CHAPTER I

THE PROBLEM

Introduction

A parent has no greater aspiration than to see their child grow up and make their

mark in the world. But for one’s progeny to even reach that point, it is imperative that

they have survived past their childhood and into adulthood. Thus, it is only

understandable how humans have developed intense protectiveness towards their young

in the hopes of guaranteeing survival.

One of this evolutionary trait and parental love, arose the greatest milestones of

human development which is the drastic lowering of the infant mortality rate and the

increase of the average human life span. This progress is attributable to the improvement

of various healthcare measures, particularly vaccination.

Vaccination is the administration of a vaccine to help the immune system develop

protection from a disease [insert citation]. Vaccines contain a microorganism in a

weakened or killed state, or proteins or toxins from the organism. In stimulating the

body's adaptive immunity, it helps prevent sickness from an infectious disease.

It is the most effective method of preventing infectious diseases. The World

Health Organization (2015) credits the worldwide eradication of smallpox and the

elimination of diseases such as polio, measles, and tetanus to vaccination efforts. Each

year, vaccination prevents between two and three million deaths worldwide, across all

age groups, from diphtheria, tetanus, pertussis and measles.

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 When a sufficiently large percentage of a population has been vaccinated, herd

immunity results. This protects those unable to get the vaccine due to medical conditions,

such as immune disorders and lessens the likelihood of individuals suffering and being

irreparably damaged due to a preventable disease.

However, despite the proven effectivity and safety of vaccines, herd immunity

cannot and has not been attained. This explains why vaccine-preventable diseases remain

the most common cause of childhood mortality with an estimated three million deaths

each year.

In response to this phenomenon, the Philippines promulgated Republic Act 10152

or the Mandatory Infants and Children Health Immunization Act of 2011. The said law

mandates vaccination to children until 59 months. The law was passed in accordance with

the policy of the state, as provided for in the Constitution, to promote the right to health

of the people and instill health consciousness by taking a proactive role in the preventive

health care of infants and children through a comprehensive, mandatory and sustainable

immunization program for vaccine-preventable diseases for all infants and children. The

mandatory basic immunization for all infants and children provided under this Act covers

the following vaccine-preventable diseases such as tuberculosis, diphtheria, pertussis,

tetanus, hepatitis B, mumps, measles, rubella, poliomyelitis, H. influenzae type B, and

rotavirus.

Despite this law and the government’s efforts, implementation of the vaccination

programs is stifled due to lack of compliance by parents borne out of genuine fear of

introducing harm to their beloved children. During the last quarter of the year 2018, the

2
Philippines has been bombarded with controversies regarding the infamous Dengvaxia

vaccine. The said vaccine aims to totally eradicate the cases of dengue in the country.

Though well intentioned, information regarding the vaccine was not disseminated

properly. Supposedly, only those children that have been exposed to dengue will be given

with the vaccine, but as a result, both unexposed and exposed children were vaccinated,

resulting in adverse reactions occurring to those children not exposed to dengue. Ever

since the incident, the entire country has been put into uproar, causing parents not to

comply with the immunizations anymore because of the fear that the Dengvaxia incident

will be repeated.

In the early 2019, the cases of measles in the Philippines skyrocketed to a

whopping 400% higher than the previous years. Alarmed, the Department of Health

prompted the health sector to launch the Oplan Ligtas Tigdas Campaign, which aims to

vaccinate every susceptible individual with AMV to reduce the incidence rate of the

disease.

But since the people feared about the effects of the vaccines, many parents

opposed the vaccination of their children. Previously, the Philippines has only a

minimum of 3 deaths per 100,000 related to vaccines yearly, but in early 2019, the

mortality rate of measles increased to 300% which alarmed the government.

Similarly, in Cebu, the cases of measles and tuberculosis has been slowly rising

ever since the Dengvaxia mishap.

In light of these unfortunate developments, there is a great need to contain the

hysteria and redeem the public’s trust in healthcare. The best response to fear and

3
ignorance is knowledge and thus, there is at present a need to fill the lacuna in academic

medical literature. While the fears caused by the Dengvaxia mishap have been well

documented by media, there are not much studies done to document a correlation

between vaccination fears and compliance. In order to remedy the situation and propose

meaningful ways to get parents to have their children vaccinated would require an

understanding on the motivations behind their behaviors and not rely on quick

presumptions.

Thus, this study seeks to fill the gap in literature by determining the level of

compliance of parents to vaccinate their children and determine the preconceived factors

of parents regarding vaccination risks. By knowing these, researchers would be able to

understand what may persuade and dissuade parents from having their children

vaccinated and thus may be translated into meaningful policies that will encourage

vaccination and ideally, attain herd immunity. It will be a valuable contribution to society

for it protects the health and well-being of the future generation.

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Theoretical Framework

The framework of the study is based on the Health Belief Model (HBM) by

Godfrey Hochbaum, Irwin Rosenstock and Stephen Kegels. HBM originated in the 1950s

when they were working in the U.S. Public Health Services (USPHS) as social

psychologists. The Model was borne in response to the catastrophic event on the free

tuberculosis (TB) health screening program.

From that point on, the HBM has been adjusted to investigate an assortment of

long-and fleeting wellbeing practices, including vaccination perception and compliance.

The model stays one of the best known and most generally utilized models in health

behavior (Nursing theories, 2013).

Glanz, K., Rimer, B.K. & Lewis, F.M Key aspects of the Health Belief Model

(Health Behavior and Health Education, 2002) propose that an individual will procure the

necessary action if that someone will:

1. Experience a threat in reference to destructive physical

condition that can be prevented.

2. Has a positive result that by making prescribed move he/she

will choose to vaccinate their children to reduce the circumstances to the

effects of the virulent communicable disease (i.e. submitting to the

scheduled immunization program according to RA 10152).

3. Take into account that a course of action can reduce the

susceptibility and seriousness.

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 4. Negative results that would intrude on somebody's eagerness to

change. (i.e, adverse reactions after the immunizations). The pros

(advantage) have to overshadow the cons (barriers).

The HBM was spelled out as far as four develops speaking to the apparent risk

and net advantages: Perceived susceptibility is to make a person threatened of how much

perceived risk require to transpire, to boost the notion of modifying behavior. Perceived

severity is to depict critical of the condition, there is a severe outcome if no action is

taken. Perceived benefits is to portray a positive outcome that can arise from behavior

change and improve health condition. Perceived barriers, a negative effect that would

disrupt in taking action in willingness to change. The cues to action would motivate that

eagerness can arouse overt actions. The final aim is to make people believe that they can

make the change and modify their lives. Lastly, self-efficacy was added in 1988 by

Rosenstock to facilitate the HBM to improve a healthy and robust lifestyle. This can also

give confidence to the individual in making a behavior change (Connor, 1996).

Furthermore, the theory endeavors to foretell health related behaviors for

individuals and cannot be relate to environmental or social and economic concern,

disparities among the population concerning awareness on health behavior varies. For

instance, smoking is bad for your health however, some people may not know that

smoking is bad for you. Not everyone has the same knowledge about health behaviors.

The main goal for the HBM is to curve the disparity by making people to change their

behavior and through the Health Belief Model it can increase knowledge to an individual

(Schimenti, 2012).

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 HBM is a well-known model in nursing, it centered in the preventive health care

practices in patients and its compliance. In addition, HBM deals with the relationship

between a person’s belief and behaviors. It gives perception to the individual, expect and

understanding on how participants will act in connection to their health and how they act

in accordance with the health care therapies. (Schwarzer, 2015).

The model is presented in figure 1 has five key factors in order to achieve

optimum well-being as the fundamental goal that are needed for the study. The

sociodemographic factors, often times people who engage to such behavior are those who

are economically relegated and some maybe in the context of oppression or coercion,

incognizant to the effects of vaccines both its risk and benefits. The lack of education,

being young may compel someone to engage into prostitution or simply the influence of

the environment like the red light district. Behavior, one can acquire such disease if a

person does not submit to the immunization schedule.

Subsequently, an individual will assimilate various diseases such as tuberculosis,

pneumonia, and other communicable diseases brought about by the Susceptibility, if one

is not prudent or cautious of his/her behavior, one other determinant to prevent

proliferation of immunizable communicable disease is information propagation. The

social media is one of the most effective channel to spread the awareness of the

importance of vaccination with practical facts. However, the City Health, DOH and other

health care services are strong contenders and robust strategic tactics to promote and

disseminate the information regarding the importance of vaccination to their children.

Conclusively, recommendations after study are desirable, for instance health teaching and

giving of brochures to remind its residents.

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 For this reason, the researchers opted this theory since it is appropriate for

sexuality setting especially in an area like Barangay Talamban .It can clearly decipher

into theoretically constructed as behaviorally focused.

The theory is very relevant in the current study of the Compliance to Vaccinations

of Children and the Perceived Risk of Parents regarding vaccinations in Barangay

Talamban, Cebu City. The risk that the residents in the area are currently facing is

pervasive in view of the fact that several cases of immunizable communicable disease are

rising in this barangay especially measle. People should be aware and constantly be

reminded that it can jeopardize the community and even threat to spread all over Cebu

providence if no action is taken.

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 Behavior
Preconceived ideas
regarding vaccination

PROFILE
Sociodemographic
factors
Age, Sex, Susceptibility
Educational
attainment, period Known information
of residency regarding vaccines
Optimum
Well-being

Information
Practical facts and
Recommendation vaccine knowledge,
Health teaching Cebu City Health
subsequent to the Department program,
study, and other health care
services
Pamplets

Figure 1. Schematic Diagram of the Theoretical Framework based on the Health Belief
Model of Godfrey Hochbaum, Irwin RosenstockRosenstock and Stephen Kegels (1984)

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Statement of Purpose

The study endeavors to appraise the compliance level to vaccinations and the

perceived risks of vaccination of parents as hypothetical in the Barangay Talamban, Cebu

City. Particularly, this seeks to answer the following questions:

1. What is the profile of the respondents?

1.1 Age

1.2 Gender

1.3 Educational Attainment

1.4 Religion

2. What is the parent’s attitude on compliance to vaccines?

3. What is the level of vaccine hesitancy?

4. Is there a significant relationship between the perceived risks of parents to vaccination

to its compliance?

5. Bases on the findings of the study, what information and education materials can be

proposed to campaigns for compliance such as infomercials?

Null Hypothesis

Ho1. There is no significant relationship between the profile and knowledge on

the compliance to vaccinations.

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Significance of the Study

Gauging the knowledge on the compliance to vaccinations and its impact on the

attitude of the residents in Barangay Talamban, Cebu City has wide ranging implications

in relation to the provision of the disease control.

Residents of Barangay Talamban, Cebu City. The residents of Barangay

Kamagayan would be the primary beneficiary in this endeavor. Through this study this

will promote and create an awareness, preclude the transmission of this communicable

disease to the whole community and even the whole province.

Government. The government needs to support this undertaking through close

watch of any reported cases and give an accessible medication to any infected individual

to prevent from spreading the disease. Emphasize the importance on the compliance of

vaccination in promoting the best favorable level of health and campaign for the

prevention of immunizable communicable disease transmission in cooperation of the

Department of Health.

City Health Department. The City Health Department is the main responsible in

endorsing the promotion of health and assessing the latest cases of immunizable

diseases. The department is in charge of information dissemination to preclude and

minimize as much as possible the spreading of the disease.

Researchers. The study provides an enhancement to the researchers and

supplementary facts in the requirement to propagate an essential data to the residents of

promoting the compliance to vaccination.

Policymakers. This study is significant for policymakers because the

policymakers will be more effective in crafting policies, programs and laws to encourage

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compliance among parents. The policies crafted can take into account the source for the

vaccine hesitance and will be able to target such in ways that present policies cannot.

Healthcare workers. Healthcare workers who work directly in implementing the

various vaccination efforts can benefit greatly from knowing what goes on in the minds

of parents. This will help them coax parents to comply with the vaccination efforts.

Future Researchers. This will impart as a citation if they make a parallel study

or similar in nature.

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 DEFINITION OF TERMS

The following are the terms used in the study and their operational uses and

definitions.

Awareness is the understanding of the parents regarding vaccination, its relevant

information and their perceived information regarding vaccines

Compliance is the voluntary submission of the parents to vaccinate their children

in the health centers.

Communicable Disease these are disorders or diseases that can be prevented by

submitting for vaccination/

Contributory Factors are different factors that greatly enhances the risks of a

parent to become non-compliant with vaccinations

Vaccine is an attenuated microorganism that is given to children to reduce the

incidence of diseases. This can be given through oral and injection. Vaccinations in the

Philippines include Pentavalent (DPT, Hepatitis B and HiB), AMV, OPV and MMR.

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 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

In this chapter, this will tackle on the different literatures utilized in the study that

will show the immunization compliance of the citizens as well as the common perceived

risks by the parents regarding immunization.

Vaccination in the 21st Century

Vaccines were developed in the twentieth century to address the needs of a

society where morbidity and mortality caused by infectious diseases in the early years of

life was the major health challenge. Thanks to the success of vaccines, in the twenty-first

century people live longer, and we should consider how vaccination can be redesigned to

meet the needs of healthcare systems that are struggling to cope with the new longevity.

Today vaccines address mostly infant diseases and we have more than 10

vaccines recommended in Western countries for infant vaccination, one (papillomavirus)

recommended for adolescent women and one (influenza) recommended for the elderly. In

developing countries, there are only five recommended vaccines, all for infants.

However, thanks to the technological revolution, genomics and the great progress in

immunology, today it is possible to design vaccines able to prevent many of the diseases

of modern society. For instance, we could develop a vaccination plan where pregnant

women receive a booster vaccine during the third trimester to generate and passively

transfer to the foetus antibodies against those diseases of the first few days or months of

life, such as group B streptococcus (GBS), tetanus, hepatitis B, meningococcus,

pneumococcus, respiratory syncytial virus (RSV), influenza, using the strategy that has

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evolved naturally to protect newborns. Infants would then be vaccinated starting at four

to five months of age to build their own active immunity. The next vaccination event

would be in adolescents, who would receive those vaccines that prevent the chronic

diseases and cancer associated with infectious diseases, such as papillomavirus

(associated with ovarian cancer), hepatitis C (which is associated with liver cancer) and

chlamydia (associated with infertility) and those vaccines that would be useful during

pregnancy, such as cytomegalovirus (CMV) and GBS. Some vaccines like CMV and

Epstein–Barr virus (EBV) also have the potential to slow ageing of the immune system,

one of the major problems beyond the age of 50. (Rappouli, 2014)

When the immune system starts to wane, vaccination could be used to fight, delay

or eliminate those diseases that are typical of a modern ageing society. These are

resurgent infectious diseases, such as influenza, pneumococcus, RSV, those diseases

associated with the risk of hospitalization (mostly nosocomial diseases) and cancer.

Finally, there are numerous other health risks in modern society that could be

minimized by using vaccination as an insurance. These include (i) prevention of those

infections caused by antibiotic resistant micro-organisms that are a major threat during

hospitalization, such as Staphylococcus aureus, Pseudomonas aeruginosa and Clostridium

difficile, (ii) prevention of pandemic influenza by appropriate pre-pandemic vaccination

using vaccines with an established safety record, and (iii) vaccines for travellers to areas

where there are diseases no longer present in the country of origin. There is thus a strong

rationale for vaccines as the best insurance against the risks of diseases associated with

modern society. (Bell, 2014)

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Vaccination on Low-income Countries

Vaccines can also make a great contribution to reduction and possibly elimination of

poverty from our planet. In developing countries, many vaccine-preventable diseases

exact a huge toll on the income of families and throw them into a downward spiral of

poverty. Currently, five vaccines are recommended for routine use in developing

countries. There is no established mechanism to develop those vaccines needed only in

developing countries and for which there is no commercially viable market. Innovative

mechanisms to make vaccines available to people in developing countries must be a

priority in the twenty-first century for Western societies and for the governments of

developing countries. Projects such as the Advanced Market Commitment, the Meningitis

Vaccine Project and the Novartis Vaccines Institute for Global Health are promising

examples of initiatives that can help with funding, developing and deploying vaccines for

the poorest people. In the coming years, the new technologies are going to offer very

promising perspectives in the development of ‘unconventional’ vaccines, i.e. vaccines

against non-infectious diseases (such as cancer, Alzheimer disease, diabetes, drug

addiction, hypertension and autoimmune diseases), to expand the potential for vaccines to

improve the quality of our lives. The potential of vaccines against cancer and chronic

diseases is covered by the works of Liu and Bachmann & Jennings. In any case,

concerted action, involving academic environments working in vaccine research and

medical teaching, vaccine manufacturers, public health policy-makers and governments,

will be needed if we want to eliminate poverty from our planet. (WHO, 2016)

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Vaccination Safety and Public Perception

The perception that vaccination may be dangerous has been a major concern for

vaccine developers and regulatory agencies that during the past few decades have been

working hard to improve vaccine safety. First, all those vaccines associated with major

safety concerns, such as smallpox, oral polio, whole cell pertussis and high dose measles,

have been discontinued or are going to be discontinued soon. Second, the new

technologies minimize the risks associated with the new generation of vaccines. Highly

purified components of known molecular entity, recombinant antigens, polysaccharides

conjugated to purified proteins and new antigens discovered by genomics have allowed

the development of a new generation of molecularly tailored vaccines that are well

characterized and intrinsically safer than the crude preparations of the twentieth century.

Live-attenuated vaccines that in the past were derived by random passages and

mutagenesis today have been replaced by strains with molecularly designed attenuating

mutations or by vectors designed to immunize but not replicate. Finally, in the era of the

technological revolution, we have plenty of new tools to predict safety risks of new

vaccines. For instance, screening the vaccine candidates for sequence homology with the

human genome allows identification and removal of those antigens that may have a risk

of inducing autoimmunity that has so often been a problem in the past. New tools that

will continue to increase vaccine safety are now promulgated to ensure increase in

confidence to be vaccinated (Thompson, 2017)

However, elimination of the vaccines with safety concerns and minimization of

the safety risks in present and future vaccines is still not going to be enough to gain

public trust in vaccines. Government agencies need to educate people that, even in

17
developed countries, infectious diseases are still around the corner and are a real threat if

one does not remain on the alert and if a preventative approach is not undertaken.

Therefore, people need to think about vaccines when they are healthy, because

vaccination is the best insurance against diseases that will be present in the twenty-first

century. Individuals need to remove from their minds the perception that vaccines are

dangerous and to be avoided, since this is no longer true. Health policy-makers should

also actively promote this message, starting from the consideration that vaccination has

contributed more than any other medical intervention to the reduction of human diseases

(Abbott, 2016)

Public Confidence Regarding Submission to Vaccination

Until very recently, vaccines had been developed following the Pasteur example

of inactivating and injecting the micro-organisms causing the diseases. These primitive

technologies, mostly developed during the first half of the twentieth century, led to crude

vaccine preparations that have nevertheless been very successful in the conquest of

diseases. However, they were often associated with some safety concerns. For instance,

although it was instrumental in the eradication of the disease, the smallpox vaccine was

essentially developed with a technology of 1796, and was associated with cases of

generalized vaccinia, encephalitis and myocarditis. The first rabies vaccine, grown in

mouse brain cells, was associated with the occasional induction of encephalitis owing to

vaccine-related autoimmune responses against the brain protein myelin. Even the Sabin

oral poliomyelitis vaccine, developed during the 1950s, was associated in one case per

million with paralytic disease in vaccines and contacts. Some of the other first generation

vaccines were also known to exert a significant reactogenicity. Therefore, it was quite

18
understandable that some public fears were associated with vaccination during the first

part of the twentieth century (Kirkwood, 2015).

Although, none of these vaccines is used any longer, at least in Western

countries , there is still a deficit of public trust which is hampering the optimal control of

some vaccine-preventable diseases. This is owing to the perception that vaccines are

great tools to fight fatal diseases but may occasionally be dangerous. This is enhanced

when the risk of infection is decreasing as a result of generalized vaccination against a

particular target disease and it is a paradox characteristic of a wealthy society. There is a

false perception that some diseases are not or are no longer dangerous. For example,

many people consider measles to be an entirely benign infection and forget the high toll

of morbidity and mortality it can cause: measles epidemics do occur today in European

countries because the rejection of vaccination has resulted in insufficient vaccination

coverage. Similarly, there was a major epidemic of diphtheria in Russia owing to

disruption of the health system in the former USSR and a reduced level of vaccination.

This prejudice against vaccines has fostered the perception that vaccines are great but

dangerous, and throughout the entire twentieth century, people regularly attributed to

vaccination all those diseases of unknown cause. For instance, in the absence of a known

cause of the rise of autism, many people concluded that it had to be caused by

vaccination. First, they associated autism with measles, mumps and rubella vaccination;

then, when that was disproved scientifically, others associated autism with the use of

thimerosal, a mercury compound used until recently to maintain the sterility of vaccines.

Now, even after the association of thimerosal with autism has been scientifically

disproved, there are still some fundamentalists who refuse to accept the scientific

19
evidence and insist that autism is caused by vaccination. Another example is war

veterans. When they come back from the drama of the war with various health problems,

such as in the case of the Gulf War, people like to attribute their disabilities to vaccines

rather than to the brutality of the war. Similar clinical pictures were observed in the

soldiers fighting in the American Civil War, at a time when vaccines (except for one) did

not exist. Another phenomenon that has happened during the past century is the increase

of allergies in developed countries: being of unknown cause, many have associated it

with vaccination (Noorfield, 2015)

The New Expanded Program on Immunization or the Republic Act 10152

In the Philippines, the Presidential Decree 996 or the Expanded Program on

Immunization act was repealed in 2010. It was passed and signed eventually in the year

2011 the Republic Act 10152 or the Mandatory Infant and Children Health and

Immunization (MICHI) or simply called the New Expanded Program on Immunization

Act of 2011. The law seeks to ensure that children, particularly infants and their mothers

have access to vaccines recommended for their age to prevent specific disease (DOH,

2015). The law provides access to vaccine and the program aims to decrease the

morbidity and mortality of communicable disease among children. When the program

was first rolled-out, the vaccine-preventable diseases include tuberculosis, poliomyelitis,

mumps, rubella, measles, diphtheria, tetanus and pertussis. But during the passing of the

new act in the year 2011, the mandatory basic immunization now covers the above

disorders including hepatitis B, H. influenzae B and rotavirus. Because of the campaign

on vaccination, the number of cases of certain diseases have been decreased in recent

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years. For example, the last case of wild poliovirus in the country was reported in 1993

(DOH, 2016).

Under the law, any “physicians, nurse, midwives, nursing aide, or skilled birth

attendant” present during the delivery of a newborn are required to inform parents or

legal guardians of the “availability, nature, and benefits” of immunizations against

vaccine-preventable diseases at birth. The mandatory basic immunization is given free at

any government hospital or health center for children up to 5 years old. Vaccine against

Hepatitis-B, meanwhile, should be administered to an infant without 24 hours after birth.

Subsequent doses shall be completed according to the recommended schedule as

provided by the DOH. In 2004, the DOH introduced the Reaching Every Barangay

(REB) strategy which aimed to improve the access to routine immunization and reduce

drop-outs in the program (DOH, 2016)

All health centers are required to have at least one staff trained to follow through

with this strategy which includes collating data on vaccinated children, strengthening

links between the community and the health sector, and supportive supervision, among

others. The REB is just one of the strategies the health department deployed to ensure

that each child in the Philippines is vaccinated. Another strategy is the Supplemental

Immunization Activity (SIA) which targets children who did not develop sufficient

immunity. Under its 2018 budget of P107.3 billion, P7.43 billion of which will be used

for public vaccination program that targets full immunization of 2.7 million infants while,

2.7 million pregnant women will receive tetanus vaccine (DOH, 2018).

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Vaccination Scare in the Philippines

Health officials in the Philippines are racing to contain a deadly measles outbreak

the government blames on a marked decline in immunizations after a scandal surrounding

a dengue fever vaccine. More than 70 people - mostly children - have died of measles

nationwide since January, with a high concentration of cases in the capital, Manila, and

its surrounding provinces. Across the country, over 4,300 people have contracted the

highly contagious disease this year, a 400-percent jump compared with the previous year,

according to the Department of Health. Many of those affected are from poor families

who depend on public health services for care and medicines, both of which the

government is now hard-pressed to supply. In communities and villages, health workers

have been urging hesitant parents to immunize their children against measles and other

diseases such as polio, diphtheria, hepatitis and the flu. Over the past year, fewer parents

have used the government's free basic immunizations, fearing the vaccines could harm

their children. Health officials say vaccination rates have gone down from 85 percent to

60 percent, even as low as 30 percent in certain communities. As a result, experts say,

many children have been left vulnerable to measles, with unvaccinated adults also facing

the risk of contagion (DOH, 2019).

The spread of the disease is a huge setback to a country that had been on its way

to eliminating measles in 2010, and it underscores the dangers of movements against

vaccinations. Just over a decade ago, in 2005, the Philippines had almost no deaths from

22
measles, according to the Philippine Foundation for Vaccination. It also follows a global

wave of measles outbreaks — with 6.7 million cases worldwide in 2017 — including in

parts of the United States and Europe, similarly fed by conspiracy theories and

misinformation. The Health Department first declared the measles outbreak in

metropolitan Manila in early February and has since expanded it across other areas on the

islands of Luzon and the Visayas. Cases have increased 392 percent compared with the

same period last year. Manila, a chaotic, crowded city dotted with high-rises and slums, is

home to 12.8 million people. But experts say the country has already been fighting the

spread of the disease in more rural parts of the archipelago, where doctors struggle to get

communities vaccinated. The Philippines’ UNICEF representative, Lotta Sylwander, said

the agency has been working with the country’s Ministry of Health to raise the alert level

“for some time now.” (DOH, 2019)

The controversy began in 2017, when pharmaceutical company Sanofi Pasteur

made a sudden announcement that its Dengvaxia vaccine could lead to severe cases of

dengue among those who had not contracted the disease before. This threw concerned

parents and the public into a frenzy, as Dengvaxia had been administered to more than

8,000 public school students in a mass immunization program the year before. The

media, too, has been accused of adding fuel to the fear. The Center for Media Freedom

and Responsibility found that three major newspapers concentrated on the “politics” of

the scare, and it said a broadcast network sensationalized the issue by running footage of

emotionally distraught parents (DOH, 2019).

Common Misconceptions Regarding Vaccinations Perceived by Parents

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 Perhaps the most common misconception is that a child’s immune system can be

“overloaded” if the child receives multiple vaccines at once. This concern first began to

appear as the recommended childhood immunization schedule expanded to include more

vaccines, and as some vaccines were combined into a single shot. However, studies have

repeatedly demonstrated that the recommended vaccines are no more likely to cause

adverse effects when given in combination than when they are administered separately.

(Riley 2015)

Some parents decide to “spread out” the time period during which their children

receive vaccinations “just in case” this misconception is accurate. However, there is no

scientific evidence to support this approach, and delaying vaccinations puts children at

risk of contracting preventable diseases (Riley, 2015).

Some people assume that because diseases like polio have disappeared from the

United States, it’s no longer necessary to vaccinate children against them. However, polio

is still widespread in other parts of the world, and could easily begin re-infecting

unprotected individuals if it were re-introduced to the country. Another example is

measles, which has become rare in the United States: U.S. outbreaks of the disease have

occurred when Americans traveling to countries where measles remains widespread

brought the disease back with them. With adequate vaccination rates, most of these types

of outbreaks can be prevented. But if vaccination rates drop, “imported” cases of

preventable diseases can begin to spread again. In the early 2019s, for example, low

vaccination rates in the Philippines allowed measles to become epidemic once again after

earlier vaccination rates had halted its continuous transmission in the country (DOH

2019).

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 Some people argue that the immunity gained from surviving a natural infection

provides better protection than that provided by vaccines. While it’s true that natural

immunity lasts longer in some cases than vaccine-induced immunity can, the risks of

natural infection outweigh the risks of immunization for every recommended vaccine.

For example, wild measles infection causes encephalitis (inflammation of the brain) for

one in 1,000 infected individuals, and, for every 1,000 reported measles cases, two

individuals die. The combination MMR (measles, mumps, and rubella) vaccine, however,

results in encephalitis or a severe allergic reaction only once in every million vaccinated

individuals, while preventing measles infection. The benefits of vaccine-acquired

immunity extraordinarily outweigh the serious risks of natural infection, even in cases

where boosters are required to maintain immunity. Additionally, the Hib (Haemophilus

Influenzae type b) and tetanus vaccines actually provide more effective immunity than

natural infection (WHO 2016).

Common Factors Affecting Vaccination Rates

Immunization programs have had a dramatic impact on reducing the number and

severity of communicable disease outbreaks. Such diseases as smallpox and polio have

been completely eradicated in most parts of the world. However, many other vaccine-

preventable diseases persist and in some cases have increased in prevalence because of

lowered immunity in the general population. Childhood vaccines do much to provide

lifetime immunity to certain diseases, but for other diseases, such as pertussis, additional

doses of vaccine are now recommended to protect individuals with waning immunity.

Experience has taught the world that there is a direct correlation between the rates of

25
infant immunization in a community and the rates of vaccine-preventable diseases (CDC,

2015).

A national goal of RA 10152 is to “achieve and maintain effective vaccination

coverage levels for universally recommended vaccines among young children.” The

specific goal is for 90% of all children to have completed the recommended series of

immunizations by age 2 years. Vaccination rates of 90% are generally sufficient to

prevent the spread of communicable disease via “herd immunity.” (DOH, 2015)

Herd immunity is conferred when most of the individuals within a community

have developed immunity either from receiving a vaccination against a particular disease

or from having contracted the disease. In communities with herd immunity, vulnerable

individuals are protected because the majority of persons with whom they come into

contact are immune to and incapable of spreading the disease. Effective vaccination

programs are important in raising the levels of herd immunity in communities (WHO,

2016)

Unfortunately, as we near the target year 2015, studies reveal that we as a nation

are falling short of this important goal. Nurses and physician assistants have a unique

opportunity to assure immunization adequacy in their patients. Many people may be

unaware of the vaccine recommendations for their age group or may not have had access

to vaccine services or information. In addition, adult patients and parents of young

children may have difficulty making sense of the conflicting stories about vaccine safety.

To reach the goal of providing herd immunity in communities requires diligence in using

each and every patient encounter as an opportunity to determine vaccination status

26
 Barriers to immunization that involve health-care organizations and economics

are considered systems barriers. Some of the factors that impact national immunization

rates include incomplete use of a centralized vaccine registry, lack of a universal

vaccination record, vaccine shortages, vaccine costs, and complexity of the immunization

schedule (DOH, 2015).

Centralized Vaccination Registries

During the devolution act of 1991 (RA 7160), the local government has the

control in managing the vaccinations among the citizenry as per issued by the law. For

the health-care provider, an IIS can be a complete record of the vaccines previously

received by a patient, not just through a specific practice but from all other sources,

including health department clinics and other providers. That information can assist the

physician or nurse in determining if vaccines should be offered while the individual is in

the office. This can reduce missed opportunities for administering vaccines during

nontraditional visits, such as a “sick” or urgent-care appointment, and avoid the need to

reschedule an appointment to receive vaccines.

IIS can also benefit patients and parents by providing an accurate, accessible

vaccine record. Many individuals are unsure about when a vaccine was last given, the

type of vaccine received, and when additional vaccines are needed.

Most regions have a centralized vaccine registry system in place, but a number of

factors can interfere with its effective utilization. For example, the value of an IIS is

limited by the number of providers who regularly and accurately upload vaccination

information into the system. Subsequently, shortages in office staff may cause delays in

27
information retrieval. When an accurate, up-to-date record is unavailable, patients can

receive duplicate, invalid, or mistimed vaccine doses, or they can miss needed vaccines

altogether. Many regions registries record only vaccines given to children and may not

store information on adults.

Vaccine Shortages

Limited amounts of vaccine are another systems barrier that can impact

vaccination rates. Reasons for vaccine shortages include dwindling numbers of

manufacturers, delays caused by the manufacturing process, and situations in which

demand exceeds supply. The number of licensed vaccine manufacturers in the Philippines

continues to decrease as many companies choose to develop more lucrative vaccines or

move their operations overseas. A number of manufacturers have ceased production of

some or all vaccines because of their lack of profitability or the high costs associated with

vaccine liability.

When vaccines have only a single manufacturer, that manufacturer may from time

to time struggle to keep up with demand and shortages can develop. Shortages can also

be precipitated by changes in vaccine requirements, e.g., to include an additional age

cohort that needs to receive the vaccine. In addition, newer vaccines may gain popularity

very quickly, and the supply may be depleted before additional vaccine can be

manufactured. In 2011, eight of the 11 universal childhood vaccines were either

unavailable or in short supply.

Several vaccines for adults have also been in short supply, such as the combined

tetanus, diphtheria, and pertussis (Tdap) vaccine and the herpes zoster, or shingles,

28
vaccine. When vaccines are unavailable, patients may reschedule their appointment to

receive the missing vaccines or they may delay receiving any vaccines until the entire

series is available. In many cases, individuals either fall behind or forget to return once

the vaccines are available.

Socioeconomic factors have been a primary concern in assuring that all children

have access to vaccines. The rates of uninsured children are at historic highs. Even when

families are covered by an insurance program, deductibles or co-pays may be very high

or coverage for vaccines may be incomplete. National programs, such as Vaccines for

Children (VFC), provide vaccines for uninsured or underinsured children, but few

programs provide free vaccines to adults.

Appointments for well-child examinations are a traditional time for vaccine

administration during the first two years of life. Some families exceed the allowance for

well-child care or immunizations before completing all the recommended visits or

vaccines. This may result in families’ postponing vaccines because of cost. Older

children and adults are less likely to receive well-care examinations and may not see a

primary-care provider for years except for acute-care or urgent-care visits. Unless the RN

or MD asks about vaccine status at these visits, individuals may not receive needed

vaccines.

Costs

The New EPI program has been important in providing vaccines to children who

are living in the Philippines. However, VFC and 317 other programs face funding

challenges and at times have had insufficient monetary support to cover all recommended

29
vaccines. In their study, Uy and colleagues found that immunization rates among VFC-

eligible children who received all recommended vaccines from their medical home were

as likely to be up to date as non-VFC-eligible children who had a medical home.7 VFC-

eligible children who lacked a medical home or who had incomplete insurance coverage

for vaccines were less likely to be adequately immunized.

In order to provide all the recommended vaccines, a health-care practice must

make a significant financial investment in supplies and in knowledgeable personnel who

can administer the injections. Some providers are unable to recover their costs. Providers

can also incur financial losses if privately purchased vaccines are lost as a result of waste

or because of refrigerator or other storage malfunction.

Immunization Schedule

Another systems barrier is the complexity of the immunization schedule. Over the

past 25 years, the number of childhood vaccines has more than doubled. In the early

1980s, there were 11 recommended childhood vaccines to prevent seven diseases. In

2017, the number of diseases preventable by childhood vaccines had increased to 16.

Children may receive as many as 24 vaccines during the first two years of life. The

complexity of the immunization schedule has posed challenges for both families and

providers

Although a number of vaccines are required by schools and day-care facilities,

there are other vaccines that are recommended but not required. Oftentimes, newer

vaccines that are recommended but not required are unavailable through the VFC

program and may not be covered by individual insurance plans. Some insurance

30
companies were initially reluctant to reimburse for the Penta vaccine but would

reimburse for the tetanus and diphtheria vaccine, leaving many adults and adolescents at

risk of contracting pertussis.

Vaccine recommendations in the Philippines are made by the DOH. The infant

immunization schedule was developed so that children could receive most of the required

as well as recommended vaccines by age 2 years. A single harmonized schedule of

recommended childhood vaccines allows for consistency across different medical

disciplines. The schedule provides age ranges (0-6 years, 7-18 years, adults) at which

vaccines can be administered as well as a catch-up schedule to get children who have

fallen behind to receive all vaccines by age 2 years. RNs and MDs can refer to the CDC

Web site for the most current vaccine recommendations for each age group in their

practice. Despite recommendations from the DOH and the CDC, some health-care

providers do not adhere to the schedule because of personal or philosophical differences.

Provider Barriers

Support from the health-care provider and clinic staff is an important predictor of

childhood immunizations. This support may take the form of educating the family on the

importance of immunizations and alleviating fears about potential benefits and risks.

Because the immunization schedule is so complex, office staff members sometimes have

difficulty interpreting the vaccine record of an individual patient. This can lead to

vaccines being overlooked or missed or to the administration of invalid doses.

Missed Opportunities

31
 One of the most significant provider-related barriers impacting immunization

rates is missed opportunities, i.e., those health-care encounters in which a child failed to

receive a required immunization for which he was eligible. Missed opportunities include

visits to the clinic by the family for a sick or urgent-care appointment; few illnesses

prevent a child from receiving a vaccine. In addition, children or adults accompanying

another child or family member to an appointment could receive vaccines if the

determination is made that they are missing recommended vaccine doses.

Missed opportunities present a significant barrier to adequate immunization by the

age of 2 years. In a study led by Bardenheier, the majority of children who were not up to

date on vaccines were behind because of missed opportunities. The authors found that

underimmunization at 3 months of age was a strong predictor for remaining

underimmunized by age 2 years In another study, delayed receipt of the vaccines due at 2

months was a strong risk factor for lack of age-appropriate vaccines at age 2 years.

The well-child exams done when children are 9 months old and 18 months old are

times when those who are behind in their vaccines could be brought up to date. In

attempting to identify reasons for incomplete immunizations in 2-year-olds, one study

found that 46% of such patients had failed to receive the fourth dose of the diphtheria,

pertussis, tetanus (DPT) vaccine at the 18-month visit. Therefore, using the 18-month

well-child examination as an opportunity for providing vaccines can significantly reduce

the number of children incompletely vaccinated at 2 years of age. In addition, asking

about immunization status at each and every office visit will ensure that children and

adults have received all needed vaccines.

32
 Combination vaccines are useful for administering multiple vaccines with a single

injection. This approach also reduces the pain associated with receiving several injections

at the same visit. Combination vaccines have been in use for years. Vaccines such as the

measles, mumps, rubella (MMR) and the DTap vaccines are familiar to clinicians. A

number of other vaccines are available in combination, including one for hepatitis A and

hepatitis B and a vaccine that contains MMR and varicella (CDC, 2017).

Vaccines and Immune System

Some parents and health-care providers are concerned about the increasing

number of vaccines being administered to very young children. Parents may be

concerned that the infant’s immune system is inadequately developed to handle all the

vaccines administered over the first two years of life and that receiving so many vaccines

could potentially overwhelm the child’s immune system. However, studies have not

demonstrated that the vaccines weaken the immune system. In fact, the number of

antigens to which a child’s immune system is exposed through the recommended

vaccines is actually lower than the number of antigens individuals encountered 40 or

more years ago from naturally occurring infections. Some parents and others may believe

that the risks associated with a vaccine are greater than the potential of contracting the

rarer diseases, such as diphtheria or polio (CDC, 2016).

Cost Factors

Financial and cost factors can influence the availability and promotion of vaccines

in private practices. The cost of administering privately purchased vaccines is prohibitive

for some providers who are poorly reimbursed for vaccines by insurance carriers and

33
managed health-care plans. The purchase of vaccines is the highest cost incurred by

pediatric offices, higher even than personnel costs. Yet some vaccines are reimbursed at a

price that does not compensate the health-care office for vaccine administration costs,

including those associated with the storage, supply, and personnel necessary to

administer vaccines. Economic losses associated with vaccines can result from the

previously noted storage problems, expiration of the vaccine before it is administered,

and coding or billing errors (WHO, 2017).

Parental Factors

Although RNs and MDs have a voice in the decision to vaccinate a child, the

personal and philosophical beliefs of the parents are the most influential in the

vaccination decision. Mothers are known to be instrumental in whether children are up to

date with vaccines. Addressing maternal concerns and fears regarding vaccines is an

important factor in the timeliness of vaccine receipt by preschool-aged children.15

Several factors can influence a parent’s decision to vaccinate. Among them are his or her

understanding of the risks and benefits of vaccines, perceived threat from the diseases

they will prevent, and information that the family has received from the media or other

influences. The information regarding vaccines can be very confusing for parents. Many

reputable-looking Web sites are actually antivaccine sites. The quality of the information

from these sites is suspect (CDC, 2016).

There has been much publicity in recent years regarding possible links between

vaccines and the development of autism or other neurologic disorders. This publicity,

along with other actual, unsubstantiated, or disproved vaccine safety concerns, has

34
resulted in parental fears and concerns regarding the safety of vaccines. Such fears may

cause families to delay immunizations or to decline them altogether (DOH, 2015).

Adverse Reactions

In 2016, concerns were raised about a causal link between the administration of

vaccines containing the preservative thimerosal and the development of autism and/or

other neurologic conditions. Since the release of that first report, however, several other

researchers have conducted studies to evaluate that relationship. No epidemiologic

evidence for a causal association between thimerosal and the development of autism

could be identified (CDC, 2015).

For many families, the fear of adverse reactions or harm from vaccines outweighs

concerns of the child’s contracting the disease. Some families may still believe that the

immunity derived from actually having the disease is superior to the immunity that

develops in response to the receipt of a vaccine. Contracting some diseases, such as

varicella, generally provides lifetime immunity (CDC, 2013).

35
 Chapter III

RESEARCH METHODOLOGY

This segment provides methodical discussion of research design, process,

environment, sampling technique, sampling size, research instrument, data gathering

procedures, data analysis and ethical considerations.

Method

This study will be utilizing a correlational type of research design. This will show

the compliance of the mothers to submit their children for vaccination in Barangay

Talamban. This will also show the different preconceived ideas regarding vaccination

among parents and will show the relationship between the information the parents have

regarding vaccination and their compliance to vaccination. There is no exploitation and

interference in doing the survey questionnaire in convening the significant data. This

technique is utilized as an appropriate approach in reference to the ethical issues in the

gathering of data. The subsequent basis of the gathering of data includes survey through

questionnaires.

Environment

Barangay Talamban is located along the Gov. Cuenco Ave, wherein most

subdivisions are located in this barangay. Talamban is situated right before Canduman,

Mandaue City and extends its territory near Barangay Pit-os. Several establishments and

even schools are located here. The streets are asphalted; lights are well-distributed but the

36
supply of water is scarce because of the scheduling in water interruption. Most of the

population living in the barangay consists of students and young workers; in which the

students are studying in the nearby schools such as University of San Carlos, University

of Cebu and University of the Visayas. Most of the houses in barangay Talamban is

usually consists of concrete and wood. The barangay hall and the health center is located

right in the heart of the barangay. According to the DOH report in Region VII, Barangay

Talamban is one of the barangays in Cebu City with the highest non-compliance rate to

vaccination, with non-compliance rate of 22%.

Respondents

The respondents will be the residents of Barangay Talamban. There will be at

least 350 respondents who will participate in this study. The inclusion criteria were the

following: a. must be a parent already with a child who is within the immunizable age

(until 59 months); b. they are able to express their ideas and concern regarding

vaccination; c. they are willing and open to participate in the study and d. they are

residents of Barangay Talamban for at least 1 year and above. The exclusion criteria are

a. they cannot express their ideas and concerns regarding vaccination; b. they decline on

participating the study and c. they live in Talamban but did not meet the minimum

criteria of living for 1 year or more.

Sampling Technique

The sample technique that was applied in the study is mixed sampling;

combination of purposive and simple random sampling. The researchers will select

certain people in Barangay Talamban residents who are qualified according to the set

37
criteria; then simple random sampling which involves a selection process in which each

element in a population has an equal, independent chance of being selected where we

gather data in no particular order with no pattern. The respondents will be able to give

their profile, knowledge, and attitude in reference to the study. It is subjected in manner

and does not specify an objective approach in assessing the respondents.

Instrument

The study will utilize the adopted WHO Vaccine Hesitancy Tool created by Maria

Chow and Clinton Dunchkin. The questionnaire comprises 3 parts; wherein the first part

consists of the profile of the respondents which includes the age, gender, educational

attainment; and the second part consist of 16 questions regarding vaccination perception

which will be answered by the parents. The questions are quantified to 5 being strongly

agree, 4 being agree, 3 being seemingly agree, 2 is not totally agree and 1 being disagree.

The third part of the questionnaire mainly composed of the attitude of the parent

regarding vaccination. This includes the perceived information regarding vaccine, level

of support to childhood vaccination, safeness of vaccines, concerns regarding vaccine

information, and perceived trust to the healthcare personnel.

Data Gathering Procedure

A methodical approach in gathering the data by the researchers is the following.

First, the researcher will solicit from the designated adviser to proceed in making a

correspondence addressed to the Dean of the College of Nursing in consent to proceed

from the institution to conduct with the investigation. Next, another letter will be send to

the Barangay Captain of Talamban that the researchers will be allowed to perform such

study among parents with children who is within immunizable age, respectively. Next,

38
the researchers should notify the Institutional Review Board (IRB) approval from the

perspective barangay. After all the requirements have approved, the researchers should

go to the site and distribute the questionnaire of the possible respondents to start the data

gathering with the help of the Barangay Captain of Talamban. The participation of

respondents in the study will have approximately take 10 – 15 minutes. In the event that

the respondent will decline to participate, the researchers will proceed then to other

residents who are willing or show interest in this undertaking.

The researchers should introduce themselves to establish rapport from the

respondents, explain clearly as to their motif and purpose in conducting the study. The

respondents will be given an ample to time to answer the questionnaires and entertain if

they have some clarification.After which, the questionnaires will be collected and is

subjected to further presentation, analysis and interpretation of data.

Ethical Consideration

The researchers will observe ethical principles in the realization of the study. In

the conduct of the study, three basic principles will be observed: the principles of respect

of persons, beneficence and justice. To maintain the ethical standards of this study,

several measures will be implemented. Informed consent will be obtained from the

respondents.

Risk-Benefit Assessment. The research study is clearly a sensitive issue in reference to

the protection of the participants and risk-benefit assessment should be cautiously

evaluated. There are numerous prospective risk and benefit related with the investigation.

Whether the benefit of the respondents involving the study comprises: financial wherein

the participants can get compensation or stipends.Probable physical, emotionally,

39
psychological and social harm to the respondents. Since the study is sensitive in

character, respondents should be assure that it will do no harm to them or create an

emotional distress and stigma in regard to divulging of information. The respondents

should maintain their privacy and anonymity. Researchers is ought to keep secret with all

of the survey. The study may be beneficial to the whole community in amplifying the

awareness, and prevention that the spreading of the diseases may minimize and possibly

to the whole City of Cebu. (Polit& Beck, 2012)

Content, Comprehension and Documentation of Informed Consent. The

informed consent will be furnished to the participants that is set up in local dialect

Cebuano/Visayan and English that is reasonably brief and simple to understand. It is to

substantiate that the informed consent have the sufficient information in relation to the

research, comprehend that information, have the ability to consent to or refuse to

participate and withdraw at any time. The questionnaire should be answered sincerely

and honestly and will be given an ample time to respond to the inquiry. Moreover, in

conducting the study the researchers should be required to be there to help out to answer

the questions. The informed consent comprises of the following fifteen (15) illustration to

respondents:

Participant status. The prospective participants of Barangay Talamban needs to

be informed that this endeavour will be for research purposes only and not a treatment of

any diseases or whatsoever.

Study goals. A continuous determination of awareness among the residents in

Talamban, to provide information propagation and to promote optimum well-being to its

residents.

40
 Type of data. The data will be collected to the prospective participants will be a

survey type of questions.

Procedures. Participants will be asked to sign an informed consent and will be

given the questionnaire for data collection. In the event that respondents cannot read, the

researcher will be the one to read and translate it to Cebuano.

Nature of the commitment. The participants will be told that that the expected

time of commitment will be approximately 10 -15 minutes and also mentioned in the

informed consent.

Sponsorship. The study is funded by the researchers as part of the academic

requirement. This information will be shared in the nursing publication.

Participant’s selection. Participants are selected based on their current status if

they have a child who is within the immunizable age. A minimum number of respondents

will be set by the researcher to preserve the integrity of the results.

Potential risks. If there maybe potential or unforeseeable risk that may arise from

the respondents, the survey questions will be discontinued. Nevertheless, there will be

minor risk involve, such as feeling of discomfort, taking extra of their time, and

disclosing some personal matters during the interview process.

Potential benefits. The participants will be benefited of the awareness of

vaccines and health teachings. The respondents will impart health teachings as a way of

expressing gratitude towards us for taking part of the study and this can also help the

barangay to establish and strengthen campaign about vaccination importance. The

researchers will also gain knowledge as part of their study and contributes to the

41
institution to provide information propagation, to promote well-being to its residents and

the adopted community of the University.

Alternatives. As of now, there are no known alternatives or any treatment that the

researchers offered to the participants.

Compensation. There shall be no monetary involvement and compensation to the

people and the community who participated willfully in the study.

Confidentiality pledge.The researchers assure respondents the guarantee of

confidentiality, the rights and privacy and anonymity through informed consent. The

respondents can reply the survey and answer the questionnaires without putting their

name.

Voluntary consent. The participants that are involved in this study are entirely

voluntary.

Right to withdraw and withhold information. The participants will fully have

the right to withdraw and withhold information at any time they wish to discontinue the

study, they will continue to be treated in the usual and customary fashion.

Contact information. The participants, if they need to, they can contact the

principal investigator of the study.

Authorization to Private Information. The information provided by the

respondents will be strictly retrieved via the researchers and the subjects only. The

authorization that needs approval from the respondents to access their file can be waived

only under circumstances. As stated in the informed consent, the respondents have the

right to inquire with reference to the study through communicating with the group leader.

The researchers were aware the possibility of information leakage and that it be should

42
kept strategically in a concealed location and locked in a cabinet. Producing of files

should be limited and safety measures are necessary by means of burning the documents

and shredding after use to safeguard the privacy of the respondents. (Polit& Beck, 2012)

Confidentiality Procedure. The researchers assure respondents the guarantee of

confidentiality, the rights and privacy and anonymity through the informed consent. The

respondents can reply the survey and answer the questionnaires without putting their

name . Since the study is delicate and sensitive in nature, it is the responsibility of the

researchers to protect from spreading the information to anybody that is not affiliated

other than the respondents themselves. All hard copies of documents and softcopies in the

related study were shredded and deleted, respectively. The respondents were issued with

certificate of confidentiality by the researchers to confirm that the management of

handling all the data were properly treated with maximum privacy. (Polit& Beck, 2012)

Debriefing Communications and Referrals. The researchers should proactively

curtail any emotional threat and should demonstrate courtesy, grace and politeness. It is

for the purpose not to alienate, distress and embarrass the respondents. The researchers

must be carefully and tactfully in uttering their questions as to the very sensitive nature of

the investigation. After the compilation of all data is completed, debriefing session should

be instigated. Participants should be encouraged to ask questions, voice out their

complaints and concerns. It is vital that debriefing can be “bent” for instance, in any

event of deception was used in clarifying a certain study in the ethical guidelines. The

investigator may also demonstrate the act of thoughtfulness by communicating with the

respondents after the study is finished. To show appreciation and thanking them for their

43
interest in participating the study. Referrals to assist the respondents to the suitable social,

health and psychological services if needed. (Polit& Beck, 2012)

Treatment of vulnerable groups. The protection of rights among groups who are

defenseless will have additional process and increased sensitivity is straightforward as to

adherence to ethical standard. Vulnerable population may be incapable of giving

informed consent for example teenager ages from 15 to 17 years old by themselves and

will need the assistance of a guardian or parent informed consent. (Polit& Beck, 2012).

Compensation. There shall be no monetary involvement and compensation to the

people and the community who participated in the study. Nevertheless, the researchers

will compromise with health teachings to the people of Barangay Talamban, Cebu City.

Evidently, health teachings should be converged and focused on awareness on

vaccination importance and its significance. This will act as our payment as we are

indebted to them and have been part in the success of our study. (Polit& Beck, 2012)

Conflict of interest. The disclosure of conflict of interest shall be deemed by both

parties between the students and teachers to validate the integrity of the study. To

guarantee in conducting throughout the study, whereby all parties involved should

employ transparency in the event of any disagreements, or potential dispute that may

transpire. Furthermore, legalities shall be proceeded in case of breach of contract. All

stipulation by contracting parties, were hereby issued with the terms and conditions that

were jointly decided upon and signed a copy to advance further. A statement of

agreement is made to prove that the student researchers are not the sole authors of the

study and the research adviser. There will be no association or whatsoever with any

44
outside organization not correlated with the University of the Visayas (Polit& Beck,

2012).

Statistical Treatment of Data

The study will utilize Pearson R and Factor mean determination in doing the

statistical analysis of the study. Pearson R is needed to show relationship between

variables especially when determining specific relationships in between them. Factor

Mean is necessary to determine generalizability of the data being gathered.

45
 References
Rappouli, Martinni (2014) Vaccination in the 21st Century Italy: Wilde and Nurk

Bell, Jessica (2014) Context of Vaccination in Medicine New York: WHO

World Health Organization (2016) Vaccination on Low-Income Countries WHO:WHO

Thompson, Alessandra (2017) Safe Handling on Vaccination Guidelines Detroit: Bund

Abbott, Alexa (2016) Vaccination Concerns of the 21st Century WHO:WHO

Kirkwood, Justin (2015) Public Safety in Mass Vaccination New York: Storks and Zweist

Noorfield, Dexter (2015) Vaccine Misconception All Around The Globe WHO:WHO

Department of Health (2016) Republic Act 10152 Context and Guideline of the MICHI Act of
2011 DOH:DOH

Department of Health (2018) Budget Allocation for Healthcare Improvement and Mobilization of
SDG #3 DOH:DOH

Department of Health (2019) Vaccine Scare of the Philippines: Aftermath of the Dengvaxia
Mishap DOH:DOH

Riley, Melissa (2015) Misconceptions on Vaccine and Perceptive Problems of the Citizens New
York: CDC

World Health Organization (2016) Significance of Vaccine Compliance WHO:WHO

Center For Disease Control (2015) Common Factors Affecting Vaccine Acceptance CDC:CDC

46
 CURRICULUM VITAE

Name: Demi Rae C. Macrohon

Address: 224 Caburihan Canelar St. Zamboanga City

Phone Number: 09496450064/ 09260257279

Email Address: [email protected]

Date of Birth: February 25, 1999

EDUCATION
Primary: Zamboanga Chong Hua High School

2006-2011

Gov. Vicente Alvarez, St. Zamboanga City

Secondary: Zamboanga Chong Hua High School

2011-2015

Gov. Vicente Alvarez, St. Zamboanga City

Tertiary: Cebu Doctors’ University

2015-2018

1 P.V Larrazabal Jr. Avenue, North Reclamation

University of the Visayas

2018-Present

Gov. M. Cuenco Ave, Banilad, Mandaue City, Cebu

47
JENNIFER MOJADO
#3 Victor Perez Cmpd., AS Fortuna, Mandaue City/09056648279
[email protected]

Work
History______________________________________________
_____________________________________________________

Certified Nurse Assistant

Vale Healthcare Center – 13484 San Pablo Ave., San Pablo, CA. 94806 01/2006 to 07/2015

 Maintained accurate records of patient care, condition, progress and concerns

 Monitored vital signs, such as blood pressure and pulse
 Responded appropriately to the physical, emotional and developmental needs of patients
 Maintained a clean, healthy and safe environment
 Assisted with patient transfer and ambulation
 Collects patient specimens and data, including vital signs, input/output and other delegated
measurements
 Answered patient calls for care and feeding
 Assisted nurses with wound care for pressure ulcers, bed sores, and surgical site wounds
 Reported any unusual circumstances in the patients’ condition or environment
 Answered call lights and aided in patient comfort and safety by adjusting beds, lights, bed
rails, pillows, patients’ clothing and bedside tables/equipment

Education_____________________________________________________________________
___________________________________

Licensed Vocational Nurse

University of the Visayas --- Cebu City, Philippines
2011
Certified Nurse Assistant
TLC Nursing School ----------Rodeo, California
2004
Secondary Education
Northern Leyte College------Palompon, Leyte, Philippines
1995

Elementary Education
Palompon Central School----Palompon Leyte, Philippines

48
Name: ANGELA REGINE A. ROSALES

Address: 105 SABANG, DANAO CITY, CEBU

Phone Number: 09325197166

Email: [email protected]

Address: 105 Sabang, Danao City, Cebu Philippines

Date of Birth: February 6, 1998

EDUCATION:

Hosanna Learning Center, 2005 - 2011

Taboc Looc, Danao City

Elementary Education

Sto. Tomas College – Danao, 2011 - 2015

Bonifacio Street, Danao City

Secondary Education

Cebu Doctors’ University 2015 - 2018

Bachelor of Science in Nursing

1 P.V Larrazabal Jr Avenue, North Reclamation

University of the Visayas – PRESENT

Bachelor of Science in Nursing

Gov. M. Cuenco Ave, Banilad, Mandaue City, Cebu

Tertiary Education

49
Name: CARL HENRIK L. RULE

Address: 138 5TH ST. EXT DONA ROSARIO VILLAGE

Phone Number: 09454391162

Email: [email protected]

Date of Birth: July 22,1996

EDUCATION:

MARIA MONTESSORI INTERNATIONAL SCHOOL, 2005 - 2011

San jose, Talamban Cebu

Elementary Education

Sacred Heart School – Ateneo De Cebu

H. Abellana, Mandaue City, Cebu

Secondary Education

Cebu Doctors’ University 2014 - 2017

Bachelor of Science in Nursing

1 P.V Larrazabal Jr Avenue, North Reclamation

University of Visayas, 2017-present

Banilad, Cebu City

Tertiary Education

50
Name: Natalie Allyson B. Tumakay

Address: Rosedale Suites, suite 1, Banilad,

Cebu City, 6000

Phone number: 0977-104-8570

Email: [email protected]

Date of Birth: September 6,1998

Education:

Podesta Ranch, 2007-2009

Stockton, Ca

Elementary Education

ABLE Charter, 2013-2016

Stockton, Ca

Secondary Education

University of Visayas, 2017-present

Banilad, Cebu City

Tertiary Education

51
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