ST.

MARY’S COLLEGE OF TAGUM, INC SMCTI

OFFICE OF THE RESEARCH ETHICS COMMITTEE QTIME
National Highway, Tagum City, 8100 Davao del Norte, Philippines
Email Address: smcti.rec@smctagum.edu.ph Faith • Excellence • Service

Quality Transformative Ignacian Marian Education

INFORMED CONSENT FORM

PARTICIPATION INFORMATION SHEET

DEAR PARTICIPANT/S:

I, Mike Christoper Emanel, a tertiary education student of St. Mary’s College of Tagum, Inc.
taking up Bachelors of Science in Nursing. We are conducting our research study entitled;
Qualitative Inquiry on the Healthcare Services of a Rural Area in Davao de Oro.

I am asking for your written and duly signed informed consent to this research study. The
purpose of your participation in this research study is to help the principal investigator to explore
and understand the experiences of the people in availing healthcare services of a rural area in
Davao de Oro. You are chosen as a possible participant in this research study based on the
following criteria:

● Must be a residence of Barangay Pangibiran, Davao de Oro or either

residence of a rural area in Davao de Oro.
● Have access to healthcare services

● Can be Male or Female

● 18 years of age and above

Please feel free to read the following information carefully and feel free to ask the above-
named principal investigator if there is anything that is not clear to you or if you need more
information and guidance. You must be eighteen (18) years of age or older to participate in this
research study.

SIGNATORY AND WITNESS/PROXY CONTENT

Nobody except you is required to sign the consent form to signify your participation in the
research study. However, if you are unable to read and/or write, you may select somebody to
accompany you during the reading and explanation of the informed consent form and sign the
same on your behalf.

No witness is required in order for the consent form to be binding nor is a proxy content
allowed. But if you are below eighteen (18) years of age, a parental informed consent from your
parent or legal authorized representative and your informed assent are needed before you can fully
participate in this research study.

PURPOSE, OBJECTIVES & SIGNIFICANCE OF THE STUDY

 ST. MARY’S COLLEGE OF TAGUM, INC SMCTI
OFFICE OF THE RESEARCH ETHICS COMMITTEE QTIME
National Highway, Tagum City, 8100 Davao del Norte, Philippines
Email Address: smcti.rec@smctagum.edu.ph Faith • Excellence • Service

Quality Transformative Ignacian Marian Education

The purpose of this phenomenological study is to explore and

understand the experiences of the people in availing healthcare services.
At this stage of research, the inquiry on the healthcare services among
the people living in the rural areas would mean, how will the available services able to meet the
health needs as well as how its location contributes significantly in the overall health-seeking
behavior and health status of the people.

Hope that the findings of this study will benefits the rural population because they will
receive the highest quality of care, affordable and excellent service from their community. This
research study will be used as basis for health administrators as they can implement a more
effective programs that will enhance the health services of the people living in the rural areas. This
study will serve as a foundation for potential constructive and successful actions for community
health providers as they will be more dedicated in providing health services through outreach
program for people living in the rural areas.

RESEARCH STUDY PROCEDURES

If you agree to participate in this research study, the following will occur:

● We the researchers will ensure data confidentiality through a variety of measures.

● We are sure of the research participants' autonomy while also ensuring full disclosure of all
study-related information, including potential risks and benefits.
● The privacy of each respondent will be protected by not publishing their names or actual
addresses.
● The duration of the interviews is limited to one to two hours both IDI and FGD, which is
sufficient time to investigate the experiences of each participant in availing healthcare
services in their area.
● The interview will be done virtually through google meet and messenger video call.

● The questions will include the topic about the experiences of the participants in availing
healthcare services.

VOLUNTARY PARTICIPATION AND ALTERNATIVE OPTIONS

Your decision whether or not to participate in this research study is completely voluntary. It
is up to you whether or not you decide to participate. If you decide to participate, you will be
required to sign this informed consent form. After you sign this consent form, you can still withdraw
 ST. MARY’S COLLEGE OF TAGUM, INC SMCTI
OFFICE OF THE RESEARCH ETHICS COMMITTEE QTIME
National Highway, Tagum City, 8100 Davao del Norte, Philippines
Email Address: smcti.rec@smctagum.edu.ph Faith • Excellence • Service

Quality Transformative Ignacian Marian Education

your consent and discontinue participation at any time and without giving
a reason. In the event that you withdraw from the study before data
collection is completed, rest assured that your data be destroyed in a
manner prescribed by law.

RISKS, BENEFITS, REMUNERATION, AND REIMBURSEMENTS

There are no known risks in participating in this study. We made sure the data
confidentiality and we made sure the research participants' autonomy while also ensuring full
disclosure of all study-related information, including potential risks and benefits. There are no
direct benefits to participation in this research study, however, your participation will help as a
basis for health administrators as they can implement more effective programs that will enhance
the health services of the people living in the rural areas. You will be given a little gesture of
appreciation for your participation in the study.

You will also be recompensed of whatever expenses that you may have incurred in the
conduct of the study. (Travel expenses, compensation for loss of income, meal expenses, internet
load, cellphone load, etc.).

PRINCIPAL INVESTIGATOR’S RESPONSIBILITY DURING ADVERSE SITUATIONS

This phenomenological study is to explore and understand the experiences of the people in
availing healthcare services of a rural area in Davao de Oro. At this stage of research, the inquiry
on the healthcare services among the people living in the rural areas would mean, how will the
available services be able to meet the health needs as well as how its location contributes
significantly in the overall health-seeking behavior and health status of the people. The study will
also gather information using online platforms like google meet, phone calls, zoom and messenger
video call in questioning and interviewing the participants on the availability of health services
offered in the area to make the research sufficient.

In order to avoid the occurrence of any potential type of harm (i.e., psychological, emotional
or social) during the conduct of this research study, I will provide you in advance with information
on counseling matters or services or appropriate support bodies (if necessary) dealing with the
issue. But in the event that interaction with you may inadvertently harm you in some unintended
way, I will take responsibility to address the issue.
 ST. MARY’S COLLEGE OF TAGUM, INC SMCTI
OFFICE OF THE RESEARCH ETHICS COMMITTEE QTIME
National Highway, Tagum City, 8100 Davao del Norte, Philippines
Email Address: smcti.rec@smctagum.edu.ph Faith • Excellence • Service

Quality Transformative Ignacian Marian Education

PRIVACY AND CONFIDENTIALITY

Your privacy is of paramount importance, and thus, it is protected by conducting the

research in a private setting and/or other space considerations or security measures will be
properly observed for online research/survey platforms. Equally, you should not be forced to
reveal any personal information to the researcher that you do not wish to reveal.

Rest assured that the data or information you provide will be treated with complete
anonymity and utmost confidentiality by means of discrete coding. No individual identities will be
used in any reports, presentations or publications resulting from the research study. All research
data or information will be kept in locked files at all times (for material copies) or password
protected folder (for electronic copies). Only the principal investigator will have access to the files.

After the research study is completed, the data collected will be retained for three (3) years
and be destroyed immediately thereafter in a secure manner that would prevent unauthorized
access, use or disclosure to any other party or the public or in a manner prescribed by law.

INFORMATION AND STUDY RESULTS

You may have access to your own data. After the analysis of all the data for this research
and you wanted to be informed of the results, you will be provided with a free copy of the results.

USE OF RESEARCH DATA

The data collected from this research study will be used solely for the attainment of the
intended purposes. It may be presented at any research for and/or published in journals or used
for any other legitimate purposes, which St. Mary’s College of Tagum considers proper in the
interest of education, knowledge, or research. This could help other educators and healthcare
providers to have a basis in enhancing healthcare service in rural areas.

AUTHORSHIP

The authors of this study are the following: Caday, Rafael Angelo; Diaz, Elaiza; Emanel,
Mike Christoper; Hingabay, Shela Mae; Viloria, Piolo Jay. Including Mrs. Lhevinne Genetializa RN.
Who is our research adviser who would be treated as a co-author of this research study.

CONFLICT OF INTEREST

I declare no conflict of interest.

PUBLICATION
 ST. MARY’S COLLEGE OF TAGUM, INC SMCTI
OFFICE OF THE RESEARCH ETHICS COMMITTEE QTIME
National Highway, Tagum City, 8100 Davao del Norte, Philippines
Email Address: smcti.rec@smctagum.edu.ph Faith • Excellence • Service

Quality Transformative Ignacian Marian Education

Results of the study may be submitted for publication. The study

may be presented in a scientific forum or published in a journal, but in a
manner where your personal identity will not be revealed.

CONTACT INFORMATION

If you have questions about the study, please feel free to contact the above-named
principal investigator by calling 09655419141 (TM) or email him/her at
emanelmike@smctagum.edu.ph. You can also contact the Chairperson of the SMCT Research
Ethics Committee, Dr. Maria Lalaine P. Chieng at 0992448449 with any questions about your
rights as a research participant or any related research concerns or contact the Data Protection
Officer, Mr. Erwin L. Sabornido at 09324858115 or email him at
erwinsabornido@smctagum.edu.ph or smctagumdpc@gmail.com for concerns regarding your data
privacy rights.

Thank you very much!

CERTIFICATE OF CONSENT

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

Please check the option that applies to you before affixing your signature below with the following
options:
I give permission for my ________________________ to be audio or video taped.

I do not give permission for my ____________________ to be audio or video taped.

For face-to-face conduct of research:

I have been informed about the risk of exposure to COVID-19 in this research study. I
understand that regardless of any precautions taken, a possible risk of exposure to the virus
still exists.

Printed Name of the Participant : ____________________________________________

Signature of the Participant : ____________________________________________

Date & Place : ____________________________________________

This portion is applicable only to participant/s who is/are illiterate:

 ST. MARY’S COLLEGE OF TAGUM, INC SMCTI
OFFICE OF THE RESEARCH ETHICS COMMITTEE QTIME
National Highway, Tagum City, 8100 Davao del Norte, Philippines
Email Address: smcti.rec@smctagum.edu.ph Faith • Excellence • Service

Quality Transformative Ignacian Marian Education

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 and
voluntarily.
Thumb Print of the Participant
Printed Name of the Witness : _____________________________

Signature of the Witness : _____________________________

Date & Place : _____________________________

Note: A literate witness must sign on behalf of the illiterate participant (if possible, he/she should
be selected by the participant and should have no connection to the principal investigator/s).
Participant/s who is/are illiterate should include their thumb-print as well.

Statement by the Principal Investigator/s Taking Consent

I, the undersigned, certify that to the best of my knowledge, the participant signing this
consent form has read the above information sheet fully or it has been read to him or her and that
this has been carefully explained to him or her and that he or she clearly understands the nature of
the risks and benefits of his or her participation in this study. I confirm that the participant has not
been coerced into giving consent, and the consent has been given freely and voluntarily.

A copy of this Informed Consent Form has been provided to the participant.

Printed Names of the Principal Investigators : RAFAEL ANGELO CADAY

ELAIZA DIAZ
MIKE CHRISTOPER EMANEL
SHELA AME HINGABAY
PIOLO JAY VILORIA

Signatures of the Principal Investigators :

Date & Place : May 19, 2022/ Tagum City, Davao del Norte