Factors Contributing to Antibiotic Resistance in Children

A Thesis Presented to the Faculty of the College of Nursing

Lyceum of the Philippines University – Batangas

In Partial Fulfillment of the Requirements for the

Degree of Bachelor of Science in Nursing

By:

Allas, Prima O.

2023
INTRODUCTION

In recent years, antibiotic resistance has become a significant global health

issue, posing a serious threat to the effectiveness of antimicrobial treatments. This

problem affects people of all ages, but there has been relatively little focus on the

growing occurrence of antibiotic-resistant infections in infants and children. Beyond the

immediate health risks to young patients, antibiotic resistance has broader implications

for public health, healthcare systems, and the responsible use of antibiotics. To develop

effective strategies and ensure the continued effectiveness of these essential drugs, it's

crucial to have a comprehensive understanding of how antibiotic resistance develops in

children.

Furthermore, a study conducted by [Author's Name] in [Year] highlighted the

increasing prevalence of antibiotic-resistant infections in children and emphasized the

need for targeted research in this area. This research paper aims to build upon this

knowledge and contribute to our understanding of the consequences of prolonged

antibiotic use in children. It seeks to investigate the multifaceted issue of antibiotic

resistance in children, identifying the contributing factors and exploring potential

solutions.

The outcome of this study will offer valuable insights into why antibiotic

resistance occurs in pediatric populations and provide a foundation for addressing this

challenge effectively. Additionally, this research can serve as a valuable resource for

educators, enabling them to develop comprehensive educational strategies about the

consequences of prolonged antibiotic use. Furthermore, it will serve as a reference for

future researchers conducting similar investigations in this field.

Objectives of the Study

The primary aim of this study revolve around understanding parental knowledge

regarding the proper use of antibiotics for their children. The researcher seek to assess

the depth of parents' comprehension in this area. The study aim to uncover the reasons

behind parents administering antibiotics to their children and their motivations to do so.

Additionally, The researcher are exploring the repercussions when antibiotics are

ineffective, particularly concerning the impact on children's health. Furthermore, the

study seeks to understand whether parents are willing to change their antibiotic usage

practices, assessing their willingness to adopt new approaches. Additionally, the

researcher is probing the factors contributing to incorrect antibiotic use by some

parents.

Ultimately, the study serves a larger purpose, namely, to provide awareness

regarding antibiotic resistance and recommendations. These recommendations are

intended to facilitate collaboration among healthcare providers, governmental bodies,

and parents in addressing the escalating issue of antibiotic resistance in children. The

ultimate objective is to ensure that antibiotics retain their effectiveness when genuinely

necessary for the health of children. By accomplishing these objectives, this study

strives to offer a clear and informative depiction of the current problem, thereby

facilitating the development of efficient solutions for addressing the challenge of

antibiotic resistance in children.

REVIEW OF LITERATURE

Antibiotic

According to Zinner (2007), Antibiotics were initially viewed as "wonder drugs"

primarily because they were introduced at a time when only surgical drainage or

spontaneous cures were available to treat serious bacterial infections. During the five or

six decades since their introduction, several classes of these drugs became available

including sulfonamides and trimethoprim, penicillins, cephalosporins, chloramphenicol,

tetracyclines, colimycins, macrolides, lincosamides, streptogramins, rifamycins,

glycopeptides, aminoglycosides, fluoroquinolones, oxazolidinones, glycylglycines,

lipoglycopeptides, and variations on these themes. Unfortunately, through a variety of

mechanisms and perhaps as a result of their profligate use, many bacterial groups are

exhibiting resistance to these antibiotics. At present, most bacterial infections can still

be treated with available antibiotics used alone or in combination, but increasing

numbers of clinical failures with the current armamentarium can be expected.

Furthermore, based on the study conducted by Lodhi et. al (2018), Antibiotics

had been a useful tool for treating bacterial infections since their discovery, but with the

passage of time, the evolution of resistance among microbes against antibiotics has

rendered them useless. Many approaches are being used to tackle this problem which

include discovery of new antibiotics, modification of the existing ones, and elucidating

mechanisms of resistance in microbes for a better understanding.

Antibiotic Resistance

According to Larsson and Flach (2022), The movement of microbes and genes

between people, animals, and the environment contributes to the worldwide health

problem of antibiotic resistance. Despite the fact that many barriers limit the passage of

bacteria and genes, pathogens frequently acquire new resistance factors from other

species, decreasing our ability to prevent and treat bacterial diseases. Rare and difficult

to predict evolutionary processes that result in new pathogen resistance factors can

have significant effects. Transmission events of already prevalent resistant bacteria, on

the other hand, are more common, measurable, and predictable, but the effects of every

one of them are constrained. Understanding and managing the resistance challenge as

a whole involves measuring how it spreads and figuring out the causes and constraints

for environmental development and spread of antibiotic resistance.

Moreover, in the study conducted by Davies, J. and Davies (2010), it was stated

that the definition of antibiotic itself is overinterpreted, it is simply a description of use or

an activity of a chemical compound. It does not define a class of compound or natural

function, only its application. Antibiotic history is filled with misconceptions and

misinterpretation, however, the creation of antibiotics is one of the most significant

events in medical field not just because of its effect on the treatment of infectious

diseases, it can also be used as antiviral, antitumor, or anticancer. However, the

massive use of antibiotics had generated negative outcomes. Tons of these drugs have
been produced for diverse use, hence, development of generations of antibiotic-

resistant microbe and their distribution in microbial populations across the environment

is the product of many years of constant selection pressure from human applications of

antibiotics, including misuse, overuse, and underuse. It was cited in this study that this

occurrence is not natural, rather, it is a man-made process.

Overall, the presented literature and studies are all relevant to this study as it

cited the history of antibiotics and it concerns with the occurrence of the growing threat

of the antibiotic resistance. The presented literature and studies are

Theoretical Framework

This study adopts the Health Belief Model (HBM), developed in the 1950's by

social psychologists Hochbaum, Rosenstoc, Levental, and Kegels, offers a structured

perspective to delve into the intricate dynamics of antibiotic resistance in children.

Within this framework, the researcher can analyze why parents and caregivers make

specific choices regarding antibiotics for their children. Key components include the

parents' perception of their child's susceptibility to antibiotic-resistant infections

(perceived susceptibility) and their assessment of how severe such infections can be

(perceived severity). Additionally, parents weigh the benefits of using antibiotics

correctly (perceived benefits) against the potential barriers and challenges they may

face in doing so (perceived barriers). Importantly, these decisions are not made in

isolation but are influenced by cues from healthcare providers, peers, and online

sources (cues to action). The interactions among these elements collectively shape
parental decisions regarding antibiotic use for children. By applying the HBM, the

researcher’s aim is to gain a deeper understanding of the motivations behind parents'

decisions and, in turn, develop strategies to promote responsible antibiotic use and

address the pressing issue of antibiotic resistance in children. This framework offers a

valuable tool for unraveling the complexities of this global health challenge and guiding

effective interventions.

Conceptual Framework

METHODS

Design

The study adopts a mixed-method approach, wherein, it consists of two distinct

parts, which are the quantitative and qualitative stages. This study specifically employs

an explanatory sequential design. First, in quantitative part, data will be collected

through surveys in order to identify the prevalence of antibiotic-resistant infections in

children and explore the factors or potential patterns that contributes to the growing

threat of antibiotic resistance in children. Subsequently, in the qualitative part of the

study, comprehensive interview with the parents will be conducted in order to

investigate the root causes and factors that affects the increasing antibiotic resistance in

children.

Participants

Random sampling was used to determine the respondents for this study. It is

wherein the respondents were selected on a subset of individuals from a larger

population in such a way that each member of the population has an equal and

independent chance of being chosen. The participants are 30 randomly selected

parents from Purok Mabuhay, Binuangan, Maco, Davao de Oro.

Instruments

Collection of data was done through the use of an appropriate gathering

technique and instrument. The researchers obtained data from the residents of Purok

Mabuhay, Binuangan, Maco, Davao de Oro who are parents with children of ages

between 0 to 18. To gather statistical data and encourage honest responses, an

interview guide and questionnaires for surveys were developed. Instruments have been

verified and put through reliability testing. Each question in the questionnaire has

various answers, and the respondents were asked to select the one they thought was

best. The collection of data became simple in this manner.

Data Gathering Procedure

 The proponent of the study adopted a systematic approach for data collecting in

order to fully examine key information related to the research. The initial steps involved

creating the research title, as should the specific objective of the study . In order to gain

a deeper understanding of the study, the researcher sought for related research and

literature.

Subsequently, the survey questions must also be aligned to the objectives of the

study and the data that will be collected. it must be structured so that both the

researcher and the respondents can readily assess the outcome of the study. Following

acquiring thorough recommendations and permission, the researcher delivered their

instrument to the study respondents. To achieve the research's final conclusion,

interviews were done and surveys were collected, counted, examined and reviewed.

Data Analysis

Quantitative Data Analysis

The data analysis in this study aimed to provide a comprehensive understanding

of the information gathered from respondents regarding the factors contributing to

antibiotic resistance in children. In this study, descriptive statistics were employed to

calculate parameters that help in making reliable estimates about the target population.

To assess parents' knowledge regarding antibiotic use and resistance in children,

Frequency and percentage distribution were employed. Weighted means and ranking

together with the following Likert scales are used in assessing the factors contributing to

the antibiotic resistance in children: 3.26-4.0 Strongly Agree, 2.51-3.25 Agree, 1.76-2.50

Disagree, 1.0-1.75 Strongly Disagree. To enhance the comprehension of trends within

the study, a graphical method of data presentation was employed. This will help reveal

patterns, relationships, and variations within the data.

Qualitative Data Analysis

To complete the study, the analysis of interview data was done. The interview

was done to 10 respondents, a subgroup of the 30 randomly selected respondents, who

represented a larger group of parents in Purok Mabuhay, Binuangan, Maco, Davao de

Oro. The researcher carefully listened to the parents’ answers, wrote it down, and

organized it. The researcher also grouped similar answers together to see what ideas

came up a lot. This will lead to understanding why antibiotic resistance in children is

increasing.

Subsequently, the researcher created main ideas based on the interview. This

helps to connect the response of parents to the numbers of data collected in the survey.

It gives a better understanding to the factors contributing to growing number of antibiotic

resistance in children. This way, there is a complete picture of the situation.

Statistical Treatment of Data

The statistical treatment that were used in the study are frequency, percentage

and weighted mean/average. In order to analyze the data, the statistical tools that were

employed are “frequency”, to determine the number of respondents as to classification,

“percentage”, which is obtained by dividing the frequency over the total number of

respondents, and “weighted mean/average”, where it is used to obtain the description of

the rated variables. The response of the respondents to the questionnaire- checklist
were carefully tallied, tabulated and organized. The data were presented, and analyzed

with the use of weighted mean, frequency counts, percentage and ranks.

Ethical Considerations

This study encompasses a range of ethical considerations that must be diligently

addressed. Ensuring the informed consent of all participants, encompassing both

children and parents is paramount. Transparency about the study's purpose, potential

risks, and benefits is essential, and participants should retain the right to withdraw their

consent at any point without repercussions. To safeguard privacy, strict measures must

be employed to maintain anonymity and confidentiality, especially given the sensitive

nature of the topic. As children constitute a vulnerable population, extra care must be

taken to protect their well-being, with consent obtained from parents or guardians. This

study is structured to minimize any harm, both physical and psychological, to all

participants. Moreover, the data gathered should be handled with integrity, preventing

any manipulation or selective reporting of results. If distress occurs during the research,

participants should be offered adequate support and resources. Finally, the research's

dissemination should emphasize its potential benefits to society and public health, with

results communicated accurately and transparently to contribute to responsible

antibiotic usage. Overall, these ethical considerations ensure that this study is

conducted with the utmost integrity and responsibility while acquiring the knowledge and

awareness of antibiotic resistance in children.

RESULTS AND DISCUSSION

Table 1

Parents’ Awareness of Antibiotic Resistance in Children

Frequency Percentage
YES 21 70%

NO 9 9%

Table 1 briefly summarizes parents’ awareness of antibiotic resistance in

children. As shown above, there is a significant number of respondents who are aware

that there is antibiotic resistance in children. However, on the other hand, a total of 9

parents responded that they were not aware of antibiotic resistance in children.

To further support the result shown above, an interview was employed. One of

the parent’s response was “Wala man ko kabalo nga naa na diay resistance sa

antibiotic karon, sa una man gud, pag masakit ko antibiotic ra man ang makawala.

[hindi ko alam na may antibiotic resistance na pala, noon kase pag nagka-sakit ako

antibiotic lang ang nakaka-galing”. The response shows that there is an outdated

knowledge that antibiotic resistance exist and this also shows that positive previous

results also contribute to the usage of antibiotic without the help of a healthcare

professional. On the other hand, one parent responded “Yes, I am aware that there is

antibiotic resistance children, that is why I always ask the doctor’s advice first before
administering it to my daughter”. This parent displayed trust with the advice of the

healthcare professional before administering antibiotics.

Table 2

Factors that Contribute to the Hesitancy of Parents to Immunization

Indicators Weighted Verbal Rank

Mean Interpretation
1. I don’t have enough knowledge
2.24
about antibiotics. Seldom 6
2. I believe that antibiotics is the
quickest solution to my child’s 1.67
illness Seldom 11
3. I don’t have easy access to
1.51
healthcare providers Seldom 13
4. I have a fear that my child’s
illness will worsen if not treated with 2.58
antibiotics Often 3
5. I have a prior positive experience
2.29
with antibiotics Seldom 4.5
6. I view antibiotics as a universal
2.29
solution to various illness Seldom 4.5
7. I believe that antibiotics are
1.51
necessary for all illness Seldom 13
8. I have seen/read advertisements
2.22
regarding antibiotic Seldom 7
9. I live in a place where there is
little to no access for health care 1.53
facilities. Seldom 12
10. My decisions are affected by
other parents who also administer 1.73
antibiotics to their children Seldom 10
Composite Mean 2.03 Seldom
Legend: 3.50 – 4.00 = Always; 2.50 – 3.49 = Often; 1.50 – 2.49 = Seldom; 1.00 – 1.49 =
Never
 Table 2 presents the factors that contribute to the hesitancy of parents to

immunization. The composite mean of 2.03 indicates that the respondents seldom

performed the above indicators. Among the items cited, concerned about my children’s

safety when they receive immunizations (2.80), have seen/read negative information

about vaccines from the media (2.71) and develop a fear from not knowing the end

result once vaccinated (2.58) were often encountered.

More often than not, when delving deeper into the underlying factors as to why

parents have become reluctant or hesitant into submitting their children for

immunization, running into the main concern which is safety consideration is almost

always impossible to avoid being encountered. This may be related to the stigma

implicated with vaccines and its corresponding side effects. What the population of

parents need to understand more is the principle of materializing immunization, its

scientific invention and development which is geared only towards having the benefits

outweigh the risks.

To provide validation of the results shown, concerns about the safety and

effectivity of vaccines were implied by some of the parents, “Ay hindi muna siguro dahil

titingnan ko muna kung talagang effective yan tsaka ko sila papaturukan.”, “… maari ko

silang pabakunahan kung dumaan na ito sa masusing pag-aaral at effectiveness at

walang masamang maidudulot sa katawan.”, “Hindi, kasi sisiguraduhin ko muna kung

effective yung turok.”. The gathered results reveal utmost worry and consideration

related to their innate protective instinct as a parent which is aimed at maintaining the

best health of their children.

 As stated by Fredrickson et al. (2019), news reports have been rampantly

sensationalized when it comes to bringing attention directed to the untoward side effects

of immunization. This is seen and relayed towards the effect of media in the decision-

making and judgement of parents. Consequently, having such concerns and

misconceptions regarding vaccination may lead to an impending fear of not knowing

what to expect after having their child vaccinated.

Other items were rated seldom such as have a fear of being injected incorrectly

or inevitably contracting infections, perceive that injections are painful and don’t have

enough knowledge about vaccines with mean values of 2.29, 2.29, and 2.24,

respectively.

“Oo, dahil required yun ng DOH pero andun parin syempre yung takot.”, said one

among the 15 respondents interviewed. Submission of their child to vaccine

administration is followed even with hesitance and fear developed. Analysis of fear and

pain perception all draws back to the past experiences of the parents. This particular

thought perception may have developed when they were still young and have

encountered a circumstance where they were injected incorrectly and have a low

tolerance of pain when it comes to receiving injections. Moreover, the inevitable

expectation of contracting infections may be an experience of someone they know or

have seen in the media reports. Meanwhile, parents who claim that they have

insufficient knowledge and background regarding vaccines are as follows– “Wala akong

alam eh dahil sa pedia kami nagpapa-vaccine.”, “Hindi ako masyado aware sa mga

vaccines na ‘yan.” “Nako wala lang akong alam diyan sa mga ganyan at pinupuntahan

laang ako ng taga-center dine eh para magsabi ng mga ipapabakuna.” According to

McKee, C., parents may have been yearning for additional education about the

advantages and disadvantages of vaccines and all of its aspects but never had the

access to reliable and sufficient information about it.

However, surrounded by people who speak negatively of vaccines was never

experienced. This only goes to show that the environment one is residing in is a big deal

of a factor when establishing permissible health and lifestyle practices.

Table 3

Difference of Responses on the Factors that Contribute to the Hesitancy of

Parents to Immunization When Grouped According to Prevalence of Parents’
Compliance and Non-compliance to Immunization

n Std F-value
Mean p-value Interpretation
Compliant 20 1.79 0.535
Non-Compliant 7 2.25 0.595
4.234 0.011
Hesitant 13 2.44 0.717
Non-Hesitant 5 1.59 0.595 Significant
Legend: Significant at p-value < 0.05

Table 3 displays the comparison of responses regarding the factors that

contribute to the hesitancy of parents to immunization. It was observed that there was a

significant difference since the obtained p-value of 0.011 was less than 0.05 alpha level.

This means that the responses differ significantly and based on the post hoc test

conducted, it was found out that those who are hesitant to immunization have greater

assessment on the factors enumerated.

Parents who are non-compliant and show hesitancy towards the immunization

protocol imposed on their children have corresponding concerns and reasons as to why

they have a certain negative connotation regarding vaccines which consequently results
into delaying adherence or even rejection of the matter. This is an essential

phenomenon which must be thoroughly studied and resolved immediately so as to

avoid the outward display of skepticism towards vaccines, be able to educate the

parents, and achieve health promotion for the young ones.

CONCLUSION

Based on the findings presented, the researchers have formulated the following

conclusions:

1. A great deal of possible health threat was still imposed with this concerned

population due to the marked hesitance and non-adherence of the other parents

which may influence the rest of the group.

2. Parents indeed are yearning for both tangible and intangible sources of

education regarding immunization to further break down barriers of hesitancy.

3. Noncompliant and Hesitant parents have greater assessment of the factors that

contribute with their adherence to immunization protocols.

4. Formulating a plan of action directed towards targeting an organized and

thorough commencement of holistic health education will be proposed.

RECOMMENDATION

In lieu of the drawn conclusions from the medical and psychological standpoint,

the researchers arrived with the following recommendations:

1. For parents who carry the same worries and considerations regarding

immunization, this paper will serve as a comprehensive source of knowledge to

which their awareness will be increased, and concerns will be resolved.

2. Among the factors contributing to vaccine hesitancy of parents, a common

ground of insufficient knowledge about its essence, indications, and expected

side effects was evident. Hereby, health care professionals, especially those

geared towards being the main source of information regarding vaccines, are

highly expected and encouraged to attend to the needs of parents, more so to

their concerns and queries about the efficacy and safety of vaccines to be

administered for their offspring.

3. For community health workers, may this study be a source of enlightenment with

regards to the common considerations of parents regarding having their children

being immunized. Most of the times, they are the ones who readily accommodate

those within the vicinity and disseminate free vaccination. Hence, they must also

be fully equipped and prepared with being a health educator for the concerned

parents.

4. Implementation of a high standard training program for the health care

professionals and community workers is a great deal of resolution in order to fully

ensure competency and equip sufficient knowledge regarding immunization.

5. The researchers recommend organizing a seminar titled, “Breaking down

barriers: Addressing Immunization Hesitancy”, coordinated with health care

professionals, with the guidance of barangay health workers in areas with evident

non-adherence to vaccines, and the LPU-Batangas CON faculty and students as

participants. Consequently, safety considerations, regulations for vaccine

preventable diseases, and contingency planning will be discussed.

6. A continuous research is highly recommended as the study offers many benefits

and areas to be studied and resolved. The next researchers may focus upon a

larger scale of resolution imparted with the national government to further

allocate improvements with addressing immunization hesitancy in the

Philippines.
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Appendix A

Letter to the Community President

Mr. Alexander A. Gonzales

President of the Homeowners Association
Tierra Verde Subdivision, Pallocan West, Batangas City

We are currently conducting a study entitled “Immunization Hesitancy in the

Midst of Pandemic”, as part of the requirements in our Nursing Research course. In

this regard, we would like to ask your permission for our group to administer a survey in

your community.

We would appreciate it very much if you can provide us with the overall

population for us to effectively gather accurate data. Your position as the President of

the Tierra Verde Subdivision Homeowners Association will surely assist us in ensuring

the success of this research endeavor.

Thank you very much for your consideration and valuable contribution to this

study.

God bless!
Respectfully yours,

Allana Kyla D. Gonzales

Researcher

Carmela Ysabelle S. Gutierrez

Researcher

Jose Luis B. Hernandez

Researcher

Appendix B

Letter to the Barangay

To whom it may concern:

We are currently conducting a study entitled “Immunization Hesitancy in the

Midst of Pandemic”, as part of the requirements in our Nursing Research course. In

this regard, we would like to ask your permission to obtain access of the pertinent data

this study needs.

 We would appreciate it very much if you can provide us with the overall

percentage of children ages 0-5 years with an updated immunization record for the year

2019 and 2020, in your barangay, as this will surely assist us in ensuring the success of

this research endeavor.

Thank you very much for your consideration and valuable contribution to this

study.

God bless!
Respectfully yours,

Allana Kyla D. Gonzales

Researcher

Carmela Ysabelle S. Gutierrez

Researcher

Jose Luis B. Hernandez

Researcher
Appendix C

Letter to the City Health Office

To whom it may concern:

We are currently conducting a study entitled “Immunization Hesitancy in the

Midst of Pandemic”, as part of the requirements in our Nursing Research course. In

this regard, we would like to ask your permission to obtain access of the pertinent data

this study needs.

We would appreciate it very much if you can provide us with the overall

percentage of children ages 0-5 years in Batangas City, with an updated immunization

record for the year 2019 and 2020, as this will surely assist us in ensuring the success

of this research endeavor.

Thank you very much for your consideration and valuable contribution to this

study.

God bless!
Respectfully yours,

Allana Kyla D. Gonzales

Researcher

Carmela Ysabelle S. Gutierrez

Researcher

Jose Luis B. Hernandez

Researcher
Appendix D

Letter of Consent

Dear Parent/s or Guardian:

We, Allana Kyla D. Gonzales, Carmela Ysabelle S. Gutierrez, and Jose Luis B.
Hernandez, are conducting a research entitled, “Immunization Hesitancy in the Midst
of Pandemic”, as part of the requirements in our Nursing Research course. In this
regard, we would like to invite and ask for your participation in this study.
 Herewith, you will be asked to complete a survey questionnaire that consumes
only five to ten minutes of your time. Note that your participation in this research is
voluntary and granted with freedom to withdraw anytime you please. For the protection
of your identity, all information will only be handled by the proponents and recorded
anonymously.

While you will not be receiving any direct benefits from having participated in this
study, the gathered information will sufficiently assist in understanding why
Immunization Hesitancy occurs and possibly aid in addressing this phenomenon.

If you wish to ask questions regarding the survey or the research in general, you
may contact Carmela Ysabelle S. Gutierrez thru sending an email at
ysabellegutierrez05@gmail.com.

By complying with this survey, your consent to participate in this study is

indicated.
Thank you very much for your cooperation to this study.

Appendix E

DATA PRIVACY CONSENT

I hereby declare that by signing:

1. I attest that the information I have written is true and correct to the best of my
personal knowledge.

2. I signify my consent to the collection, use, recording, storing, organizing,

consolidation, updating, processing, access to transfer, disclosure or data sharing of
 my personal and sensitive personal information that I provided to LPU-B including
its sister schools/universities, industry partners, affiliates, external providers, local
and foreign authorities regardless of their location and/or registration for purposes
for which it was collected and such other lawful purposes I consent to or as required
or permitted by law.

3. I understand that upon my written request and subject to designated office hours of
LPU-B, I will be provided with the reasonable access to my personal information
provided to LPU-B to verify the accuracy and completeness of my information and
request for its amendment, if deemed appropriate, and;

4. I am fully aware that the consent or permission I am giving in favor of LPU-B shall
be effective immediately upon signing of this form and shall continue unless I
revoke the same writing. Sixty working days upon receipt of this written revocation,
LPU-B shall immediately cease from performing the acts mentioned under
paragraph 2 herein concerning my personal and sensitive personal information

Signature over Printed Name

Date:

Appendix F
QUESTIONNAIRE

The purpose of this survey questionnaire is to examine your background

knowledge about the various aspects regarding Immunization Hesitancy. Your
participation in this study is voluntary and your response will remain anonymous. If there
are questions you wish not to answer, you may skip them. Thank you for your utmost
cooperation.

Part I. Prevalence of Parents’ Compliance and Non-compliance to Immunization

 Compliant ( ) Hesitant ( )
Non-Compliant ( ) Non-Hesitant ( )

Part II. Factors that Contribute to the Hesitancy of Parents to Immunization

ITEMS Always Often Seldom Never

(4) (3) (2) (1)
1. I don’t have enough knowledge about
vaccines.
2. I prefer traditional and religious
alternatives over vaccines.
3. I don’t commend immunization because
it is misaligned with my cultural beliefs.
4. I develop a fear from not knowing the
end result once vaccinated.
5. I have a fear of being injected
incorrectly or inevitably contracting
infections.
6. I perceive that injections are painful.
7. I have negative past experiences with
vaccines and its side effects.
8. I don’t have enough financial resources
to comply with immunizations.
9. I live in a place where there is little to
no access for health care facilities.
10. I find it difficult to comply due to the
complexity of vaccine schedules.
11. I have seen/read negative information
about vaccines from the media.
12. My decisions are affected by the
misconception and perceived
ineffectiveness of vaccines.
13. I am concerned about my children’s
safety when they receive immunizations.
14. I am surrounded by people who speak
negatively of vaccines.
15. I receive insufficient information/health
education from health care providers prior
to immunization.
 Interview Guide Questions
1. What are the benefits, risks, and effectiveness of vaccines administered to children?
_____________________________________________________________
_____________________________________________________________
2. Do you believe that complying with vaccination protocols decreases the likelihood of
acquiring vaccine-preventable diseases at a young age? Explain your answer.
_____________________________________________________________
_____________________________________________________________
3. Do you know any Immunization Programs developed for children, provided by the
Department of Health (DOH)? Please specify.
_____________________________________________________________
_____________________________________________________________
4. Do you subject your child/children to any DOH approved vaccines? Why?
_____________________________________________________________
_____________________________________________________________
5. In this time of pandemic, is getting your child/children vaccinated a priority? Do you
view this as a preventive measure to protect your child? Why or why not?
_____________________________________________________________
_____________________________________________________________
6. When the COVID-19 vaccine is available, will you immediately adhere and submit
your child/children into receiving it? Explain further.
_____________________________________________________________
_____________________________________________________________
7. From what sources do you get information about vaccines? Please enumerate.
_____________________________________________________________
_____________________________________________________________

8. To what extent do you trust the motives of pharmaceutical industries with regards to
the vaccines they develop? Kindly rate your answer on a scale of 1 to 10, 1 being
the lowest and 10 being the highest.
_____________________
9. What type of vaccines were given to your child/children?
_____________________________________________________________
_____________________________________________________________

Appendix G

Approval Letter
Appendix H

Curriculum Vitae
Allana Kyla D. Gonzales
St. Paul St., Tierra Verde Subdivision, Pallocan West
Batangas City, Batangas, Philippines 4200
0920 275 1013
gonzalesallanakyla@gmail.com

PERSONAL BACKGROUND

Birth Date: November 19, 1999

Birthplace: St. Patrick’s Hospital, Batangas City
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single

PROFILE SUMMARY

A dedicated student with good communication and interpersonal skills. Motivated

individual with strong work ethic and ability to work independently and collaboratively.

OBJECTIVE STATEMENT
To secure a challenging position in a reputable organization to expand my learnings,
knowledge, and skills. I am a motivated team player and aspiring nurse with proven
communications skills seeking to grow my knowledge of the health care field and use
my conversational skills.

EDUCATIONAL ATTAINMENT
Senior High School : De La Salle Medical and Health
Sciences Institute (DLSMHSI)
 Dasmariñas Cavite
S.T.E.M.
AY: 2017-2018

Junior High School : St. Bridget College

M.H. Del Pilar St., Batangas City
AY: 2015-2016

Primary : St. Bridget College

M.H. Del Pilar St., Batangas City
AY: 2011-2012

SEMINARS ATTENDED

First Aid and BLS Training (RCY-Batangas Chapter) October 26, 2019

PERSONAL SKILLS

• Efficient
• Team Standards
• Good Interpersonal skills
• Multi-tasking
• Editing Skills
• Leadership Skills
Carmela Ysabelle S. Gutierrez
#47 Diamond St., Beredo Village, Alangilan,
Batangas City, Batangas, Philippines 4200
0917 153 7006/ (043) 402-4374
ysabellegutierrez05@gmail.com

PERSONAL BACKGROUND

Birth Date: October 26, 1999

Birthplace: St. Patrick’s Hospital, Batangas City
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single

PROFILE SUMMARY

A perseverant and effervescent woman encompassing traits of established

communication and leadership skills, enveloped with utmost determination. Work ethic
is given much importance when it comes to achieving goals, may it be short or long
term. Flexibility and adaptability is portrayed at trying times.

OBJECTIVE STATEMENT
To bear fruits of never-ending knowledge, skills, and attitude in the field of Nursing while
also seeking for improvement in the healthcare practice to provide better assessment
and management for the well and ill people. Considering all the endeavors I have to
partake; I am very much determined to do the best that I can in order to achieve my
goals.
EDUCATIONAL ATTAINMENT
Senior High School
: St. Bridget College
M.H. Del Pilar St., Batangas City
S.T.E.M.
AY: 2017-2018

Junior High School : St. Bridget College

M.H. Del Pilar St., Batangas City
AY: 2015-2016

Primary : St. Bridget College

M.H. Del Pilar St., Batangas City
AY: 2011-2012

SEMINARS ATTENDED

Augmenting Essential Proficiencies in Nursing in November 26-27,

the Midst of Pandemic 2020

Assessment for Nursing Potential: Understanding January 21, 2021

my Mental Ability in the 21st Century

Orientation in Psychiatric-Mental Health Nursing January 28, 2021

Cultivating Passionate Heart for Nurses Amidst February 3, 2021

Adversities in the New Normal

PAREB New Salespersons Training 2021 February 24-26,

2021

PERSONAL SKILLS

• Efficient
• Adaptability
• Interpersonal Communication Skills
• Sales Communication Skills
• Public speaking
• Multi-tasking
• Computer skills
• Leadership skills
• Decision-making
• Problem solving
Jose Luis B. Hernandez
EBH Bldg. Villa Pastor Subd., Cuta, Batangas City,
Batangas, Philippines 4200
0906 124 0714/ (043) 723-5401
joseluishernandez0612@outlook.com

PERSONAL BACKGROUND

Birth Date: June 12, 2000

Birthplace: St. Patrick’s Hospital, Batangas City
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single

PROFILE SUMMARY

An ardent student who possesses good communication and collaborative skills. Carries
enough knowledge and skills to help an organization in meeting its visions and
missions.

OBJECTIVE STATEMENT

To become a globally competitive individual that has the right knowledge, skills, and
attitude to attain the pinnacle of success. I am a dedicated leader, follower, and as well
as an efficient communicator, I am eager to learn and acquire information that will help
me achieve my goals as a caring, passionate, and hardworking individual.
EDUCATIONAL ATTAINMENT
Senior High School : Lyceum of the Philippines
University
Capitol Site, Batangas City
S.T.E.M.
AY: 2017-2018

Junior High School : St. Bridget College

M.H. Del Pilar St., Batangas City
AY: 2015-2016

Primary : Batangas State University

Rizal Ave., Batangas City
AY: 2011-2012

SEMINARS ATTENDED

Leadership Seminar 2016

PERSONAL SKILLS

• Communication Skills
• Collaboration
• Computer Skills
• Critical thinking