Knowledge Behavior Attitude of Teenage Pregnant Women On Reproductive Health

CHAPTER 1
THE PROBLEM AND ITS SCOPE
INTRODUCTION
Rationale
Every pregnancy always has associated risks for both the mother and her baby.
These risks are magnified if pregnancy occurs at a very early age. Most pregnant
teenagers did not plan to get pregnant. Teen pregnancies carry additional health risks to
both the mother and the baby. Often, teens do not get prenatal care soon enough, which
can lead to problems later on. They have a higher risk for pregnancy-related high blood
pressure and its complications. The situation could also bear risks for the baby, which
include premature birth and low birth weight.
Teenage pregnancy is a global problem and is considered a high-risk group.
According to Hadley et al. (2017), despite the conflicting evidence about the outcomes of
teenage pregnancy, it is a universal fact that this dilemma poses an increased risk for poor
obstetric outcomes with concurrent physical, social, and psychological effects. Cultural
practices, poor socioeconomic conditions, low literacy rates, and lack of awareness of the
risks are some of the main contributory factors (Da Silva Ribeiro et al., 2016).
According to Darroch et al. (2016), there is an estimated 21 million girls between
the ages of 15 – 19 years old that become pregnant in developing regions, with
approximately 12 million of them giving birth and at least 777,000 births occurring to
adolescent girls younger than 15 years in developing countries (Lebese et al., 2015).
According to the World Health Organization (2020), at least 10 million
unintended pregnancies occur each year among adolescent girls aged 15–19 years in the
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developing world, complications during pregnancy and childbirth are the leading cause of
death for 15–19-year-old girls globally, and of the estimated 5.6 million abortions that
occur each year among adolescent girls aged 15–19 years, 3.9 million are unsafe,
contributing to maternal mortality, morbidity, and lasting health problems. Adolescent
mothers face higher risks of eclampsia, puerperal endometritis, and systemic infections
than women aged 20 to 24 years, and babies of adolescent mothers face higher risks of
low birth weight, preterm delivery, and severe neonatal conditions.
Concurrently, teen pregnancy poses a challenge to teen mothers as they lack the
skills needed to handle their pregnancy and motherhood. Physically, after childbirth, their
body undergoes different changes, such as gaining weight, hair loss, wrinkles, and stretch
marks on different body parts, which may cause them to lower their self-confidence
(Cahyaningtyasa et al., 2020).
Emotionally, they will go through a lot. A baby's birth can trigger a jumble of
many powerful emotions that these mothers may never expect. Others may feel joy and
accomplishment; some may also experience postpartum depression, postpartum anxiety,
and hopelessness and overwhelmed due to the pressure of their new maternal identity
(Chiazor et al., 2016).
Mentally, new moms may experience unexplainable mood swings due to the
different stresses as they take care of their babies. Motherhood also changes the maturity
of the woman. They become selfless as they prioritize their babies' wellness before
focusing on themselves (Xavier et al., 2017).
The Philippines is considered to have the highest number of teen pregnancies in
Asia in 2016. The number of pregnant children below 15 in the archipelago has doubled
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in the past ten years and pregnancies among children aged between 10 to 14 years old
went up to 2,200 in 2018, more than double the 1,000 recorded in 2007 based on the
Commission on Population and Development Report (Nortajuddin, 2021). Recently, the
agency revealed that the country had recorded a seven percent increase in births among
girls aged 15 and below in 2019, up from the figure for teenage pregnancies in 2018.
The Philippine Statistical Authority (2017) estimated that 538 babies are born
daily from these Filipino teenage mothers leading to the declaration of a national social
emergency by the Philippine National Economic Development Agency in August 2017
due to the continuous rise of teenage pregnancies.
In order to better understand the extent of teenage pregnancy in the researchers'
locale, the researchers conducted a literature search of related studies and articles
regarding teenage pregnancy in Cebu City through online search engines such as Google
Scholar, Medline, and PubMed found very few studies on teenage pregnancy in the
Philippines and no published study specific to Cebu City.
Based on the researchers' observation in their different facilities, despite the
numerous national and local health programs intended to combat teenage pregnancies,
there is still a continuous growth of pregnancy cases among young individuals, with the
age range getting younger every year. In this connection, the researchers opted to
investigate the knowledge, behavior, and attitudes of pregnant teenagers on reproductive
health to determine the factors that influenced their situation. This research work intends
to propose an action plan to prevent the risks brought about by teenage pregnancy and
raise awareness among young people of the different adverse impacts of early pregnancy
based on the study's findings.

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Theoretical Background
This study was anchored on the Theory of Reasoned Action by Fishbein and
Ajzen in 1975. The Theory of Reasoned Action (TRA) suggests that a person's behavior
is determined by their intention to perform the behavior and that this intention is, in turn,
a function of their attitude toward the behavior and subjective norms (Fishbein & Ajzen,
1975). The best predictor of behavior is intention or instrumentality, which is the belief
that the behavior will lead to the intended outcome. Instrumentality is determined by
three things: their attitude toward the specific behavior, their subjective norms, and
their perceived behavioral control. The more precise the attitude and the subjective norms
and the greater the perceived control, the stronger the person's intention to perform the
behavior (He et al., 2019).
Different models have been utilized regarding teen sexual behavior and
pregnancy; however, when compared to other theories, the Theory of Reasoned Action
(TRA) was the only theory that accounted for a significant amount of variance in
unprotected intercourse in teenage mothers and was a better predictor of teenage girls age
at first intercourse and consistency of contraceptive use (Dippel et al., 2017).
The TRA, which assumes the best predictor of behavior is behavioral intention, is
guided by two primary constructs. Attitudes are the beliefs and feelings about specific
behaviors and the values (positive or negative) attached to the outcome of that behavior.
Subjective norms are the perceptions of social norms, including a belief about whether
referent individuals approve or disapprove of behavior and the individual's motivation to
comply with these normative beliefs. Intervention studies that utilize the TRA have found
that changing attitudes and subjective norms often lead to a subsequent change in a
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variety of health behaviors in young adults, including the use of contraception, making it
an essential tool in addressing behaviors related to teen pregnancy. Overall, attitudes and
subjective norms show consistent relationships between intentions to use birth control
and sexual behavior in teens. For example, one study found that attitudes and subjective
norms for condom use were significantly related to the intention to use condoms, and, in
turn, the intention to use condoms was predictive of eventual condom use (Aloba, 2016).
The Health Belief Model by Irvin Rosenstock is a theory to support this research.
The Health Belief Model is a theoretical model that can guide health promotion and
disease prevention programs. It is used to explain and predict individual changes in health
behaviors. It is one of the most widely used models for understanding health behaviors.
Key elements of the Health Belief Model focus on individual beliefs about health
conditions, which predict individual health-related behaviors. The model defines the key
factors that influence health behaviors as an individual's perceived threat to sickness or
disease (perceived susceptibility), the belief of consequence (perceived severity),
potential positive benefits of action (perceived benefits), perceived barriers to action,
exposure to factors that prompt action (cues to action), and confidence in the ability to
succeed (self-efficacy) (Skinner et al., 2015).
One of the best things about the Health Belief Model is how realistically it frames
people's behaviors. It recognizes that sometimes wanting to change a health behavior is
not enough to make someone do it. Therefore, it incorporates two more elements into its
estimations about what it takes to get an individual to leap. These two elements are cues
to action and self-efficacy. Self-efficacy looks at a person's belief in his/her ability to
make a health-related change. It may seem trivial, but faith in your ability to do
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something has an enormous impact on your actual ability to do it. Thinking that you will
fail will almost make sure that you do. In recent years, self-efficacy has been one of the
most critical factors in an individual's ability to comply successfully with family planning
methods (Gueye et al., 2015).
Another theory to support the study is the Trait Factor Theory by Fran Parson.
This theory assesses an individual's trait through objective measures and then matches an
individual's trait to those typically required for successful performance in a given career
area. Parson suggested three steps for enhancing the individual's career decision–making.
First, there must be a clear and objective understanding of one's self, including abilities,
interests, and attitudes. Second, knowledge of the requirements and characteristics of
specific behavior must be present. Lastly, there should be recognition and application of
the relationships between the first and the second for successful decision-making (Gibson
& Michell, 2018).
Early motherhood has significantly affected adolescent girls and their spouses,
family, school, and society. Transitioning to motherhood needs physical, psychological,
social, and cognitive preparedness, but teenage mothers are not ready to become mothers.
Motherhood becomes cumbersome and convoluted for teenage mothers, who
simultaneously endure the maternal role and developmental task of adolescence. They
must adapt to adulthood social roles, physical changes of puberty, significant brain
development, and nurturing of an infant. Most teenage mothers are not in an excellent
socioeconomic condition, so the transition to motherhood becomes problematic for them
(Mangeli et al., 2017).

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In developing countries, approximately 21 million girls aged 15 to 19 years
become pregnant every year, and about 12 million give birth. In developing countries, at
least 777,000 births occur in teenage girls younger than 15. Over the last 20 years, the
projected global adolescent-specific fertility rate has fallen by 11.6 percent. Adolescents
face obstacles to obtaining contraception, including discriminatory legislation and
regulations on the availability of contraceptives depending on age or marital status,
stigma, and lack of desire to accept the reproductive health standards of adolescents, and
the unwillingness of adolescents to obtain contraceptives due to knowledge,
accommodation, and financial restrictions (WHO, 2020).
Many teenagers fail to use contraception because all they know is that it would
appear as if they were planning to engage in sexual behavior. From 2000 to 2010, in the
Philippines, teenage mothers' number of live births rose by more than 60 percent. Civil
registry data from the Philippine Statistics Authority (PSA) shows that there are teenagers
who have begun childbearing as early as ten years old from all areas of the country. Data
from NDHS also reveal that the age bracket of 15-to-19-year-old girls continues to
register an increase in fertility rate, the lowest contraceptive prevalence rate, and the
highest unmet need for family planning. The Philippine Statistics Authority likewise
showed an average of 6 200,000 female teens having become first-time mothers in the
last five years (Gregorio, 2018).
In Central Visayas, there is an increasing number of teenage pregnancies noted as
of 2019, especially in Negros Oriental, with 4,452 as of August last year (3,471 in 2018).
Bohol has 1,868 as of the 3rd quarter last year (2,310 as of 2018); 383 in Cebu as of the
2nd quarter last year (4,883 in 2018); and 64 in Siquijor as of the 2nd quarter last year
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(174 in 2018). Cebu Province registered a declining statistic considering that there were
10,511 cases noted in 2015. However, the most recent data on teenage pregnancy in
Central Visayas during the pandemic is unavailable (Van et al., 2021).
Recent medical experts' studies revealed that teenage pregnancy was associated
with a high rate of complications if maternal diet and prenatal care were inadequate and
the mother was less than 15 years of age. Particular social issues impact teen pregnancy
rates. Those teenagers who continue their pregnancies come from less supportive
families. The individuals who are also vulnerable to getting pregnant have insufficiency
regarding options or freedom to decide independently (Coll et al., 2019). For example,
here in our country, the Philippines, we have a Muslim culture that supports early and
fixed marriage.is 5% (five percent) of our nation's 97 (ninety-seven) million residents are
Muslim (Macapundag, 2016). It is unfair, but they have no choice but to do what their
parents decide. No legal actions can counteract this case since Muslims have their own
rules that are accepted and followed.
When pregnancy occurs in young teenage moms, the burden and risk of
pregnancy is only the woman who bears, in most cases, child care. These pregnancy
types are unplanned or planned to care for a child, becoming a full-time job. Moreover,
many teen moms are students. Being pregnant and having a child at a young age while
being a student becomes more stressful because child-rearing is not easy. It consumes
time and energy, with a few exceptions because the women are the child's primary
caregivers. These nontraditional students are often student mothers and should be given
special attention because they are also mothers and caregivers at home. Many see or
consider their families to hinder their wrong education. They should see it as a motivator
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because, primarily, student mothers return to studying. After all, they want to provide for
their child (Cook & Cameron, 2017).
Dankyi et al. (2019) have said that student mothers go through several challenges
as they live double lives as mothers and students. Challenges are often faced, like lack of
support due to other factors like financial strain and limited time. A study by Vyskocil
(2018) shows the feeling of student mothers regarding lifestyle. One participant said she
juggles multiple lifestyles as a full-time student and a full-time mom. Some first-time
young mothers are very stressed and cannot handle the tasks. That is why they need help
from their families or friends. Although having someone to help the mother is good, the
expectation of receiving support after giving birth often causes stressors that may lead to
depression during the postpartum period.
According to Koech (2019), their coping mechanisms included: problem-focused,
avoidance, and emotion-focused strategies, and the support they received upon resuming
studies was spiritual and social support. It is necessary to ensure that an adequate
childcare resource is available. Parenting is very stressful, and some young teenage moms
cannot deal with all the involved tasks. There should be people around to help teenage
mothers do other tasks. It is best to have family, friends, and spousal support after giving
birth to a baby because it will help the young mom feel loved by herself and the baby.
Adolescent pregnancy may also negatively impact children, their families, and
their societies in social and economic terms. Unmarried pregnant teens may face shame
or rejection and threats of abuse from parents and peers. Similarly, girls who become
pregnant before age 18 are more likely to suffer abuse within a marriage or a relationship.
About education, leaving school can be a decision when a girl perceives pregnancy as a
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safer alternative than continuing education in her conditions or can be a clear trigger of
pregnancy or early marriage (Maravilla et al., 2017).
Also, it is estimated that around three million teenage girls undergo abortions,
specifically unsafe abortions like taking prohibited drugs or medicines and other unsafe
practices, which may result in consecutive reproductive problems or even death. They are
willing to do everything to get rid of the unplanned baby without knowing the effects or
the possibility that it might put their lives in danger and add a burden on the part of their
parents when they are brought to the hospital. Adolescent pregnancy is a common
condition associated with elevated risks before and after pregnancy of maternal and
neonatal complications. In low- and middle-income countries affected by inadequate
health care systems, the vast majority of adolescent pregnancies occur; thus,
complications during conception, delivery, and the postpartum period are the second
cause of death among girls (e.g., 42 days after birth) are aged between 15 and 19 years
worldwide (Whitworth et al., 2019).
Ineffectiveness in the maternal role was the other problem of teenage mothers.
Teenage mothers were not able to take care of their child 14 independently. Teenage
mothers do not have adequate knowledge and competence. Teen mothers expose their
children to risk due to knowledge deficits (Wood & Hendricks, 2017).
Manzi et al. (2018) believed that teenage mothers are not ready for motherhood.
They stated that low commitment, inability to change lifestyles, low accountability, lack
of confidence, and dependence on others; show teenage mothers are unprepared for the
maternal role. Emotional and mental distress was another problem faced by teenage
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mothers. They had experienced fear, worry, regret, frustration, guilt, shame, depression,
and disruption in couples' relationships.
Mann et al. (2020) showed that teenage mothers experience fear of inability to
accept maternal responsibilities, shock, depression, denial, fear, shame, regret, loneliness,
social isolation, and mental exhaustion. Wong (2020) stated that childcare would prevent
teenagers from going to school, and sometimes they are forced to drop out of school.
When teenage mothers face these challenges in child rearing, health care providers can
help them through several interventions. Health care providers can help teenage mothers
to do planning and manage what teenage mother wants for their child's future, or maybe
she has a plan to go back to school—requesting help and support from family, friends,
loved ones, and health care providers to reduce the burden of their responsibilities.
Early pregnancy is a huge problem, for it will affect the life of the teenage
mother, her family, and the country. It is a kind of problem that we should find a solution
to as soon as possible, especially that now on social media like Facebook, there is a trend
in which they encourage teenagers to be pregnant because it is not a problem for them;
instead, a blessing. It looks like their perception is far from the truth and that they did not
see the real effects of having a child at a very young age. The realities inherent in raising
a child are also unprepared for adolescents. Dynamic partnerships and financial pressures
are often overwhelming, along with balancing education and parenting, which can place a
baby at risk. Being a single parent will have financial and emotional stressors, and a
depressed parent puts a kid at risk. Parents will need tools to help them handle their
child's well-being and development. Teens might be unaware of this assistance (Garn et
al., 2017).
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THE PROBLEM
This study determined teenagers' level of knowledge, behavior, and attitudes on
reproductive health. The study findings were the basis for a proposed action plan.
Specifically, the study sought to address the following questions:
1. What is the profile of the respondents in terms of:
1.1 gender;
1.2 marital status;
1.3 educational attainment; and
1.4 religion?
2. As perceived by the respondents, what is the level of reproductive health:
2.1 Knowledge;
2.2 Behaviors; and
2.3 Attitudes?
3. Is there a significant relationship between the profile of the respondents and their level
of reproductive health?
4. Based on the study's findings, what action plan can be proposed?
Statement of the Null Hypothesis
The following null hypothesis was tested at the 0.05 level of significance.
Ho1: There is no significant relationship between the profile of the respondents and their
level of reproductive health.

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Significance of the Study

Mothers/Parents. The study will help elevate teenage mothers' consciousness about
using reproductive health programs. This will educate teenage parents on the significance
of conscious reproductive health adherence to ensure optimal family health. This study
will further increase the mothers' knowledge about reproductive health programs and
their inclusions, such as modern family planning methods, and address common concerns
about reproductive health. The study will help children of teenage parents attain
improved levels of health and well-being through proper spacing where parents can be
more focused on the care of their child with increased capacity to provide and address the
children's varying health needs.
Barangay Health Center. The study will serve as a form of documentation for the
barangay to assess the level of reproductive health program utilization. This will aid in
knowing what reproductive health activities, such as family planning methods, are
utilized mainly by mothers and the common misconceptions mothers have about
reproductive health. This will assist the barangay health center in improving its service
delivery by formulating action plans to augment the utilization of the Department of
Health's Reproductive Health Program using the study results.
Department of Health. The study shall provide meaningful information to the DOH
as to the different reproductive health methods used in the research locale, what methods
are commonly utilized and the misconceptions that need to be corrected, and the level of
compliance of the implementation of the Reproductive Health Program.

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BSM students. Being the ones who usually educate mothers and parents about the
different reproductive health at the grass root level, the study has great significance as it
will serve as a basis to improve educators' knowledge and teaching capacity using
evidence-based data.
Researchers. As practicing midwives, the study shall enrich the knowledge and skills
of the researchers on teenage reproductive health, understand the knowledge, behaviors,
and attitudes of teenage mothers, plan for ways to improve compliance with the
reproductive health program, and promote better community health through different
reproductive health methods.
Future Researchers. This study will serve as the basis for future researchers of
related studies and an in-depth explanation of the current research topic.

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RESEARCH METHODOLOGY
Research Design
The study utilized a quantitative correlation research design to determine
teenagers' knowledge, behavior, and attitudes toward reproductive health in the selected
Municipality. The study used a researcher-modified questionnaire to gather pertinent
information to answer the research queries. The study used the following research flow:
INPUT PROCESS OUTPUT
Descriptive
 Profile of the Correlational
respondents Research Design
 Respondents’
knowledge,  Validation and
behavior, and establishing
attitudes on Proposed
reliability
reproductive Action Plan
 Data gathering
health using researcher
made
questionnaire
 Data processing
and statistical
treatment
 Analysis and
interpretation of
data
Figure 1. Research Flow

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Research Environment
The study was conducted in the Municipality of San Fernando, Cebu. San
Fernando is a 2nd class municipality in Cebu, Philippines. According to the 2020 census,
it has a population of 72,224 people. San Fernando is composed of 21 barangays and is
bordered to the north by the City of Naga, to the west is the town of Pinamungajan, to the
east is the Cebu Strait, and to the south is the city of Carcar. The Municipal Health Unit
of San Fernando is the central public health unit of the Municipality duly located in its
capital barangay, Barangay Poblacion. It is operated by one municipal health officer, two
public health nurses, and six midwives. Each midwife is designated to oversee the health
activities of 2 to 3 barangays, which include delivering maternal and child healthcare.
Each barangay health unit in the Municipality is assigned more than ten barangay health
workers to assist the rural health midwives' delivery of the reproductive health care
programs in their specific catchment areas.
Research Respondents
The research respondents of the study were teenagers from the different
barangays of San Fernando. Based on the data provided to the researchers by the
Municipal Health Office, the total number of teenagers was 12,500 to 13,000. To
determine the sample size of the respondents, Slovin's Formula was utilized using a 5%
margin of error and 95% confidence level for the 13,000 population. The sample size was
computed to be 297. The actual responses gathered by the researchers were 412, which
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was considered the sample size to increase the accuracy of the survey results. The 412
respondents were taken from the 21 barangays of the Municipality of San Fernando, with
15 – 20 randomly selected respondents who answered the survey questionnaire per
barangay.
Research Instrument
A researcher-modified questionnaire was utilized to gather relevant data for this
research study. Part I consisted of questions to gather the respondent's gender, marital
status, educational attainment, and religious profile. Part II comprised 15 statements that
determined the respondents' reproductive health knowledge. Statements 5, 6, and 9 under
this category are considered negative statements and were inversely scored during the
data tabulation process. Part III consisted of statements that allowed the researchers to
determine the behaviors of the respondents relating to reproductive health. Part IV is
composed of statements aimed at identifying the respondents' attitudes towards
reproductive health. Statements 1, 2, 3, 5, 9, and 10 are considered negative statements
and were also inversely scored during the tabulation process.
Dry Run Procedures. The reliability of the research instrument was pilot tested
among forty teenagers in Barangay Poblacion, Cordova. The copies of the survey
instrument were distributed among the identified dry-run respondents, and the questions
were explained to them. The researchers gathering the data for pilot testing were required
to stay with the respondents until they finished answering the research instrument to
make way for possible questions and clarifications by the respondent of the inquired data
in the research instrument. The reliability of the questionnaire was established using
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Cronbach's Alpha at a 0.05 level of significance. After the data were statistically treated,
Cronbach's Alpha revealed a score of 0.9, which indicated that the research questionnaire
has excellent reliability and can use to gather data from the actual respondents (Please
see Appendix E for the reliability test result).
Research Procedure
The research procedure began by sending a transmittal letter to the Dean of
Midwifery of the Integrated Midwives Association of the Philippines (IMAP) to ask for
approval of the research title. Once approved, the study was subjected to a design hearing
attended by a panel of experts. With the approval of the study by the panel, the
researchers proceeded with pilot testing. During the pilot-testing process, a transmittal
letter was sent to the Barangay Captain of Barangay Poblacion, Cordova, to ask
permission to conduct the study and distribute the research questionnaire to 40 randomly
selected teenagers in the barangay. The data gathered was then subjected to a reliability
test. Once reliability was established, the researcher proceeded with the data gathering
process.
Data gathering. The researchers first sent out communication letters to the
Municipal Health Officer (MHO), Public Health Nurse (PHNs), and Rural Health
Midwives (RHMs) of San Fernando, asking permission to conduct the study. With the
approval of the personnel above, the researchers scheduled the data gathering with the aid
of the Rural Health Midwives. The researchers visited each of the barangays of the
Municipality and randomly selected 15 – 20 respondents to participate in the study. Once
consent to participate in the study was taken from the respondents, the researchers
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distributed the research instrument. Safety protocols were instituted by the researcher
during the data gathering process following. The data was gathered from the second to
the third week of January 2022. The gathered information from the respondents was then
collated, tabulated, and statistically treated. Analysis and interpretation of data were made
after that by the researchers.
Statistical Treatment
The respondents' responses were subjected to statistical treatment using different
statistical tools. The first tool that was used in order to interpret the profile of the
respondents was a simple percentage. Weighted mean was used to determine the
respondents' level of knowledge, behavior, and attitudes on reproductive health using the
following hypothetical mean range and interpretation and meaning.
In terms of reproductive health knowledge, the following interpretation was used:
Scale Mean Range Hypothetical Interpretation Meaning

4 3.25 – 4.00 Strongly Agree Highly Knowledgeable
3 2.50 – 3.24 Agree Moderately Knowledgeable
2 1.75 – 2.49 Disagree Less Knowledgeable
1 1.00 – 1.74 Strongly Disagree Not Knowledgeable
In terms of reproductive health behaviors, the following interpretation was used:

4 3.25 – 4.00 Strongly Agree Excellent Behavior
3 2.50 – 3.24 Agree Good Behavior
2 1.75 – 2.49 Disagree Fair Behavior
1 1.00 – 1.74 Strongly Disagree Poor Behavior
In terms of reproductive health attitude, the following interpretation was used:

4 3.25 – 4.00 Strongly Agree Excellent Attitude
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3 2.50 – 3.24 Agree Good Attitude

2 1.75 – 2.49 Disagree Fair Attitude
1 1.00 – 1.74 Strongly Disagree Poor Attitude
The third formula used for statistical data analysis was the Chi-square test of
independence. This was to determine the significant relationship between the profile of
the respondents and their knowledge, behavior, and attitude on reproductive health.
Pearson R was used to determine the significant relationships between the respondents'
knowledge and behavior, knowledge and attitude, and behavior and attitude on
reproductive health. To assist in the statistical treatment of data and the statistical analysis
of the computed information, a statistician was commissioned by the researchers.
Ethical Considerations
Four ethical standards were followed for this research endeavor. These included
the principle of respect, confidentiality, beneficence, and justice. The first principle
conformed to the respect of persons. According to this concept, the respondents were not
forced or coerced to participate in this study. They reserved the right to decide what
activities they would partake in or will not participate in the study. Their signed informed
consent evidenced their willingness to participate. The second principle to be adhered to
is confidentiality. The researcher made the utmost effort never to share or disclose any
respondent's pertinent information outside the context of this study. All documented
information collected was only used for data tabulation and interpretation. The third
principle that was adhered to was beneficence. The researchers ascertained that this study
maximized its benefits and minimized, if not eliminated, related risks. It is rudimentary
that the researchers do not cause any harm to the respondents in the implementation of
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the research procedure, collection, and treatment of data. The last principle was justice
which encompassed the equitable selection of the research respondents. All respondents
were subjected to the same data collection procedure by answering the predetermined
research questionnaire. The study ensured that respondents should be the primary
beneficiary of the research.
DEFINITION OF TERMS
The following terms used in the study are operationally defined as:
Attitude. This pertains to viewpoint, outlook and perspectives of teenagers on
reproductive health.
Behavior. This pertains to the conduct, deportment and actions of teenagers
related to reproductive health.
Knowledge. This pertains to the level of awareness, understanding and
comprehension of the respondents on the different information, activities, and services
related to reproductive health.
Proposed Action Plan. This refers to a plan of care that will be implemented
based on the findings of the study recognizing the need for an improved reproductive
health program and its implementation.
Reproductive Health. This is a state of complete physical, mental and social well-
being of teenagers in all matters relating to their sexual and reproductive functions and processes.
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Teenager. This pertains to men and women of reproductive age between 16 to 19
years old.
CHAPTER 2
PRESENTATION, ANALYSIS AND INTERPRESENTATION OF DATA
This chapter interprets and analyzes the data gathered by the researchers, which
identified teenagers' level of knowledge, behavior, and attitudes on reproductive health in
a selected municipality in Cebu. The data include the profile of the respondents in terms
of gender, marital status, educational attainment, and religion.
This chapter also presents specific tables to indicate the respondents' level of
knowledge, behavior, and attitudes on reproductive health and the significant
relationships of the different variables to each other. Eight pertinent data groups are
presented, and salient points and significant results are explained following a tabular
presentation. Interpretation of the results follows to expound better on the meaning of the
results of the conducted research.
Table 1
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Profile of the Respondents

n = 412
Profiles Frequency Percentage

Gender
Male 230 55.83
Female 182 44.17
Marital Status
Single 412 100.00
Educational Attainment
Elementary Level 0 0.00
Elementary Graduate 117 28.40
High School Level 145 35.19
High School Graduate 150 36.41
Religion
Roman Catholic 406 98.54
Protestant 2 0.49
Christian 4 0.97
Table 1 presents the profile of the respondents in terms of gender, marital status,
educational attainment, and religion. As shown in the table, the majority of the
respondents, 55.83%, are male, while 44.17% are females. All of the respondents are
single. Most of them, 36.41%, are high school graduates, followed closely by those at the
high school level at 35.19%. None of them are college-level or college graduates. Most
respondents are Roman Catholic, 98.54%, while 0.97% are Christians and 0.49% are
Protestants.
Table 2 presents the level of knowledge of the respondents on reproductive
health. The table shows that the respondents are generally moderately knowledgeable
about reproductive health, as indicated by the overall mean of 3.14. This means that there
is information about reproductive health that the respondents are not fully aware of or
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have less understanding of. Regarding the specific indicators for knowledge of
reproductive health, the respondents showed that they are highly knowledgeable and
aware that no one should be forced to have sexual intercourse with their partners at a 3.66
weighted mean, followed closely by their awareness that pregnancy should be planned at
3.65. The table further showed that the respondents are less knowledgeable in terms of
the effects of masturbation, as indicated by the lowest weight mean among the indicators,
which is 2.32. This means that the respondents perceive that masturbation damages their
health.
According to Solikhah and Nurdjannah (2017), adolescents' lack of knowledge
about reproductive health makes teens easily influenced by misinformation that is
harmful to their reproductive health.
Table 2
Respondents’ Knowledge on Reproductive Health
n = 412
Weighted
Indicators Interpretation
Mean
1. A woman can get pregnant the very first time that 3.40 Strongly Agree
she has sexual intercourse.
2. Condoms are an effective method of protecting 3.47 Strongly Agree
against HIV.
3. Condoms are an effective method of preventing 3.42 Strongly Agree
pregnancy.
4. The oral pill is an effective method of preventing 3.48 Strongly Agree
pregnancy.
5. Women can get pregnant through kissing or 2.40 Strongly Agree
touching.
25
6. Withdrawal is an effective method of preventing 2.38 Strongly Agree

pregnancy.
7. Within the menstrual cycle, there is a period during 2.44 Disagree
there is a high possibility of pregnancy.
8. A woman is most likely to get pregnant if she has 2.41 Disagree
sexual intercourse half way between her periods.
9. Masturbation causes serious damage to health. 2.32 Disagree
10. Casual sex can result to pregnancy. 3.56 Strongly Agree
11. Close intimacy such as kissing and hugging with
the opposite sex may lead to sexual act resulting to
pregnancy. 3.53 Strongly Agree
12. Sexual Intercourse must be done at a right age to 3.50 Strongly Agree
maintain reproductive health.
13. Pregnancy must be planned. 3.65 Strongly Agree
14. No one should be forced to have sexual intercourse 3.66 Strongly Agree
with their partners.
15. Everyone have the right to complete physical, 3.53 Strongly Agree
mental and social well-being including sexual well-
being.
Overall Mean 3.14 Agree
Legend:
3.26-4.00 Strongly Agree 1.76 - 2.50 Disagree
2.51 -3.25 Agree 1.00 - 1.75 Strongly Disagree
Health education is vital in increasing their knowledge to maintain good
reproductive health. The study showed that adolescents' knowledge about reproductive
health would be beneficial in preparing young people to attain optimal reproductive
health and appropriately address reproductive health issues, given that their knowledge
does not conflict with the norms prevailing in the community.
Kyilleh et al. (2018), in their study, identified that adolescents generally engaged
in risky reproductive health choices, which can negatively affect their health because of
their lack of knowledge about reproductive health. Teenagers also have difficulties
getting the correct information on reproductive health because they are reluctant to talk
26
about reproductive health to informed adults such as health workers and teachers for the
reason that they are uncomfortable with the topic and would instead the information on
their own even if that information are inaccurate or wrong. Adolescents also face
challenges utilizing available reproductive health services because of barriers to socio-
cultural and health systems.
Kumalasari et al. (2020) explained that the teenage phase is equated to
delinquency, especially in terms of sexuality. Sexuality which is still considered taboo
during this stage, makes the lack of knowledge and low perceived behavior control in
adolescents so that more teenagers have had sexual relations before marriage. Premarital
sexual behavior impacts health, that is, the transmission of sexually transmitted
diseases/infections and teenage pregnancy, which can result in dropping out of school,
other social sanctions or complications during pregnancy, childbirth, and puerperal. The
authors added that it is essential for teenagers to get the necessary education and
information to ensure better awareness of sexual and reproductive health.
Table 3
Respondents’ Behavior on Reproductive Health
n = 412
Weighted
Mean
1. I make it a point to attend health teachings about 3.49 Strongly Agree
reproductive and sexual health to know more about
my body.
2. I am aware of different contraceptive methods and 3.29 Strongly Agree
use these methods to prevent pregnancy
3. I talk to reliable persons (teachers, family, health 3.44 Strongly Agree
workers) to obtain information about contraceptive
use.
4. I do not engage in casual sexual intercourse to 3.49 Strongly Agree
avoid getting sexually transmitted diseases.
27
5. I do not rely on information taken from the internet 3.43 Strongly Agree
to know more about contraceptive methods and
6. I make sure that information I acquire regarding 3.28 Strongly Agree
contraceptive use and reproductive health is
accurate, valid and truthful.
7. I seek the help of health care providers (doctors, 3.50 Strongly Agree
nurses, midwives) when I see and feel
abnormalities in my genitalia.
8. I seek information about sexually transmitted 3.31 Strongly Agree
diseases from teachers, healthcare providers and
family
9. I engage in sexual activity only with one partner. 3.54 Strongly Agree
Overall Mean 3.42 Strongly Agree
Legend:
Table 3 presents the respondents' behavior on reproductive health. As shown in the
table, the respondents manifest excellent behavior regarding reproductive health, as
represented by the overall weighted mean of 3.42. This means that despite the young age
of the respondents, the majority of them engage in behaviors that allow them to attain
optimal reproductive health. In terms of the specific indicator, engaging in sexual activity
with only one partner got the highest weighted mean of 3.54, while making sure that the
information they acquire about contraceptive use and reproductive health is accurate,
valid, and truthful got the lowest weighted mean of 3.28. This means that although the
respondents' behavior on reproductive health is favorable, there are still behaviors that
these teenagers engage in that put their reproductive health at risk.
Scott et al. (2016) said that teenagers' sexual behaviors have both short-term and
long-term consequences, and interventions that focus on multiple risk domains may be
the most effective in helping promote overall reproductive health among young adults.
28
Their study found that four in 10 youth reported at least three risk factors during
adolescence. Teenagers exposed to increasing risks had an elevated likelihood of having
had multiple sex partners rather than none, having an increased likelihood of STDs, and
having had an intended or unintended birth. Inconsistent contraceptive use due to lack of
accurate information also predisposes them to risky sexual behaviors, multiple partners,
and unplanned pregnancies.
Handayani et al. (2019) explained in their study that 50% of teenagers had
premarital sexual intercourse at 10-15 years old. Adverse outcomes such as teenage
pregnancies and increased incidence of STDs are most common amongst those who
engage in risky sexual behaviors due to curiosity and lack of information regarding the
risks of their behaviors. The authors suggested the significant role of school and
education in preventing and addressing the problems brought about by inappropriate
sexual behaviors, especially among adolescents.
Table 4
Respondents’ Attitude on Reproductive Health
n = 412
Weighted
Mean
1. It is acceptable for young people to engage in 2.44 Disagree
intimate relationship with the opposite sex.
2. It is alright for unmarried teenagers to engage in 1.80 Disagree
casual sexual activity.
3. It is alright for teenagers to engage in sexual 1.61 Disagree
activities for as long as they love each other.
4. Everyone should not have sexual intercourse until 3.22 Agree
they are of the right age and only when they are
29
married.
5. It is alright to have sexual intercourse for as long as 2.07 Disagree
contraceptive methods are used.
6. My religion and personal beliefs are against 3.44 Strongly Agree
premarital sex.
7. It is alright for teenagers to engage in close 3.16 Agree
physical intimacy such as kissing, hugging and
touching as long as they do not result to sexual
intercourse.
8. It is generally acceptable in my society to have sex 1.96 Disagree
even before marriage.
9. I believe that premarital sex is important to 2.12 Disagree
maintain a good relationship with my partner.
10. Everybody has a right to have sexual intercourse 2.23 Disagree
with anyone they have intimate relationship as they
are the ones who can determine their own health.
Overall Mean 2.41 Disagree
Legend:
Table 4 presents the attitude of the respondents on reproductive health. The table
shows the overall mean of the respondents' attitudes is 2.41. Because questions 1, 2, 3, 5,
8, 9, and 10 are to be scored inversely, the weighted mean is interpreted as an exemplary
attitude on reproductive health. This implies that the respondents are manifesting a
positive attitude toward reproductive health. Regarding the specific indicators, the
respondent's religion and personal beliefs against premarital sex have the highest
weighted mean of 3.44. This means that the attitude of the respondents on reproductive
health is based on the perception that having premarital is against their values.
You (2017) conducted a literature review on adolescents' attitudes on
reproductive health and found that people reported poor sexual knowledge, especially
30
concerning reproductive matters and sexually transmitted infections. The media, such as
television, magazines, and the Internet, were seen as their primary sources of information
on sex.
Despite the frequently reported liberal attitudes to sexual behavior, only a small
number of young people had already had adverse outcomes. Young men were more likely
than women to report having had sex, while respondents at vocational high schools were
less likely to remain virgins than those at high schools. Although the prevalence of sexual
intercourse among teenagers was still lower than that reported in studies conducted in
most western countries, the findings reflect changes in the sexual values and behavior of
young people within the country.
They also suggest developing more comprehensive sex education programs in
cooperation with young people, schools, health organizations, families, and communities
and making sexual and reproductive health services accessible to teenagers and
unmarried young people.
Table 5
Results of the Hypothesis on the Relationship between
Respondents’ Profile and their Knowledge on Reproductive Health
[ Significant at 0.05 ]
31
Computed Critical
Variables df Decision Interpretation
Value of X² Value
Gender 9.239 7.815 3 Reject Significant
Marital Status 15.117 12.592 6 Reject Significant
Educational Attainment 25.845 24.996 15 Reject Significant
Religion 13.267 12.592 6 Reject Significant
Factor Average 15.867 14.499 Reject Significant
The Chi-square computation implied that the null hypothesis would be rejected if
the computed value was more significant than the critical value. The results obtained
from the 412 respondents using the survey questionnaire as the research instrument have
been analyzed, and the result revealed that there was a significant relationship between
the profile of the respondents and their level of knowledge on reproductive health, as
shown in the computed values of chi-square which were more significant than the critical
values. It was also revealed in the factor average that the computed value of chi-square of
15.867, which is greater than the critical value of 14.499. Hence the null hypothesis was
rejected. Therefore, there was a significant relationship between the profile of the
respondents and their level of knowledge on reproductive health at a 5% level of
significance.
Table 6
Respondents’ Profile and their Behaviors on Reproductive Health
32
Computed Critical
Value of X² Value
Educational Attainment 23.455 24.996 15 Accept Not Significant
As seen from the data, there were significant relationships in the respondent
gender, marital status, and religion as revealed in the computed values of chi-square
10.341 for gender; 14.672 for marital status, and 16.119 for religion which was higher
than the critical values of 7.815 for the gender; 12.592 for the marital status and religion.
This means that gender, marital status, and religion are indicators of their behaviors on
However, there was no significant relationship in the respondents ‘educational
attainment, as shown in the computed value of the chi-square of 23.445, which was lesser
than the critical value of 24.996. This means the educational attainment of the
respondents has an impact on their behaviors on reproductive health.
Generally, as reflected in the factor average, the computed value of the chi-square
of 16.147 was more significant than the critical value of the chi-square of 14.499. Thus,
the null hypothesis was rejected. So, the empirical evidence showed a significant
relationship between the profile of the respondents and their behaviors on reproductive
health at a 5% level of significance.
Table 7
33

Respondents’ Profile and their Attitudes on Reproductive Health
Computed Critical
Value of X² Value
Educational Attainment 22.114 24.996 15 Accept Not Significant
Table 7 showed a significant relationship between the respondents’ profile and
their attitudes on reproductive health regarding gender, marital status, and religion as
obtained in the computed values of chi-square, which were higher than the critical values.
This led to the rejection of the null hypothesis. This means that the profile of the
respondents had strong relationships to their attitudes on reproductive health in terms of
gender, marital status, and religion. However, there was no significant relationship
between the profile of the respondents and their attitudes on reproductive health in terms
of educational attainment, as shown in the computed value of the chi-square, which was
lesser than the critical value. Hence, the null hypothesis was accepted.
Generally, the results connoted a significant relationship between the profile of
the respondents and their attitudes on reproductive health, as shown in the computed chi-
square value in the factor average of 15.789, which was greater than the critical value of
14.499. Thus, the null hypothesis was rejected. This means that the profile of the
respondents can affect their attitudes on reproductive health at 5% significance.

34
Table 8
Result of the Test of Hypothesis on the Significant Relationship between
the Respondents’ Knowledge on Reproductive Health and their Behavior
Pearson r
Pearson r
Variables Computed Decision Interpretation
Critical Value
Value
Respondents’
Knowledge on 0.0556 0.0409 Reject Significant
Reproductive
Health and their
Behavior
LEGEND:
r Verbal Interpretation
0.0 to ± 0.20 Slight Correlation
±0.21 to ±0.40 Low Correlation
±0.41 to ±0.60 Moderate Correlation
±0.61 to ±0.80 High Correlation
±0.81 to ±1.00 Very High Correlation
Table 8 showed a significant relationship between the respondents’ knowledge of
reproductive health and their behavior. The result showed a positive relationship between
the respondents’ knowledge of reproductive and their behavior as reflected in the overall
computed value of Pearson r of 0.0556, which is greater than the critical value of 0.0409.
This leads to the rejection of the null hypothesis. This means a significant positive
relationship exists between the respondents’ knowledge of reproductive health and their
behavior at a 0.05 (5%) level of significance. A positive correlation means that the other
variable also tends to increase as one variable increases. It means that adequate
knowledge can lead to positive behavior. The verbal interpretation of Pearson r showed a
slight correlation between the two variables.

35
Table 9
the Respondents’ Knowledge on Reproductive Health and their Attitude
Pearson r
Pearson r
Critical Value
Value
Respondents’
Reproductive
Health and their
Attitude
LEGEND:
Table 9 shows a significant relationship between the respondents’ knowledge of
reproductive health and their attitudes. The result shows a positive relationship between
the respondents’ knowledge of reproductive health and their attitudes, as reflected in the
overall computed value of Pearson r of 0.0843, which is greater than the critical value of
0.0409. This leads to the rejection of the null hypothesis. This means a slight direct
relationship exists between the respondents’ knowledge of reproductive health and their
attitudes at a 0.05 (5%) level of significance. It indicates that both variables move in the
same direction. It implies that the higher the level of knowledge, the higher the possibility
of having a positive attitude.

36
Table 10 shows a significant relationship between the respondents’ behavior on
reproductive health and their attitudes.
Table 10
the Respondents’ Behaviors on Reproductive Health and their Attitude
Pearson r
Pearson r
Critical Value
Value
Respondents’
Reproductive
Health and their
Behavior
LEGEND:
The result shows a positive relationship between the respondents’ behavior on
reproductive health and their attitudes, as reflected in the overall computed value of
Pearson r of 0.1676, which is greater than the critical value of 0.0409. This leads to the
rejection of the null hypothesis. This means a slight direct relationship exists between the
respondents’ behavior on reproductive health and their attitudes at a 0.05 (5%) level of
significance. It indicates that the two variables tend to move in tandem, meaning that
when one moves up, the other will typically move up. When individuals focus more on
their attitudes, they tend to act on those attitudes; hence, attitude and behavior are related.
37
In addition, when individuals feel more responsible for their actions as opposed to being
part of a group, their attitudes are more consistent with their behavior (Kroesen, 2017).
CHAPTER 3
SUMMARY, FINDINGS, CONCLUSION AND RECOMMENDATIONS
This chapter presents the summary of the study. The findings obtained the
conclusion made by the researcher based on the study's findings and the researchers'
recommendations.
Summary
This study determined teenagers' level of knowledge, behavior, and attitudes on
reproductive health. The study findings were the basis for a proposed action plan.
Specifically, the study sought to address the following questions:
1. What is the profile of the respondents in terms of:
1.1 gender;
1.2 marital status;
1.3 educational attainment; and
1.4 religion?
2. As perceived by the respondents, what is the level of reproductive health:
2.1 Knowledge;
2.2 Behaviors; and
2.3 Attitudes?
38
3. Is there a significant relationship between the profile of the respondents and their level
of reproductive health?
4. Based on the study's findings, what action plan can be proposed?
The study utilized a quantitative descriptive correlation research design using an
adapted standardized questionnaire. The study was conducted in the Municipality of San
Fernando. The research respondents were 412 teenagers in the different barangays of the
Municipality. Information on the respondents' profiles and their knowledge, behavior,
and attitudes on Reproductive Health were gathered. The collected information was
tabulated, statistically treated, interpreted, and analyzed.
Findings
1. Most respondents are male, single, high school graduates, and Roman Catholic.
2. The majority of the respondents were moderately knowledgeable about
Reproductive Health.
3. The majority of the respondents have excellent Reproductive Health behaviors.
4. The majority of the respondents have a good attitude toward Reproductive Health.
5. The profile of the respondents has a significant relationship to their knowledge,
behavior, and attitude toward Reproductive Health.
6. There is a significant relationship between the respondents' knowledge of
Reproductive Health and their behaviors.
7. There is a significant relationship between the respondents' knowledge of
Reproductive Health and their attitude.

39
8. There is a significant relationship between the respondents' behaviors on
Reproductive Health and their attitudes.
Conclusion
The current study adds to the understanding of teenagers' knowledge, behavior, and
attitudes regarding Reproductive Health. The study's result suggests that teenagers'
knowledge, behaviors, and attitudes on reproductive health are significantly influenced
by their gender, marital status, educational attainment, and religion. Moreso, teenagers'
knowledge, behavior, and attitudes toward Reproductive Health are significantly related
as each one affects the other.
Recommendations
1. That the relevant findings of the study be communicated to the stakeholder and
the health unit of the Municipality.
2. That the proposed action plan will be implemented.
3. That various pieces of training, seminars, and workshops be utilized to sustain
efforts in improving the knowledge, behavior, and attitudes of teenagers towards
Reproductive Health in the Municipality.
4. Those future researchers will endeavor studies that will evaluate the significance
of teenagers' knowledge, behavior, and attitudes on Reproductive Health in
decreasing incidences of teenage pregnancies.

40
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43
APPENDIX A
TRANSMITTAL LETTER TO THE DEAN
September 23, 2021
Ma. Gi G. Defensor, RM-BSM, MMHA

Dean
IMAP Foundation School of Midwifery, Inc.
41 Burgos St., La Paz, Iloilo City
Dear Dean Defensor:
In partial fulfillment of the requirements for the degree in Bachelor of Science in

Midwifery, we the midwifery students of the Integrated Midwives Association of the
Philippines (IMAP) Foundation School of Midwifery, are currently endeavoring a
research study entitled: Knowledge, Behavior and Attitude of Teenagers on
Reproductive Health. It is the ultimate goal of this research, with bases on the findings
of the study, to propose an action plan geared towards the improvement of the
knowledge, behavior and attitudes on reproductive health of teenager.
In this connection, we the researchers would like to ask the approval of your good office
to conduct the study and distribute questionnaires to teenagers in the different barangay
health units of the Municipality of San Fernando, Cebu. We assure that all information
gathered in the course of our study will be treated with utmost confidentiality
Hoping for your positive response and approval.

44
Respectfully yours,
Jacklyn Pacible, RM Jinky Tigley, RM Nancy Sardido, RM
Marrynil Lumangyao, RM Ailyn Putong, RM Esmeralda Great, RM
Recommending Approval:
Marjorie R. Sta. Teresa, MSN, RN, RM-BSM

Research Adviser and BSM Program Coordinator
Approved by:

Dean
TRANSMITTAL LETTER TO THE MUNICIPAL HEALTH OFFICER
September 23, 2021
Alfredo P. Manugas IV, MD

Municipal Health Officer
Municipality of San Fernando
Cebu
Dear Dr. Manugas:

knowledge, behavior and attitudes on reproductive health of teenager.
In this connection, we the researchers would like to ask the approval of your good office
to conduct the study and distribute questionnaires to teenagers in the different barangay
health units of the Municipality of San Fernando, Cebu. We assure that all information
gathered in the course of our study will be treated with utmost confidentiality
Hoping for your positive response and approval.

45
Respectfully yours,


Dean
Approved by:
Dr. Alfredo P. Manugas IV

TRANSMITTAL LETTER TO THE MUNICIPAL HEALTH OFFICER

(CORDOVA)
September 23, 2021
Efren B. Dico, MD
Municipality of Cordova
Cebu
Dear Dr. Dico:

knowledge, behavior and attitudes on reproductive health of teenagers.
In this connection, we the researchers would like to ask the approval of your good to
allow us to conduct a pilot testing procedure of our research questionnaire to forty
teenagers in one of the barangay health units of the municipality. The purpose of this is to
46
establish the reliability of our research questionnaire. We assure you that all information
provided to us by these pregnant teenagers will be dealt with full confidentiality.
Respectfully yours,


Dean
Approved by:
Dr. Efren B. Dico

Cordova Municipal Health Officer
TRANSMITTAL LETTER TO THE BARANGAY CAPTAIN
September 23, 2021
Hon. Remar Baguio

Barangay Captain
Barangay Poblacion
Cordova, Cebu
Dear Hon. Baguio:

knowledge, behavior and attitudes on reproductive health of teenagers.
In this connection, we the researchers would like to ask the permission of your good to
allow us to conduct a pilot testing procedure of our research questionnaire to forty
teenagers your barangay health unit. The purpose of the procedure is to establish the
47
reliability of our research questionnaire. Rest assure you that all information provided to
us by these pregnant teenagers will be treated confidential.
Respectfully yours,
Marjorie R. Sta Teresa, RN, MSN, RM-BSM


Dean
Approved by:
Hon. Remar Baguio

Barangay Captain – Poblacion, Cordova
APPENDIX B
LOCATION MAP
48
APPENDIX C
INFORMED CONSENT
[Informed Consent form for the Teaching and Non-Teaching Employees of Higher Education Institution]
49
Name of Principal Investigator: Jacklyn Pacible (Group Leader)]

[Name of Organization: Integrated Midwives Association of the Philippines Foundation School of
Midwifery Inc.]
[Name of Proposal: Knowledge, Behavior and Attitudes of Teenagers on Reproductive Health]
This Informed Consent Form has two parts:
 Information Sheet (to share information about the research with you)
 Certificate of Consent (for signatures if you agree to take part)
You will be given a copy of the full Informed Consent Form
PART I: Information Sheet
Introduction
We are the students of Integrated Midwives Association of the Philippines taking up Bachelor of
Science in Midwifery. We are currently conducting a study entitled: “Knowledge, Behavior and Attitudes
of Teenagers on Reproductive Health.” In line with this, I am inviting you to be a respondent of this
investigation and request you to spare few minutes of your time to answer this questionnaire honestly.
However, you do not have to decide today whether or not you will participate in the research. Before you
decide, you can talk to anyone you feel comfortable with about the research. If there are contents in the
questionnaire that you do not understand and find ambiguous then feel free to contact the researcher. Rest
assured that all the answers will be treated with utmost confidentiality.
Purpose of the research
Teenage pregnancy has been an ongoing issue both in terms of its impact to young women’s health
and to society in general. This investigation it aims determine the knowledge, behaviour and attitudes of
pregnant teenagers toward reproductive health with the end goal of developing an action plan to improve
teenage women’s knowledge about their reproductive health, foster positive behaviors and improve their
outlook and attitude towards reproductive health.
Type of Research Intervention
This research will involve a researcher made survey questionnaire directed at identifying the
knowledge, behavior and attitude of teenagers. The survey tool is divided into four parts. Part one identifies
the profile of the respondents in terms of gender, marital status, educational attainment, and religion. The
second part contains statements aimed to determine the knowledge of teenagers regarding reproductive
health. The third part is composed of statements indicating the behaviors of teenagers regarding
reproductive health while part four contains statements that determines the attitude of teenagers towards
Participant selection
We are inviting the teenagers who are currently residing the different barangays of the Municipality.
Voluntary Participation
50
Your participation in this research is entirely voluntary. It is your choice whether to participate or not.
Whether you choose to participate or not. You may change your mind later and stop participating even if
you agreed earlier and this will not be taken against you later on.
Procedures and Protocol
In this investigation you will be asked to answer a questionnaire that will be distributed to you by the
researchers themselves through face to face intercept in the health center. The survey questionnaire will be
collected thereafter. The questionnaire can be read aloud and you can give the answer on those items that
you intend to answer. If you do not wish to answer some of the questions included in the questionnaire, you
may skip them and move on to the next question. The information recorded is confidential and no one else
except the researchers, our research adviser, will have access to these questionnaires. The questionnaires
will be destroyed after 6 months once the study has been completed.
To ensure that you will be able to have full grasp on the purpose of the study, the proponents will first
explain the objectives of the study and the intended benefits to the participants.
Duration
The research takes place in 6 months. If you intend to answer the questionnaire immediately, then the
researchers will ask for 30-45 minutes of your time to answer the said questionnaire. Your engagement as a
respondent will only take once.
Risks
I am asking you to share and divulge your personal information and your knowledge, behavior and
attitude toward reproductive health and you may feel uncomfortable talking about the topics. You must
know that you do not have to give answer to all questions if you do not like to answer some of the items in
the questionnaire that you are not comfortable with, and that is also fine. You do not have to give reasons
for not responding to any question, or for refusing to take part in the survey. I will not be sharing with your
responses to anyone not part of this research endeavor.
Benefits
There will be no immediate and direct benefits to you, the action plan as an output of this study will
intend to enhance your knowledge, behavior and attitude toward reproductive health.
Reimbursements
You will not be provided with any payment to take part in the research.
Confidentiality
We will not be sharing information about you. The information that we collect from this research
project will be kept confidential. Information about you and your perception that will be collected from this
research will be put away and no one but the researcher will be able to see it. Any information about you
will have a number on it instead of your name. Only the researchers will know your number/contact
information and we will lock that information up with a lock and key. It will not be shared with or given to
anyone except my research adviser, Ms. Marjorie Sta. Teresa.
51
Sharing the Results
At the end of the study, we will be sharing what we have learned with from the respondents and with
the community. We will do this by meeting first with the participants and then with the larger community.
Nothing that you answered in the questionnaire will be shared with anybody outside the research. A written
report will also be given to the participants which that they can share with their families.
Right to Refuse or Withdraw
You may choose not to participate in this study and does not have to take part in this research is you
do not wish to do so. Choosing to participate or not will not affect your disposition. You will still benefit
from the implementation of the action plan. You may stop from participating in the survey at any time that
you wish without either you losing your rights here.
Who to Contact
If you have any questions, you can ask them now or later, even if the study has started. If you wish to
ask questions later, you may contact any of the following:
Ms. Jacklyn Pacible (09286746429)
This thesis proposal has been reviewed and approved by my thesis panel at the Integrated
Midwives Association of the Philippines Foundation, School of Midwifery Inc. which is a committee
whose task is to make sure that researchers have properly conducted the study. If you have any questions
for may panel, please contact the ________________________________________
PART II: Certificate of Consent
I have read the foregoing information, or it has been read to me. I have had the opportunity to ask
questions about it and any questions that I have asked have been answered to my satisfaction. I
consent voluntarily to participate as a participant in this research.
Print Name of Participant________________________________
Signature of Participant _________________________________
Date ___________________________
Day/month/year
If illiterate
52
A literate witness must sign (if possible, this person should be selected by the participant and should have
no connection to the research team). Participants who are illiterate should include their thumb-print as well.
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.
Print name of witness_____________________ AND Thumb print of participant

Signature of witness ______________________
Date ________________________
Day/month/year
Statement by the researcher/person taking consent
I have accurately read out the information sheet to the potential participant, and to the best of my ability
made sure that the participant understands that the following will be done:
1. That they will be asked t participate in the study without coercion

2. That they reserve the right to participate, decline or discontinue their participation in the study.
3. That all information gathered in this study will be treated with utmost confidentiality.
I confirm that the participant was given an opportunity to ask questions about the study, and all
the questions asked by the participant have been answered correctly and to the best of my ability. I confirm
that the individual has not been coerced into giving consent, and the consent has been given freely and
voluntarily.
A copy of this ICF has been provided to the participant.
Print Name of Researcher/person taking the consent___________________________
Signature of Researcher /person taking the consent____________________________
Date ___________________________
Day/month/year
53
APPENDIX D
RESEARCH QUESTIONNAIRE
KNOWLEDGE, BEHAVIOR AND ATTITUDE OF TEENAGERS ON

REPRODUCTIVE HEALTH
To our Research Respondents:
A pleasant day to you!
We, the researchers of the study would like to express our sincere appreciation for your cooperation and
time that you allotted to take part in our research study. The following questionnaire will ask you to answer
different statements that you will rate based on a criteria given. Your answers are very important to our
study and we hope that you will read the statements carefully and answer them honestly. Thank you!
Sa among mga Respondedor:
Maayong adlaw kaninyong tanan!
Dako kaayo kami ug kalipay ug pasalamat sa inyong pag-gahin sa inyong oras ug kooperasyon para
mahimong parte sa among panukiduki sa kaalam, buhat ug kinaiya sa mga mabdos nga tin-edyer
mahitungod sa reproductive health. Ang mga sumusunod nga pangutana ug pahayag nagkinahanglan sa
inyong tubag base sa gilakip nga kriterya. Kami nanghinaot nga inyo kaning tubagon sa sakto ug matinud-
anon. Daghang Salamat!
Control No. _________
PART 1. PROFILE OF THE RESPONDENTS (Personal nga Impormayon sa mga Respondedor)

Instruction: Please fill-in the necessary information by putting a check mark on the choice that
corresponds your profile. (Tugon: Palihog tubaga ang mga gikinahanglan nga impormasyon mahitungod
kanimo).
Biologic Gender ( ) male / lalaki ( ) female / babaye
Marital Status (Estado sa Kaminyoon):
( ) Single / dili minyo ( ) Married / minyo ( ) Cohabiting / dunay kapuyo
Educational Attainment (Nahuman nga Grado sa Eskwela):
( ) Elementary Level / elementarya ( ) College / Colegio

( ) Elementary Graduate / nakagraduar sa elementarya
( ) High School Level
( ) High School Graduate / nakagraduar sa Highschool
Religion (Relihiyon):
( ) Roman Catholic/ Roman Katoliko

( ) Protestant / Protestante
54
( ) Christian / Kristiano o Born Again Christian

( ) Muslim
( ) Others, please specify / Uban ng relihiyon: ___________________
PART II. REPRODUCTIVE HEALTH KNOWLEDGE / KAALAM SA

REPRODUCTIVE HEALTH
Direction: The following statements measures your level of knowledge on Reproductive

Health. Please check the appropriate column that best describes your answer using the
following rating:
(Tugon: Ang mga sumusunod nga pahayag nagasukod sa imong kaalam mahitungod sa
Reproductive Health. Palihog sa pagmarka ug tsek ( √ ) sa mga pilianan nga mga
numero nga motunong sa inyong panlantaw).
(4) Strongly Agree / Uyon Kaayo

: if you perceive the statement to be totally true.
: kung sa imong pagtuo hingpit nga tinuod ang pahayag
(3) Agree / Uyon

: if you perceive the statement to be less true.
: kung sa imong pagtuo tinuod ang pahayag
(2) Disagree / Dili Uyon

: if you perceive the statement to be false.
: kung sa imong pagtuo sayop ang pahayag
(1) Strongly Disagree / Hingpit nga Dili Uyon

: if you perceive the statement to be totally false.
: kung sa imong pagtuo hingpit nga sayo ang pahayag
4 3 2 1
Statements (SA) (A) (D) (SD)
1. A woman can get pregnant the very first time that she
has sexual intercourse.
Ang babaye pwede mamabdos bisan sa una niyang

pakighilawas.
2. Condoms are an effective method of protecting against

HIV.
Ang condom epektibo mga pamaagi sa pagprotektar batok

sa HIV.
55
3. Condoms are an effective method of preventing

pregnancy.
Ang condom epektibo nga pamaagi para dili mamabdos usa

ka babaye.
4. The oral pill is an effective method of preventing

pregnancy.
Ang pag-inom ug pills epektibo nga pamaagi para dili

mamabdos ang usa ka babaye.
5. Women can get pregnant through kissing or touching.
Ang usa ka babaye pwede maburos pinaagi lamang sa

paghalok.
6. Withdrawal is an effective method of preventing

pregnancy.
Ang withdrawal epektibo nga pamaagi para dili mamabdos

usa ka babaye.
7. Within the menstrual cycle, there is a period during

there is a high possibility of pregnancy.
Sa panahon nga reglahon ang usa ka babaye, dako ang

possibilidad nga kini siya pwede maburos.
8. A woman is most likely to get pregnant if she has sexual

intercourse half way between her periods.
Mas dako ang posibilidad nga maburos ang usa ka babaye

sa tunga-tunga nga parte sa iyang pag regla.
9. Masturbation causes serious damage to health.
Ang masturbation pwede mahinungdan sa pagkadaot sa

panglawas sa usa ka tawo.
10. Casual sex can result to pregnancy.
Ang kaswal nga pakighilawas pwede makaresulta sa

pagkamabdos.
56
11. Close intimacy such as kissing and hugging with the

opposite sex may lead to sexual act resulting to pregnancy.
Ang pakigsuod sama sa paghalok ug pag.gakos sa usa ka

babaye didto sa us aka lalaki pwede moabot sa
pakighilawas nga moresulta sa pagkaburos.
12. Sexual Intercourse must be done at a right age to

maintain reproductive health.
Ang pakighilawas dapat lamang buhaton kun ang babaye

naa sa sa iyang sakto nga edad sa iyang reproductive
health.
13. Pregnancy must be planned.
Ang pagmabdos dapat planado.
14. No one should be forced to have sexual intercourse

with their partners.
Walay bisan kinsa nga babaye nga dapat mapugos sa

pakighilawas sa ilang mga partners.
15. Everyone have the right to complete physical, mental

and social well-being including sexual well-being.
Ang tanan nay katungod sa ilang hingpit nga pisikal,

mental, ug sosyal lakip na ang seksual nga kaayohan.
PART 111. REPRODUCTIVE HEALTH BEHAVIORS
Direction: The following statements identifies your behaviours related to reproductive

health. Please check the appropriate column that best describes your answer using the
following rating:
(Tugon: Ang mga sumusunod nga pahayag nagasukod sa imong mga buhat mahitungod
sa Reproductive Health. Palihog sa pagmarka ug tsek ( √ ) sa mga pilianan nga mga

57
(3) Agree / Uyon



4 3 2 1
1. I make it a point to attend health teachings about

reproductive and sexual health to know more about my
body.
Akong gipaningkamot permi nga makatambong ug mga

pagtudlo kabahin sa akong reprodaktib ug seksual nga
panglawas para mahimong mas maalam mahitungod sa
akong lawas.
2. I am aware of different contraceptive methods and use

these methods to prevent pregnancy.
Nahibalo ako sa mga nagkalain-laing pamaagi ug pag-

gamit sa contrasepsyon para malikayan ang pagmabdos.
3. I talk to reliable persons (teachers, family, health

workers) to obtain information about contraceptive use.
Nakigstorya ako sa mga kasaligan nga mga tawo sama sa

akong pamilya, maestra ug health workers kabahin sa mga
impormasyon mahitungod sa contrasepyon.
4. I do not engage in casual sexual intercourse to avoid

getting sexually transmitted diseases.
Wala ako nagbuhat o niapil sa mga kaswal nga

pakighilawas para malikayan nako ang mga makatakod
58
nga sakit nga makuha sa kini nga pamaagi.
5. I do not rely on information taken from the internet to

know more about contraceptive methods and reproductive
health.
Dili ako dayon mosalig sa mga impormasyon nga akong

nakuha sa internet mahitungod sa contraceotion ug
6. I make sure that information I acquire regarding

contraceptive use and reproductive health is accurate, valid
and truthful.
Akong gisigurado nga ang impormasyon nga akong

makat-onan mahitungod sa reproductive health kay sakto,
tukma, balido ug matinud-anon.
7. I seek the help of health care providers (doctors, nurses,

midwives) when I see and feel abnormalities in my
genitalia.
Moduol ako sa mga healthworkers sama sa mga doctor,

nars ug midwife kon ako naay makita ug pamation nga
abnormal labi na sa akong kinatawo.
8. I seek information about sexually transmitted diseases

from teachers, healthcare providers and family.
Nangutana ako ug mga impormasyon kabahin sa mga sakit

nga makatakod sa seksual nga pamaagi didto sa akong
maestro, healthcare providers ug pamilya.
9. I engage in sexual activity only with one partner.
Makighilawas ako sa akong partner lamang ug wala nay

lain.
PART IV: REPRODUCTIVE HEALTH ATTITUDE
Direction: The following statements identifies your attitudes related to reproductive

health. Please check the appropriate column that best describes your answer using the
following rating:
59
(Tugon: Ang mga sumusunod nga pahayag nagasukod sa imong kinaiya mahitungod sa
Reproductive Health. Palihog sa pagmarka ug tsek ( √ ) sa mga pilianan nga mga

(3) Agree / Uyon



4 3 2 1
1. It is acceptable for young people to engage in intimate

relationship with the opposite sex.
Ang pagsulod sa intimate nga relasyon sa mga

kabatanonan kay usa ka dalawaton nga buhat.
2. It is alright for unmarried teenagers to engage in casual

sexual activity.
Okay ra para sa mga tin-adyer ang mobuhat ug kaswal nga

pakighilawas.
3. It is alright for teenagers to engage in sexual activities
for as long as they love each other.
Okay ra sa mga tin-adyer ang pakighilawas basta sa ila

lamang mga partner o minahal.
60
4. Everyone should not have sexual intercourse until they

are of the right age and only when they are married.
Ang pakighilawas dapat lamang buhaton sa hamtong nga

edad ug kon sila kasado na.
5. It is alright to have sexual intercourse for as long as

contraceptive methods are used.
Okay ra ang pakighilawas basta mogamit lang ug pamaagi

sa contrasepsyon.
6. My religion and personal beliefs are against premarital

sex.
Ang akong relihiyon ug personal nga pagtuo dili uyon sa

pakighilawas sa dili pa kasado.
7. It is alright for teenagers to engage in close physical

intimacy such as kissing, hugging and touching as long as
they do not result to sexual intercourse.
Okay ra para sa mga tin-adyer ang pakihalok, pag-gakos

ug ang uban pang intimate nga binuhatan basta dili lng
kini moresulta sa pakighilawas.
8. It is generally acceptable in my society to have sex even

before marriage.
Okay ra ug dalawaton nga butang sa katilingban ang

pakighilawas sa dili pa kasado.
9. I believe that premarital sex is important to maintain a

good relationship with my partner.
Dako akong pagtuon nga ang pakighilawas sa dili pa kasal

usa ka pamaagi nga mabaton ang nindot nga relasyon sa
akong partner.
10. Everybody has a right to have sexual intercourse with

anyone they have intimate relationship as they are the ones
who can determine their own health.
Ang tanan naay katungod sa pakighilawas sa bisan kinsa

nga aduna silay relasyon kay sila lamang ang makatino sa
61
ilang panglawas.
APPENDIX E
STATISTICAL REPORTS
62
Roselita Rafols Doming

Statistician
63

Statistician
T-test Computation for
GENDER AND ATTITUDE
Difference Scores Calculations
Treatment 1
N1: 230
df1 = N - 1 = 230 - 1 = 229
M1: 2.4
SS1: 83.7
s21 = SS1/(N - 1) = 83.7/(230-1) = 0.37
64
Treatment 2
N2: 182
df2 = N - 1 = 182 - 1 = 181
M2: 2.23
SS2: 100.7
s22 = SS2/(N - 1) = 100.7/(182-1) = 0.56
T-value Calculation
s2p = ((df1/(df1 + df2)) * s21) + ((df2/(df2 + df2)) * s22) = ((229/410) * 0.37) + ((181/410) *
0.56) = 0.45
s2M1 = s2p/N1 = 0.45/230 = 0

s2M2 = s2p/N2 = 0.45/182 = 0
t = (M1 - M2)/√(s2M1 + s2M2) = 0.17/√0 = 2.53
Significance Level:
The t-value is 2.52546. The p-value is .005965. The result is significant at p < .05.
T-test Computation for
GENDER and Behavior
Difference Scores Calculations
Treatment 1
N1: 230
df1 = N - 1 = 230 - 1 = 229
M1: 3.42
SS1: 2.04
s21 = SS1/(N - 1) = 2.04/(230-1) = 0.01
65
Treatment 2
N2: 182
df2 = N - 1 = 182 - 1 = 181
M2: 3.42
SS2: 1.64
s22 = SS2/(N - 1) = 1.64/(182-1) = 0.01
T-value Calculation
s2p = ((df1/(df1 + df2)) * s21) + ((df2/(df2 + df2)) * s22) = ((229/410) * 0.01) + ((181/410) *
0.01) = 0.01
s2M1 = s2p/N1 = 0.01/230 = 0

s2M2 = s2p/N2 = 0.01/182 = 0
t = (M1 - M2)/√(s2M1 + s2M2) = 0/√0 = 0.15
The t-value is 0.15132. The p-value is .439897. The result is not significant at p < .05.

Statistician
66
APPENDIX F
RELIABILITY TEST RESULT

67

Knowledge Behavior Attitude of Teenage Pregnant Women On Reproductive Health

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CHAPTER 1

THE PROBLEM AND ITS SCOPE

include premature birth and low birth weight.

Teenage pregnancy is a global problem and is considered a high-risk group.

According to Darroch et al. (2016), there is an estimated 21 million girls between

According to the World Health Organization (2020), at least 10 million

contributing to maternal mortality, morbidity, and lasting health problems. Adolescent

low birth weight, preterm delivery, and severe neonatal conditions.

(Cahyaningtyasa et al., 2020).

accomplishment; some may also experience postpartum depression, postpartum anxiety,

(Chiazor et al., 2016).

focusing on themselves (Xavier et al., 2017).

The Philippines is considered to have the highest number of teen pregnancies in

Commission on Population and Development Report (Nortajuddin, 2021). Recently, the

emergency by the Philippine National Economic Development Agency in August 2017

due to the continuous rise of teenage pregnancies.

In order to better understand the extent of teenage pregnancy in the researchers'

Philippines and no published study specific to Cebu City.

Based on the researchers' observation in their different facilities, despite the

investigate the knowledge, behavior, and attitudes of pregnant teenagers on reproductive

based on the study's findings.

behavior (He et al., 2019).

at first intercourse and consistency of contraceptive use (Dippel et al., 2017).

referent individuals approve or disapprove of behavior and the individual's motivation to

factors that influence health behaviors as an individual's perceived threat to sickness or

disease (perceived susceptibility), the belief of consequence (perceived severity),

potential positive benefits of action (perceived benefits), perceived barriers to action,

succeed (self-efficacy) (Skinner et al., 2015).

people's behaviors. It recognizes that sometimes wanting to change a health behavior is

to action and self-efficacy. Self-efficacy looks at a person's belief in his/her ability to

methods (Gueye et al., 2015).

interests, and attitudes. Second, knowledge of the requirements and characteristics of

& Michell, 2018).

family, school, and society. Transitioning to motherhood needs physical, psychological,

Motherhood becomes cumbersome and convoluted for teenage mothers, who

socioeconomic condition, so the transition to motherhood becomes problematic for them

(Mangeli et al., 2017).

In developing countries, approximately 21 million girls aged 15 to 19 years

face obstacles to obtaining contraception, including discriminatory legislation and

regulations on the availability of contraceptives depending on age or marital status,

the unwillingness of adolescents to obtain contraceptives due to knowledge,

accommodation, and financial restrictions (WHO, 2020).

last five years (Gregorio, 2018).

In Central Visayas, there is an increasing number of teenage pregnancies noted as

Central Visayas during the pandemic is unavailable (Van et al., 2021).

rules that are accepted and followed.

their child (Cook & Cameron, 2017).

depression during the postpartum period.

According to Koech (2019), their coping mechanisms included: problem-focused,

pregnancy or early marriage (Maravilla et al., 2017).

neonatal complications. In low- and middle-income countries affected by inadequate

worldwide (Whitworth et al., 2019).

children to risk due to knowledge deficits (Wood & Hendricks, 2017).

and disruption in couples' relationships.

This study determined teenagers' level of knowledge, behavior, and attitudes on

Specifically, the study sought to address the following questions:

1. What is the profile of the respondents in terms of:

1.2 marital status;

1.3 educational attainment; and

2. As perceived by the respondents, what is the level of reproductive health:

2.2 Behaviors; and

4. Based on the study's findings, what action plan can be proposed?

Statement of the Null Hypothesis