing Policy for Children at
Risk: Vol. 10 : Iss. 2 , Article 7.
Murdan, S., Ali, N., & Ashiru-Oredope, D. (2021). The Pharmaceutical Journal.
https://doi.org/10.1211/PJ.2021.175260
Neshovski, R. (2020). United Nations Sustainable Development. United Nations.
https://www.un.org/sustainabledevelopment/
Omer, S.B., Salmon, D.A., Orenstein, W.A., deHart, M.P., & Halsey, N. (2009).
Vaccine refusal, mandatory immunization, and the risks of vaccine-
preventable diseases. The New England journal of medicine, 360(19), 1981-
1988. https://doi.org/10.1056/NEJMsa0806477
 52

Opel, D.J., Taylor, J.A., Mangione-Smith, R., & Solomon, C. (2011). Validity and
reliability of a survey to identify vaccine-hesitant parents. Vaccine, 29(38):
6598-605. https://doi.org/10.1016/j.vaccine.2011.06.115
Pulse Asia. (2021, March 26). February 2021 Nationwide Survey on COVID-19.
(2021). http://www.pulseasia.ph/february-2021-nationwide-survey-on-covid-
19/
Shmueli, L. (2020). Predicting intention to receive COVID-19 vaccine among the
general population using the Health belief model and the theory of planned
behavior model. MedRxiv, 1–13.
https://doi.org/10.1101/2020.12.20.20248587
Social Weather Stations. (2020). Social Weather Stations | SWS September 17-
20, 2020 National Mobile Phone Survey – Report No. 17: 66% of adult
Filipinos are willing to get the Covid-19 vaccine.
http://www.sws.org.ph/swsmain/artcldisppage/?artcsyscode=ART-
20201119203953
Statistics How To. (2021, January 14). Likert Scale Definition and Examples.
https://www.statisticshowto.com/likert-scale-definition-and-examples/
Tam, C. & Qiao, S. (2020, January 1). Factors associated with decision making on
COVID-19 vaccine acceptance among college students in South Carolina.
MedRxiv.
https://www.medrxiv.org/content/10.1101/2020.12.03.20243543v1.full#:%7E
:text=Factors%20of%20individual%20cognitions%20include,in%20which%2
0vaccines%20are%20made).
The World Bank. (2020, October 27). COVID-19 to Add as Many as 150 Million
Extreme Poor by 2021. https://www.worldbank.org/en/news/press-
release/2020/10/07/covid-19-to-add-as-many-as-150-million-extreme-poor-
by-2021
Verger, P., Fressard, L., Collange, F., Gautier, A., Jestin, C., Launay, O., et al.
(2015). Vaccine hesitancy among general practitioners and its determinants
during controversies: a National Cross-sectional Survey in France.
EBioMedicine, 2(8):891-7. https://doi.org/10.1016/j.ebiom.2015.06.01
WHO. (2014). Report of the Sage Working Group on. October, 64.
https://www.who.int/immunization/sage/meetings/2014/october/1_Report_W
ORKING_GROUP_v
 53

Wigham, S., Ternent, L., Bryant, A., Robalino, S., Sniehotta, F.F., & Adams, J.
(2014). Parental financial incentives for increasing preschool vaccination
uptake: systematic review. Pediatrics, 134(4), e1117-e1128.
https://doi.org/10.1542/peds.2014-1279
Willett, T. (2015). Analyzing Likert Scale Data: The Rule of N=30. Simulation
Canada. https://www.sim-one.ca/community/tip/analyzing-likert-scale-data-
rule-n30
Williams, N., Woodward, H., Majeed, A., & Saxena, S. (2011). Primary care
strategies to improve childhood immunisation uptake in developed
countries: systematic review. JRSM short reports, 2(10), 81.
https://doi.org/10,1258/shorts.2011.011112
World Health Organization. (2013). Vaccine Safety Basics.
https://www.who.int/vaccine_safety/initiative/tech_support/Vaccine-safety-E-
course-manual.pdf
World Health Organization. (2019). Ten threats to global health in 2019.
https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
World Health Organization. (2020a). Coronavirus – World Health Organization.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
World Health Organization. (2021a). COVID-19 vaccines.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-
19-vaccines
World Health Organization. (2021b). WHO Coronavirus (COVID-19) Dashboard.
https://covid19.who.int/
World Health Organization. (2020b, December 31) Coronavirus disease (COVID-
19): Herd immunity, lockdowns and COVID-19. https://www.who.int/news-
room/q-a-detail/herd-immunity-lockdowns-and-covid-
19?gclid=CjwKCAjwqIiFBhAHEiwANg9szpriYEzvx-
TPrrJo8oszBi67X8E0Cz4bRQ9GHRwh30EJ-
bXOuouZWhoC32AQAvD_BwE#
YouGov. (2021, January 12). COVID-19: Willingness to be vaccinated.
Yougov.co.uk; YouGov. https://yougov.co.uk/topics/international/articles-
reports/2021/01/12/covid-19-willingness-be-vaccinated
Yu, C. (2020, March 23). What Is Herd Immunity? WebMD.
https://www.webmd.com/lung/what-is-herd-immunity#1
 54

Zimmerman, R.K., Wolfe, R.M., Fox, D.E., Fox, J.R., Nowalk, M.P., Troy, J.A., &
Sharp, L.K. (2005). Vaccine criticism on the world. Journal of medical
internet research, 7(2):e17. https://doi.org/10.2196/jmir.7.2.e17

Ashby, B., & Best, A. (2021). Herd immunity. Current Biology, 31(4), R174–R177.
https://doi.org/10.1016/j.cub.2021.01.006

Randolph, H. E., & Barreiro, L. B. (2020). Herd Immunity: Understanding COVID-

19. Immunity, 52(5), 737–741. https://doi.org/10.1016/j.immuni.2020.04.012

Schwarzinger, M., Watson, V., Arwidson, P., Alla, F., & Luchini, S. (2021). COVID-
19 vaccine hesitancy in a representative working-age population in France: a
survey experiment based on vaccine characteristics. The Lancet Public Health,
6(4), e210–e221. https://doi.org/10.1016/S2468-2667(21)00012-8
 55

APPENDICES
Appendix A.
Research Instrument
Dear Respondents,
Greetings! We are Quezon National High School Grade 11 STEM-A students
who are currently researching “Immunity vs. Tolerance: Factors Influencing Selected
Parents' Decision on COVID-19 Vaccination in Lucena City.” If you agreed to the
consent we provided you, you are a respondent in this study. Your response will be
extremely helpful to us. Thank you very much.

PART I. PERCENTAGE OF THE PARENTS WHO WILL VACCINATE THEIR

CHILDREN
Direction: Kindly select a response that best answers the question.
1. What is your decision on your child’s vaccination against COVID-19?
a. I will definitely have my child vaccinated
b. I will probably have my child vaccinated
c. I will probably not have my child vaccinated
d. I will definitely not have my child vaccinated

PART II. FACTORS AFFECTING COVID-19 VACCINATION DECISION-MAKING

AMONG PARENTS
2.1 Vaccination Decision-Making in Terms of Sociodemographic Variables
Direction: Kindly select a response that best answers the question.
1. Age
a. 41-45
b. 46-50
c. 51-55
d. 56-60
e. 61-65
f. 66-70
g. 70 and up

2. Gender
a. Male
b. Female
c. Rather not say

3. Education
a. No schooling completed
b. Elementary graduate
c. High school graduate
 56

d. College graduate
e. Associate’s degree
f. Bachelor’s degree
g. Master’s degree
h. Professional school degree
i. Doctorate degree

4. Socioeconomic Status
a. Low (PHP 31, 560 and lower)
b. Medium (PHP 31, 560 to PHP 118, 350)
c. High (PHP 118, 350 to PHP 157, 800)

2.2 Vaccination Decision-Making in Terms of Health Related Variables

Direction: Read each statement below. Place a check ( / ) on the space provided for
your preferred answer or response. Use the scale below as your guide in choosing your
answer.
Legend:
Strongly Agree (4) Agree (3) Disagree (2) Strongly Disagree (1)

4 3 2 1

No. Health-related variables

Strongly Strongly
Agree Disagree
Agree Disagree

1 In general, would you say that your

child’s health is good?

2 My child has no known drug

allergies or any substance.

3 My child has been denied medical

insurance.

4 My child had been linked to alcohol

and substance abuse
 57

5 My child had an anesthetic

complication (e.g. pain, nausea and
vomiting, fever, et. al. after
puncture)

6 My child had been diagnosed with

lung or respiratory diseases.

7 My child had a record of seizures or

convulsions.

2.3 Vaccination Decision-Making in Terms of Vaccination Beliefs

4 3 2 1

No. Vaccination Beliefs

Strongly Strongly
Agree Disagree
Agree Disagree

1 I believe that if my child does not

get vaccinated, the likelihood of
them getting infected with corona
will increase.

2 I believe that if my child does not

get vaccinated, the likelihood of my
family and relatives getting infected
in Corona will increase.

3 Even if my child will get infected

with COVID-19 I do not think it will
cause them significant suffering or
complications.
 58

4 Even if my child gets infected with

COVID-19, the likelihood of them
recovering from the disease is very
high.

5 I believe that COVID-19 vaccine

will have high efficacy in
preventing significant suffering and
complications of the disease.

6 I believe that if my child gets

vaccinated against COVID-19 the
risk of getting infected with the
disease or infecting others will
decrease.

7 Getting vaccinated is expensive,

requires time and effort

8 The chances of my child getting

vaccinated against COVID-19 will
increase if opinion leaders on
social media express support for
the benefit of the vaccine

9 The chances of my child getting

vaccinated against COVID-19 will
increase if friends and family
express support for the benefit of
the vaccine.
 59

10 The chances of my child getting

vaccinated against COVID-19 will
increase if official guidelines from
the Department of Health are
published.

11 The chances of my child getting

vaccinated against COVID-19 will
increase if their general practitioner
recommends them.

12 My child exercises as
recommended for their age

13 My child makes sure to eat a

healthy and varied diet

14 Getting vaccinated is a tedious

process that requires time and
effort

15 Most of my friends will support the

COVID-19 vaccine

16 If I tell my friends and relatives that

I intend to get my child vaccinated
against COVID-19 when a vaccine
is available, they will respond
positively

17 If my child takes all the necessary

precautions (disinfection of hands,
etc.), they do not need to be
vaccinated against corona
 60

2.4 Vaccination Decision-Making in Terms of Political Factors

4 3 2 1

No. Political Factors

Strongly Strongly
Agree Disagree
Agree Disagree

1 My child will get vaccinated if the

vaccine has received an
emergency use authorization from
the US Food and Drug
Administration (FDA)

2 My child will get vaccinated if the

vaccine is endorsed by different
administrations that are responsible
for protecting public health.

3 My child will get vaccinated if the

vaccine is endorsed by one of my
political partisans.

4 My child will get vaccinated if the

country of origin of the vaccine has
a reported centralized and
developed healthcare system.

5 My child will get vaccinated if the

country of origin of the vaccine has
provided sufficient data about the
timeliness of vaccine development
and availability.
 61

PART III. SOLUTIONS AND STRATEGIES TO ADDRESS PROBLEMS IN

VACCINATION DECISION-MAKING

No. Solutions and Strategies to 4 3 2 1

Vaccine Hesitancy

Strongly Agree Disagree Strongly

Agree Disagree

1 Conduct of seminar or symposium

by professional healthcare to listen
and acknowledge the respondents'
concern.

2 Provide enough information in

weighing up the risks versus
benefits of being immune.

3 Correcting misinformation,
accepting questions, and
explaining.

4 Providing personal examples (e.g.

pharmacist's own vaccination, fact
sheets, and other resources)

5 Communicate the high level of

endorsement of vaccines by
various communities.

6 Proactively engage in and raise the

topic of vaccination.
 62

7 Increase the physical availability,

affordability, willingness-to-pay,
geographical accessibility and
ability to understand influence
uptake of the vaccine.

8 Increase the trust and confidence

of the respondents by increasing
the reliability and competence of
healthcare professionals, health
services and/or the motivation of
policy makers who make decisions
about vaccines.

9 Social media intervention to

increase the uptake of all vaccines.

10 Provision of communication tool-

based training for health care
workers.

11 The application of mass media to

target parents with low levels of
awareness of health services as an
effective intervention.
 63

Appendix B.
Curriculum Vitae

Arabella B. Isles
133 Central Red-V, Ibabang Dupay,
Lucena City
arabellaisles14@gmail.com
"Dreaming today, making it real
tomorrow."

Personal Information

Date of Birth: November 14, 2003

Place of Birth: Lucena City
Age: 17 years old
Nationality: Filipino
Civil Status: Single
Religion: Roman Catholic
Citizenship: Filipino

Educational Background

Secondary: Quezon National High School

M.L. Tagarao St., Ibabang Iyam, Lucena City
2016 - present
Primary: Lucena East 8 Elementary School
Purok Little Baguio 1, Ibabang Dupay, Lucena City
2010 - 2016
 64

Sofiah Illyzah G. Marquez

Acacia Street, Villa Juliana Subd., Brgy. Ibabang Dupay,

Red-V, Lucena City

sofiahillyzahm22@gmail.com
"Running with endurance the race that is set before me.” me"

Personal Information

Date of Birth: February 10, 2004

Place of Birth: Lucena City
Age: 17 years old
Nationality: Filipino
Civil Status: Single
Religion: Born Again
Citizenship: Filipino

Educational Background

Secondary: Quezon National High School

M.L. Tagarao St., Ibabang Iyam, Lucena City
2016 - present
Primary: Lucena West 1 Elementary School
M.L. Tagarao St., Ibabang Iyam, Lucena City
2012 - 2016
 65

Arabella Q. Lagaya
Purok Anak Bagong Sinag, Barangay Cotta,
Lucena City
allebara10@gmail.com
“Believing in yourself is the first secret of
success."

Personal Information

Date of Birth: October 10, 2003

Place of Birth: Lucena City
Age: 17 years old
Nationality: Filipino
Civil Status: Single
Religion: Roman Catholic
Citizenship: Filipino

Educational Background

Secondary: Quezon National High School

M.L. Tagarao St., Ibabang Iyam, Lucena City
2016 - present
Primary: Lucena East 3 Elementary School
Purok Sampaguita I, Barangay X, Lucena City
2010-2016
 66

Appendix C.
Consent Form

Informed Consent Form

You are being invited to take part in a research study. Before you decide to participate in
this study, it is important that you understand why the research is being done and what
your participation will involve. Please read the following information carefully and feel
free to ask the researcher/s if there are words, concepts, and proceedings written in this
form that is not clear or if you need more information about the study. You may take time
to reflect on whether you want to participate or not.

STUDY TITLE

Immunity Vs. Tolerance: Factors Influencing Selected Parents’ Decision on COVID-19

Vaccination in Lucena City

PURPOSE OF THE STUDY

The study aims to examine the perspective of selected parents of senior high school
students in Lucena City regarding the COVID-19 vaccination on their child. Specifically,
the researchers seek to (1) determine the proportion of the different decisions made by
the respondents; (2) assess the factors considered by the respondents on their decision;
and (3) find possible solutions/strategies that will address problems regarding the
vaccination decision-making among the respondents. You have been chosen as one of
the participants of the study because limited studies and researchers had focused on the
perception of parents on their child’s COVID-19 vaccination. Thus, the parents of senior
high school students in Lucena City will be the main target population of this study.

PARTICIPANT INVOLVEMENT

If you choose to participate in the study, you will be asked for a written informed consent
whereas the protocols and ethical considerations for the respondents will be briefly
discussed. A link for the google forms that contain the questionnaire necessary for this
study will be sent to the respondents once the consent is done. The questions are all
aligned to the aforementioned objectives of this study. This is a self-administered
questionnaire which means that this will be completed by the respondents without
intervention of the researchers collecting the data.

DURATION

Involvement in the study may last ten (10) minutes which involves the reading and
completing of the informed consent and the answering of the designated questionnaire.

PARTICIPATION
 67

Participation in this study is voluntary. It is up to you whether or not you decide to

participate. If you decide to participate, you will be asked to sign this consent form. After
you sign this consent form, you are still free to withdraw prior to the completion of the study
and without giving a reason.

RISKS

You may refuse to answer any questions or items if you feel uncomfortable. Your
participation in the study shall be in your most comfortable time and place as long as it will
not dampen the purpose of the study. The main potential risk of this study to subjects is
physical risks wherein the respondent may experience a sudden eye strain due to
exposure to radiation. In case you felt unease during the conduct of the study, feel free to
withdraw your participation or to reschedule the data gathering.

BENEFITS

The information you will provide will have significant contributions on addressing various
vaccine phenomena such as vaccine hesitancy which delays the achievement of herd
immunity in our country. You will also be of big help in providing an in-depth,
comprehensive, and a detailed explanation on the different insights, opinions, beliefs or
even perception of an individual to other people in the community. With your participation
you will also receive a certificate of participation as part of the researchers’ manifestation
of gratitude for your kind cooperation in this study.

CONFIDENTIALITY

Any information about yourself and data you have provided in this research will be
confidential. In return, you shall maintain confidentiality of other research participants and
data you have shared in this study. You may access only the information you have shared.
All other research data will only be accessed by the researcher/s and research supervisor.
The data will be strictly kept by the researchers in place to protect the privacy of
participants and their information from unauthorized use, access, and publication.
Moreover, the researchers will protect personally identifiable information and only those
necessary data which will answer the objectives of this study will be published. Rest
assured that the responses will be named anonymously.

CONTACT INFORMATION

This study was approved by the Ethics Review Board of Quezon National High School. If
you have any concerns, you may contact the researchers through their mobile numbers
(0951-868-6263 and 0921-876-5432). Likewise, the researchers may reach you through
this number (0947-123-4567).
 68

CONSENT

[This section is mandatory]

I have read the provided information, or it has been read to me. I have had the opportunity
to ask questions and clarify things about the involvement in the study. Queries I have
raised have been answered to my satisfaction. I understand that I will be given a copy of
this form, and the researcher will keep another copy on file. I consent voluntarily to be a
participant in this study.

____ Being over the age of 18 years old or legally independent, I hereby consent to
participate in this study.

____ *Being under/18 years old, I hereby invoke parental consent to participate in this
study.

________________________________ ________________________________
Participant Parent / Guardian

(Date: __________________________) (Date:__________________________)

ARABELLA B. ISLES ARABELLA Q. LAGAYA SOFIAH ILLYZAH G. MARQUEZ

Lead-Researcher Co-Researcher Co-Researcher

[If the participant is illiterate]

I have witnessed the accurate reading of the consent form to the potential participant, and
the individual has had the opportunity to ask questions. I confirm that the individual has
given consent freely.

_____________________________ ______________________________
Participant Signature/Thumbmark Witness

(Date: __________________________) (Date: __________________________)