Chapter 1

Chapter 1

PROBLEM AND ITS BACKGROUND

Introduction

Health centers provide primary care to specific populations and are staffed by

nurse practitioners and community health nurses. Although nurses are the primary

providers of care to clients visiting the center, a physician’s consultation is available as

needed. (Kozier 8th edition 2008) A community health center offers health services such

as check up for pregnant women, check up for the elderly, free immunizations, and

referral to other health facilities.

The Local Government Code of the Philippines declared that local government

units shall be given more powers, authorities, responsibilities, and resources. The

process of decentralization shall proceed from the national government to the local

government units. The Code shall apply to all provinces, cities, municipalities,

Barangays, and other political subdivisions as may be created by law, and, to the extent

herein provided, to officials, offices, or agencies of the national government. (R.A 7160)

In the Philippines the national government only allocated 11.563 billion pesos for

health services or 25 centavos per Filipino. (Department of Budget and Management

2008)

Type of health services offered in the Philippine Health Care System includes a

wide array of promotive, preventive, curative and rehabilitative

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services. Government health facilities provide preventive, promotive, curative and

rehabilitative services. While private sectors focus more on direct personal care that are

curative and rehabilitative in nature.

Public health nursing is a special field of nursing that combines the skills of

nursing, public health and some phases of social assistance and functions as part of the

total program for the promotion of health, the improvement of conditions on the social

and physical environment, rehabilitation of illness and disability. (WHO)

Community health nursing is a unique blend of nursing and public health practice

woven into a human service that properly developed and applied has a tremendous

impact on human well being. Its responsibilities extend to the care and supervision of

individuals and families in their homes, in places of work, in schools, and clinics.

Community Health nursing responds to the health needs of its clients. There are

different levels of clientele in community health nursing- The individual, family,

population group and community. (Maglaya, 2004)

The ultimate goal of community health services is to raise the level of the

citizenry. The goal of community health nursing is to help communities and families to

cope with the discontinuities in health and threats in such a way to maximize their

potential for high level of wellness, as well as to promote reciprocally supportive

relationship between people and their physical and social

environment. (Community Health Nursing Services in the Philippines 9th edition 2000)

The recipients of nursing are sometimes called consumers, sometimes patients,

and sometimes clients. A client is a person who engages the advice or services of

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another who is qualified to provide this service. The term client presents the receivers of

health care as collaborators in the care, that is, as people who are also responsible to

their own health. (Kozier 8th edition 2008)

Client satisfaction measures the extent to which a client's expectations for a

good or service are met. Thus, it is essential to distinguish clearly the two components

of satisfaction - client expectations and the actual or perceived quality of the service

offered - and not to consider satisfaction as a global entity. A proper measure of

satisfaction includes an separate assessment of both client expectations and the quality

of service provided.

Even before entering in contact with the organization, most clients already have

more or less precise expectations of the level and quality of service that it should be

providing. These expectations may not be in line with what the program is or should be

delivering, as stated in its objectives, or with what it can actually provide, given the

resources available. Communications efforts are usually needed to inform clients of the

goals, limits and possibilities of the program, in order for the clients to have more

realistic expectations.

Quality of service refers to the quality of both the transaction and the outcome

of the service. It is a multi-dimensional concept. An honest portrait of

client satisfaction implies that variation for each of the major dimensions has been

measured. (Zeithalm)

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STATEMENT OF THE PROBLEM

This study aims to ascertain the resident’s level of satisfaction with the health care

services of the health center of Brgy Pansol. Specifically this study sought to answer the

following:

1. What is the profile of the respondents of Brgy. Pansol Health Center Calamba

City in terms of the following:

1.1 Age,

1.2 Gender,

1.3 Civil Status, and

1.4 Family Income level?

2. What is the level of satisfaction of the respondents with the health care services

of the health center of Brgy. Pansol Calamba City when grouped according to:

2.1 Maternal Check up,

2.2 Immunization Services,

2.3 Family Planning Services, and

2.4 Sanitation Services

3. Is there a significant difference in respondent’s level of satisfaction on the

different health care services offered by Brgy. Pansol Health Center in terms of :

3.1 Maternal Check up,

3.2Immunization Services,

3.3Family Planning Services, and

3.4Sanitation Services?

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STATEMENT OF HYPOTHESIS

Ho: There is no significant difference among the respondents level of satisfaction in

terms of:

1. Maternal Check up,

2. Immunization Services,

3. Family Planning Service, and

4. Sanitation Services.

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Department of Health (DOH)

Health CareServices

Maternal Checkup

Immunization Services

SanitationServices

Family Planning services

THEORETICAL FRAMEWORK

Figure 1. Theoretical Framework

The DOH recommends that all pregnant women have at least four antenatal

visits during each pregnancy. The Expanded Program on Immunization, another pillar

health program of the DOH, aims to protect children against preventable diseases such

as tuberculosis, polio, diphtheria, pertussis, tetanus, and measles. The State shall

protect and advance the right of the people to a balanced and healthful ecology in

accord with the rhythm and harmony of nature. The Reproductive Health (RH) Bill

promotes information on and access to both natural and modern family planning

methods, which are medically safe and legally permissible.

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CLIENTS PROFILE:

AgeCivil StatusGenderFamily Income level

DOH HEALTH CARE SERVICES:

Maternal Check upImmunization servicesFamily Planning servicesSanitation services

QUESTIONNAIRES IMPROVED HEALTH CARE SERVICES

The Department of Health framework about health services, researchers

believe, was meant to improve the health care services rendered in the health center.

This will be best applied when rendering the health services.

Conceptual Framework

INPUT PROCESS OUTPUT

Figure 2. Conceptual Paradigm

Figure 2 illustrates the conceptual paradigm of the study. Clients of Brgy. Pansol

Health Center are categorized in terms of Age, Gender, Civil status, and

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Family income level. After undergoing on the different services offered by the health

center and answering the questionnaires provided the researcher were able to evaluate

client satisfaction. The cooperation and truthfulness of the respondents in answering the

questionnaires will matter a lot to this study.

SIGNIFICANCE OF THE STUDY

Client satisfaction measures the extent to which a client’s expectations for a

good or service are met. Thus it is essential to distinguish clearly the components of

satisfaction. A proper measure of satisfaction includes a separate assessment of both

client expectations and the quality of service provided.

The researchers believe that the general feeling of the clients towards health

care services is one way to measure up to a great extent, its importance. Thus, it was

for this reason this research study was made.

The result of the study will benefit the following:

Brgy. Pansol Health Center. That they determine ways on how to improve the

services they render to their clients and on what aspects to work on with. It will help

them develop program to improve community health services.

Residents of the Health Center. For them to avail of proper health care

services. And be aware of their rights as clients.

Nursing students. That this research study will help them determine the

importance of the different services rendered in a health center and how valuable the

profession they are in.

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For Future Researcher. That this may serve as a motivation and may somehow

pave the way for students nurses and registered nurses to have room for further

improvement with regards to client satisfaction and perhaps to introduce innovations in

client expectations to the nursing profession.

SCOPE AND LIMITATION OF THE STUDY

The scope of the study was concern about the level of satisfaction of the

residents with the health care services rendered on Brgy. Pansol Health Center

Calamba City.

It encompassed the residents of Brgy Pansol who visits the Health Center for

maternal checkups, immunization services, and, family planning services, and sanitation

services.. Due to limited time available to conduct the study, only the factors that were

considered relevant in the conduct of this research will be given emphasis.

With the above mentioned scope and limitations, the researchers do not claim

to be in the position to make broad generalizations and general conclusion regarding

the client’s satisfaction.

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DEFINITION OF TERMS

The following terms were operationally used by the researcher in the study:

Client. Person who engages the advice or services of another who is qualified

to provide this service.

Satisfaction. Refers to the fulfillment of a need or want

Community Health Nursing. Is a service rendered by a professional nurse with

the community, families and individuals.

Health services. Includes variety of services like maternal check up,

immunization services, sanitation services, and family planning services.

Immunization Services. A basic health service for infants and children. This

includes BCG, DPT, OPV, Hepatitis B, Measles etc.

Maternal Checkup. Service given to pregnant women which include physical

examination, tetanus toxoid immunization.

Family Planning Services. Service provided on couples to maintain the spacing

birth of their family.

Sanitation Services. Health care services rendered to prevent deleterious effect

on the community’s health, well being and survival.

Health Center. A place where people seek primary health services like

maternal check up, Immunization services, family planning services, and sanitation

services.

Service. Given to a client. It may be in form of maternal check up, immunization

etc.

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Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

The importance of this chapter was to determine related studies undertaken by

local and foreign authors. The researchers reviewed several studies made by them

which served as significant details and provided the researcher insights and views on

the constituents of the study. The related information and details were in one way or the

other related in some aspect to the present attempt which added more relevance and

depth of the research study.

LOCAL LITERATURE

Concepts basic to the nursing are used in working with the clients. Some of these

concepts are: primary focus of community health nursing is promotion; it is extended to

benefit not only the individual but the whole family and community. Nurses are

generalists in terms of their practice through life’s continuum. (Community Health

Nursing in the Philippines 9th edition 2000)

Health problems that are beyond the capability of PHC units and beyond the

competence of PHC workers are referred to an intermediate health facility, usually a

Rural Health Unit located in town or poblacion. The team includes physician, dentist,

public health nurse, midwife, sanitarian and other health workers.

Health workers employed in all hospitals, sanitaria, health infirmaries, health

centers, rural health units, barangay health stations, clinics and other

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health related establishments owned and operated by the government shall include

medical, allied health professionals, administrative and supports personnel. Section 3

Republic Act No. 7305 (The Magna Carta of Public Health Workers)

The DOH recommends that all pregnant women have at least four antenatal

visits during each pregnancy. It further recommends that the first antenatal checkup

should occur in the first trimester of the pregnancy to detect complications early. It is

also essential that women had iron or folate supplementation to prevent anemia.

Delivery itself should be conducted in health facilities or birthing centers with a skilled

professional birth attendant.

The Expanded Program on Immunization, another pillar health program of the

DOH, aims to protect children against preventable diseases such as tuberculosis, polio,

diphtheria, pertussis, tetanus, and measles. A child is considered to have complete

immunization when he/she has received three dosages of diphtheria, pertussis, tetanus

(DPT) vaccine and oral polio vaccine, as well as one dose each of measles and Bacillus

Calmette-Guerin (BCG) vaccines. This program brought about improvements in

prevention and control of vaccine preventable diseases among infants and children in

the past but the vulnerability of nonimmunized population increases with a drop in the

proportion of fully-immunized children from 90% in 1997 to 69.8% in 2003. (DOH,

Manila Philippines 2005).

The State shall protect and advance the right of the people to a balanced and

healthful ecology in accord with the rhythm and harmony of nature. The State shall

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promote and protect the global environment to attain sustainable development while

recognizing the primary responsibility of local government units to deal with

environmental problems. The State recognizes that the responsibility of cleaning the

habitat and environment is primarily area-based. Finally, the State recognizes that a

clean and healthy environment is for the good of all and should therefore be the concern

of all. (Republic Act 8749).

Environmental Health Services (EHS) of the Department of Health is responsible

for the promotion of healthy environmental conditions and prevention of environmental

related diseases through appropriate sanitation strategies. Through EHS DOH has

authority to act on all issues and concerns in environment and health including the

comprehensive Sanitation Code of the Philippines (PD 856, 1978).

The Reproductive Health (RH) Bill promotes information on and access to both

natural and modern family planning methods, which are medically safe and legally

permissible. It assures an enabling environment where women and couples have the

freedom of informed choice on the mode of family planning they want to adopt based on

their needs, personal convictions and religious beliefs. The bill does not have any bias

for or against either natural or modern family planning. Both modes are contraceptive

methods. Their common purpose is to prevent unwanted pregnancies. The bill will

promote sustainable human

development. The UN stated in 2002 that “family planning and reproductive health are

essential to reducing poverty.” The Unicef also asserts that “family planning could bring

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more benefits to more people at less cost than any other single technology now

available to the human race.” (“Reproductive Health bill by Lagman, Edcel [Philippine

daily inquirer] 2008)

FOREIGN LITERATURE

Competent practice is a major legal safeguard for nurses. Nurses need to

provide care that is within the legal boundaries of their practice and within the

boundaries of agency policies and procedures. Nurses therefore must be familiar with

their various job descriptions. (Kozier, 8th edition 2008)

Government agencies are established at the local state and federal levels to

provide public health services. Health agencies at the state, county or city level vary

according to the need of the area. State health organizations are responsible for

assisting the local health department. In some remote areas, state departments also

provide direct services to the people.

Davis, Fredrickson (2004) United States law requires that immunization

providers use Centers for Disease Control Vaccine Information Statements (VISs) and

inform parents about vaccine risks and benefits prior to every childhood immunization. A

recent national survey found that public health clinics (PHCs) reported high compliance

with this law.

Cross, Sharon (2006) described the development and initial testing of an

instrument to measure population-based public health nursing competencies. Although

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multiple lists of public health competencies exist, literature review did not elicit a valid

instrument that could measure changes in public health nursing competency over time

Mobilizing for action through planning and partnership is the most recent

planning tool in used in public health practice which is built upon a long history of

planning by local public health agencies. Planning by local public health agencies has

evolved over a half century from the earliest problem/program focused planning through

more comprehensive approaches like the planned approach to community health and

the assessment protocol for excellence in public health. (Lenihan 2005)

Government agencies are established at the local state, and federal levels to

provide public health services. Health agencies at the state, county or city level vary

according to the need of the area. Their funds, generally from taxes are administered

by elected or appointed officials. Local health departments have responsibility for

developing programs to meet the health needs of the people, providing the necessary

nursing and other staff and facilities to carry out these programs. (Kozier, 8th edition

2008)

In programmes for older persons, the UN general assembly adopted Resolution

46 on December 16, 1991 the UN principles for older persons to add life to years that

have been added to life. The Principles call for action in many

areas, among them: Independence: Older persons should have access to food, water,

shelter, clothing, health care, work and other income-generating opportunities,

education, training, and a life in safe environments.  Participation: Older persons should

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remain integrated into community life and participate actively in the formulation of

policies affecting their well-being. : Older persons should have access to social and

legal services and to health care so that they can maintain an optimum level of physical,

mental and emotional well-being. This should include full respect for dignity, beliefs,

needs and privacy.  Self-fulfillment: Older persons should have access to educational,

cultural, spiritual and recreational resources and be able to develop their full potential.

Dignity: Older persons should be able to live in dignity and security, be free of

exploitation and physical or mental and be treated fairly regardless of age, gender and

racial or ethnic background.  (United Nations)

FOREIGN STUDIES

Studies have shown that investments in public health workforce development are

based on the assumption that capacity and competencies are linked with the

effectiveness and efficiency of providing essential public health services. However,

evidence of the effects of workforce quantity or quality on the performance of core

public health functions is limited. (Ogolia, 2007)

Bernal, Shellman and Reid (2004) said that University and community

partnerships are being created to increase community-based educational

experiences for nursing students and to assist agencies in facing ever-decreasing

resources to pay for health services for clients. Many challenges often burden these

partnerships, leading to a less than satisfying experience for all those involved.

Results of the study underscores that client satisfaction is determined by the

cultural background of the people. It shows the dilemma that, though optimally care

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should be capable of meeting both medical and psychosocial needs, in reality care that

meets all medical needs may fail to meet the clients emotional or social needs.

Conversely, care that meets psychosocial needs may leave the clients medically at risk.

It seems important that developing countries promoting client-oriented health services

should carry out more in-depth research on the determinants of client satisfaction in the

respective culture. (Aldana, Piechulek, Al-sabir, 2001).

Advanced practice nurses and nurse researchers with experience in clinical

settings may encounter challenges in the initial development and implementation of

community-based projects. Participatory action research methodology, a user-friendly

framework for community-based research activities, provides a way for researchers and

community members to work together to define a problem, take action, and evaluate

their work Suggestions for initial steps and the planning and review cycles are

presented, along with examples from the literature. (Kelly 2005)

In a research study, 289 of the eligible public health nurses in five California

counties, returned survey questionnaires regarding their demographics, employment,

education and scope of practice. Nurses were asked how frequently they performed

specific interventions aimed at the individual-family, the community and the health care

system. Over all the public health nurses regularly performed interventions aimed at the

individual-family. The most often performed intervention was case management of

individuals/families. Few nurses reported frequently performing interventions at the

community. The researchers concluded that the public health nurses were not really

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fulfilling their role since “the focus of public health nursing is not on providing direct care

to individuals on community settings” but rather on promoting the health of populations.

(Grumbach, Miller, Mertz, Finocchio 2004)

LOCAL STUDIES

Majority of pregnant women in the provinces of Western Samar, Surigao del Sur

and Sorsogon still prefer to give birth at home instead of delivering their babies in a

lying-in clinic or private hospital in their area, according to a recent study sponsored by

the Department of Health. The baseline survey, which was conducted from June 2007

to March 2008, showed that up to 75 percent or three out of four babies in parts of the

three provinces are delivered at home. Less than three percent of deliveries in the three

provinces were in private hospitals or private clinics. Twenty-two percent of deliveries in

Western Samar, 19 percent of

deliveries in Surigao del Sur and 38 percent of deliveries in Sorsogon were done in

government hospitals. The survey interviewed 1,200 women and 350 health care

providers including doctors, midwives and traditional birth attendants in the three

provinces. It was conducted by the UP Center for Economic Policy Research for the

DOH Women's Health and Safe Motherhood Project. The survey showed that traditional

birth attendants or hilots attended to about a third of deliveries in Western Samar, 20

percent of deliveries in Sorsogon and 43 percent of deliveries in Surigao del Sur. In

Sorsogon, 20 percent of pregnant women were attended to by physicians compared to

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18 percent in Surigao del Sur and 15 percent in Western Samar. On the other hand,

nurses attended to 18 percent of pregnancies in Surigao del Sur, 11 percent in

Sorsogon and nine percent in Western Samar. ( Recidoro 2008)

Corruption in the Philippines is undermining its delivery of health services,

reducing its child immunization rate by 10 to 20 percent, and increasing the waiting time

in public health clinics by 30 percent, a study says. The group ranked the Philippines as

the ninth most corrupt country in the world last year — worse than in 2004 when it

ranked 11th. Corruption in the Philippines’ health sector reduces the chances of children

completing their vaccination by four times, the report says. “Corruption affects all health

systems, but its effects are disproportionate upon the poor who cannot afford private-

sector alternatives and for whom the fees charged represent a large proportion of their

family budget.” According to the study, the Philippines is an ideal place to study the

impact of corruption on service delivery, especially because it has devolved both

political authority and administrative control of many health and education services to

local government units. (Mencias 2006)

SYNTHESIS OF THE STUDY

In general clients who are satisfied with the program may be contributing to the

status quo more than they are helping managers to pinpoint areas of client satisfaction

and discontent, or to find innovative solutions to improve program delivery. Good client

satisfaction studies are not ends in themselves; they are means to improve service to

the public. Knowledge of client’s expectations and of the extent to which these are met

may prove really beneficial. Broadly speaking, this knowledge serves two purposes: (1)

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identifying areas of improvement in the quality of the services offered; and (2)

highlighting the need for corrective actions when clients’ expectations exceed what the

organization can afford to offer or what a particular program is meant to provide.

The significance of such studies in this research is that the contents were clearly

stated and the client satisfactions were given emphasis in terms of its foundation,

principle, background and importance of health services to the community.

Nevertheless, these studies gave rise to the researchers to come up with positive

outlook on how client satisfaction is important to the clients.

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Chapter 3

RESEARCH METHODOLOGY AND PROCEDURES

This chapter presents the methods of research used by the researchers in

formulating this study in order to have a clearer picture of the contents of the research.

In this chapter there are five categories such as: (1) The research method used, (2)

Participants of the study’ (3) Research instrument (4) Data gathering procedure and

finally (5) Statistical treatment of data.

RESEARCH METHOD

A research method is a structural plan and strategy of investigation visualized to

obtain answers to the research problems and questions formulated. It ensures the

attainment of the objectives, the formulation of valid conclusions and impact in a field of

specialization, Nazareno-Martinez (2002). More so, it is a course of action or plan that is

followed in order to solve a problem in a research which consist of strategies and

procedures that will arrive to valid and reliable answers.

In this study, the researchers used descriptive survey method which was

conducted through observations, interviews and questionnaires. A descriptive research

method will be use because it was similar to other studies related to the objectives

presented in this research. It will allow the assessment and observation of the data that

established the nature and occurrence of existing

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circumstances, practices or descriptions of objects, processes and persons subject to

the method used.

PARTICIPANTS OF THE STUDY

The participants of the research study are the residents of Brgy. Pansol who

visits the health center for maternal check up; immunization services; and family

planning services and sanitation services Criterias to become a participant are (1) one

year residence at Brgy. Pansol; (2) residents who regularly visits the health center; (3)

must be 17 years old and above. The researchers will have an overall 100 respondents

and will use a convenience non probability sampling where the samples most available

are chosen.

RESEARCH INSTRUMENT

For this research study the researchers used questionnaires to obtain answers

from the respondents. The questionnaire is composed of two parts. The first part

consists of the respondents’ demographic profile such as gender, age, civil status and

family income level. The second part which is a recognition type questionnaire where

the respondents can encircle the best answer that suits their response in every question

(Manalaysay). The questions was about the health care services that the health center

offers and the option on how the respondents can rate the different health care services

provided on them. The researcher used Likert Scale to determine the client’s level of

satisfaction.

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DATA GATHERING PROCEDURES

The researchers gathered data and prepared questionnaires that will survey the

responses of the residents regarding their satisfaction on the health care services

offered by Brgy. Pansol Health Center.

Questionnaires are distributed among the residents who visited the health center

for maternal check up, immunization services and family planning services and

sanitation services.

STATISTICAL TREATMENT OF DATA

In analyzing the data and in coming up with valid conclusions by relevant facts,

the researchers will use:

Percentage will be used in the treatment of data. Percentage will be use to

determine the profile of the respondents.

Thus:

F% = x 100

N

Where:

% means percentage

F means frequency of occurrence of each response

N means the total number of respondents and the quotient

multiplied by 100

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Weighted mean will be use in order to translate a total number of respondents for

every question into averages which will fall into the level with corresponding verbal

descriptions.

The general formula for weighted mean is:

TWF

WM =

N

Where:

WM means weighted average

TWF means total weighted frequency

N means the total number of respondents

WM = VS (4) + S (3) + NI (2) + P (1)

N

Weighted Mean Descriptive Interpretation

1.00 – 1.50 Not Satisfied

1.51 – 2.50 Somehow Satisfied

2.51 – 3.50 Satisfied

3.51 – 4.00 Very Satisfied

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To test for the significant difference Analysis of Variance (ANOVA) was used.

Step 1. Determine the Null and Alternative Hypotheses

Step 2. Find SStot ( Sum of squares total )

Step 3. Find Ssbet (Sum of squares between)

Step 4. Find SSw ( Sum of square within )

Step 5. Find Variance Estimates ( Mean squares )

Degrees of Freedom

1. d.f. bet = K – 1 ; and

2. d.f w = N – K

K is the number of groups and N is the total sample size.

Msbet = Ssbet = Ssbet

d.f bet K – 1

MSw = SSw = SSw

dfw N – K

Step 6. Find the F ratio and complte the ANOVA test

F = Msbet

MSw

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Chapter 4

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter will present the result of the survey, as well as the analysis and

interpretation of the data gathered from the respondents. For the purpose of an orderly

discussion the restrictions in the study was deemed in order.

I. Resident’s Demographic Profile

Table 1

Percentage Distribution of the Ages of

the Respondents from Brgy. Pansol

Age Frequency Percentage

17-21 17 17%

22-26 30 30%

27-31 23 23%

32-36 12 12%

37-41 8 8%

42-46 3 3%

47-51 3 3%

52 above 4 2%

Total 100 100%

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Table 1 showed that residents whose age ranges from twenty two – twenty six

(22-26) had the highest percentage as evidenced by a percentage of thirty (30%)

followed by those in age which ranges from twenty seven – thirty one (27-31) as

evidenced by a percentage of twenty three (23%) then followed by those age that

ranged from seventeen – twenty one (17-21) with a percentage of seventeen (17%).

Twelve percent (12%) of the respondents were in the age bracket of thirty two – thirty

six, eight percent (8%) were within the age bracket of thirty seven – forty one (37-41),

three percent (3%) were in the age bracket of forty two – forty six (42-46) and forty

seven – fifty one (47-51), four percent (4%) of the respondents were in the age bracket

of fifty two (52) and above. This implies that those whose age ranges from twenty two –

twenty six (22-26), twenty seven – thirty one (27-31), are those in the working group and

are most likely to visit the health center more frequently than those whose age ranges

from forty seven – fifty one (47-51) and fifty two and above.

Mong Palatino (2007) explained in one of his blogs that the Philippines is the

14th most populous country in the world and third in the Southeast Asian region. Young

dependents aging 1-18, comprise 34 percent of the population, individuals aging 20-40

years received a 62 percent rating that belong to the working-age group and 4 percent

are categorized as elderly dependents. Scholars have estimated that the large youth

population will continue until the year 2040, but the working-age population and the

number of senior citizens will increase much faster.

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Table 2

Percentage Distribution of Male and Female

Respondents from Brgy. Pansol

Table 2 showed that the number of female respondents is higher as noted by a

percentage of ninety (90%) and the male respondents has percentage of ten (10%)

among the sample population of 100 residents of Brgy. Pansol.

Gender Frequency Percent

Male 10 10%

Female 90 90%

Total 100 100%

This signifies that female respondents visits the health center and avails of its

services more than its male respondents. It implies that female visits the health center

more often because female are more responsible with taking care of themselves, and

their family.

According to Julian (2005), one reason why men do not attend the doctor is

because it has been the traditional role of women to bring the children to the doctor and

to look after the health of the children". "That connection between mother and child

could exclude men from familiarity with the surgery". Generally the clinics and hospitals

are pretty women-oriented. Most often hospitals and clinics do not feel like ‘male-

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friendly’ places, causing men to shy away even more from visiting the doctor altogether.

Thus the feeling of ignominy prohibits them from visiting such places.

Table 3

Percentage Distribution of Civil Status of the

Respondents from Brgy. Pansol

Table 3 showed that the number of married respondents is higher as noted by a

percentage of sixty four (64%) and thirty six percent (36%) were single.

Civil Status Frequency Percent

Single 36 36%

Married 64 64%

Total 100 100%

This signifies that married respondents’ visits the health center and avail of its

health care services more than the single respondents. This implies that those who are

married are the ones who are responsible for the health of their family so they are the

ones who frequently visit the health center.

Table 4

Percentage Distribution of the Income Level of the

Residents from Brgy. Pansol

Income Frequency Percent

Below 5,000 72 72%

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Above 5,000 28 28%

Total 100 100%

Table 4 showed that only twenty eight percent (28%) of the respondents had an

income of higher than Php5, 000 and seventy two percent (72%) of the respondents

had only an income below Php5, 000. This signifies that most of the respondents who

avail of the services of the health center are those with limited income.

The face of poverty in the Philippines is manifested in chronic deprivation in

many rural and urban areas and the ubiquitous presence of pockets of slums in urban

areas; many others experience transient poverty, not persistently poor, but highly

vulnerable even in the best of time. (Juarez, 2005)

Table 5

Percentage Distribution of the Frequency of Consultation of the

Residents from Brgy. Pansol

Frequency of Consultation Number Percent

In Case of Emergency 11 11%

Once a Week 22 22%

Once a Month 65 65%

Once a Year 2 2%

Total 100 100%

30

Table 5 showed that sixty five percent (65%) of the respondents visit the health

center once a month, twenty two percent (22%) visit the health center once a week,

eleven percent (11%) visit the health center in case of emergency and two percent (2%)

visit the health center once a year. This implies that those who visit the health center

are the pregnant women who seek maternal services.

The Department of Health (2005) recommends that there should be three (3)

prenatal visits during pregnancy following the prescribed schedule: The first prenatal

visit should be made as early in pregnancy as possible; second visit during the second

trimester; the third and subsequent visits during the third trimester. More frequent visit

should be done for those at risk or with complications.

II. Resident’s Level of Satisfaction with the Health Care Services of the health

center of Brgy. Pansol, Calamba, City

Table 6

Level of Satisfaction of the Residents

with Maternal Check up

QUESTIONS WM INTERPRETATION RANK

1. Basic prenatal services 3.59 Very Satisfied 1

2. Informed of pregnancy complications 3.18 Satisfied 3

3. Referral to health facilities 3.1 Satisfied 5

4. Confidentiality of examination results 3.15 Satisfied 4

5. Quality of service 3.24 Satisfied 2

Weighted Average = 3.25 Satisfied

31

Legend:1.0 – 1.50 Not Satisfied

1.51 – 2.50 Somehow Satisfied2.51 – 3.50 Satisfied3.51 – 4.00 Very Satisfied

Table 6 showed the residents level of satisfaction with maternal check up. Of the

five questions, it was noted that the lowest weighted mean was given to the question

“referral to health facilities” as evidenced by a three point one (3.1) weighted mean with

a rating of “satisfied”. Closely followed by the question “confidentiality of examination

results” where it gained a weighted mean of three point fifteen (3.15) with a rating of

“satisfied” next to this is the question “informed of pregnancy complications” where it

gained a weighted mean of three point eighteen (3.18) which also had a rating of

“satisfied”. The question “quality of service” gained a weighted mean of three point

twenty four (3.24) with a rating of ‘satisfied”. The question “basic prenatal services”

gained the highest weighted mean of three point fifty nine (3.59) with a rating of “very

satisfied”. This implies that the residents although satisfied with the maternal services

there can still be a room for improvement.

The nurse-midwife, as an individual educated in the discipline of nursing and

midwifery has played an important role in assisting women with pregnancy and child

bearing. Either independently or in association with an obstetrician, the nurse-midwife

can assume full responsibility for the care and management of women with complicated

pregnancies. (Pillitteri, 2002)

32

Table 7

Level of Satisfaction of the Residents

with Immunization Services

Table 7 showed the level of satisfaction with immunization services on the

response of 100 residents. Of the five questions, it was noted that the question “enough

supplies” had the lowest weighted mean of two point nine (2.9) followed by the question

“completeness of immunization” with a weighted mean of three point one (3.1).

QUESTIONS WM INTERPRETATION RANK

1. Assessment and evaluation of the immunization program

3.25 Satisfied 2

2. Health teachings about the risk and benefit of immunization

3.28 Satisfied 1

3. Quality of service3.22 Satisfied 3

4. Completeness of immunizations offered3.1 Satisfied 4

5. Enough supplies2.9 Satisfied 5

Weighted Average = 3.15 Satisfied

Legend:1.0 – 1.50 Not Satisfied

1.51 – 2.50 Somehow Satisfied2.51 – 3.50 Satisfied3.51 – 4.00 Very Satisfied

Next to the question pertaining to “completeness of immunization” is the “quality

of service” with a weighted mean of three point twenty two (3.22). Closely followed by

the question “health teachings about the risk and benefit of immunization’ it gained a

weighted mean of three point twenty eight (3.28). Lastly the question “assessment and

33

evaluation of the immunization program” gained a weighted mean of three point twenty

five (3.25). This implies that the residents although satisfied, that the health center

lacks fund and supplies.

According to Section 2 of the “Act requiring mandatory basic immunization

services against Hepatitis-B for infants amending for the purpose of Presidential Decree

No. 996” of Sen. Pia Cayetano (2008) the amount necessary to carry out the provisions

of this Act shall be taken from the two and half percent (2.5%) allocation for the disease

prevention program of the Department of Health (DOH) from the incremental revenues

from the alcohol and tobacco  excise taxes, as provided for under R. A. 9334.The

Philippine Health Insurance Corporation (PHIC) shall include the basic immunization

services in its benefit package when actuarial studies have determined its financial

feasibility.

Table 8

Level of Satisfaction of the Residents

with Family Planning Services

QUESTIONS WM INTERPRETATION RANK1. Counseling for family planning acceptance 3.25 Satisfied 12. Provide basic family planning services 3.2 Satisfied 23. Informed of family planning techniques 3.06 Satisfied 34. Family planning programs 2.94 Satisfied 45. Complete options 2.88 Satisfied 5

Weighted Average = 3.07 SatisfiedLegend:

1.0 – 1.50 Not Satisfied

1.51 – 2.50 Somehow Satisfied2.51 – 3.50 Satisfied3.51 – 4.00 Very Satisfied

34

Table 8 showed the level of satisfaction with family planning services. Out of the

five questions, it was noted that the question “complete options” has the lowest

weighted mean of two point eighty-eight (2.88). Followed by the question “family

planning programs” where it gained a weighted mean of two point ninety four (2.94).

The question “informed of family planning techniques” gained a weighted mean of three

point zero six (3.06). Next to it is the question “provide basic family planning services

which gained a weighted mean of three point two (3.2). Lastly the question “counseling

for family planning acceptance gained the highest weighted mean of three point twenty

five (3.25). Hence the respondents

were satisfied with the family planning services it implies that there is scarcity of funds

and proper programs regarding the family planning services.

Today, an estimated 350 million couple’s worldwide lack access to effective and

affordable family planning. Family planning does more than help couples limit their

family size: It safeguards individual health and rights, preserves natural resources, and

can improve the economic outlook for families and communities. Family planning also

saves lives; up to one third of all maternal deaths and illness could be prevented if

women had access to contraception. The need for quality family planning services is all

the more urgent today because more than 1 billion young people aged 15-24 are

entering their reproductive years, guaranteeing an enormous surge in population growth

through 2050. Eighty percent of these young people live in the developing world.

(Esguerra, 2008)

35

Table 9

Level of Satisfaction of the Residents

with the Sanitation Services

Table 9 showed the level of satisfaction of the residents with the sanitation

services. Of the five questions it was noted that the question “conducts program to

make the environment clean gained the lowest weighted mean of two point sixty five

(2.65).

QUESTIONS WM INTERPRETATION RANK

1. Informed about the campaign on health and environmental hazards

3.13 Satisfied 1

2. Policy and practical programs 2.95 Satisfied 2

3. Programs on health risk minimization 2.83 Satisfied 3

4. Cleanliness of the environment 2.75 Satisfied 4

5. Conducts programs to make environment clean

2.65 Satisfied 5

Weighted Average = 2.86 Satisfied

Legend:1.0 – 1.50 Not Satisfied

1.51 – 2.50 Somehow Satisfied2.51 – 3.50 Satisfied3.51 – 4.00 Very Satisfied

Closely followed by the question “cleanliness of the environment” which gained a

weighted mean of two point seventy five (2.75). Followed by the question “programs on

health risk minimization which gained a weighted mean of two point eighty three (2.83).

36

Next to it was the question “policy and practical programs” which gained a weighted

mean of two points

ninety five (2.95). The question “Informed about the campaign on health and

environmental hazards gained the highest weighted mean of three point thirteen (3.13).

The above results implies that sanitation services, although the residents were satisfied,

is still lacking of funds and programs.

The World Bank said poor sanitation in the Philippines costs the government

P77.8 billion a year. In its study “Economic Impacts of Sanitation in the Philippines,” the

World Bank said poor sanitation also causes 31 premature deaths a day and reduces

income from fishery, tourism and other sectors. The study aims to heighten public

awareness on the national economic impacts of poor sanitation and call on lawmakers,

economists, investors and media to help solve the problem. (The Manila Times, Darwin

Amojelar, 2008)

III. to determine if there is a significant difference among the respondents

responses, ANOVA was used:

Table 10

Summary of Table for One – Factor ANOVA of the significant difference with the health

care services of the health center of Brgy. Pansol Calamba City

Sources Variations

Sum of Square

Degree of Freedom

Mean Square

Computed F

Decision Interpretation

Between 0.12 3 0.04 0.55 Accept Not

37

ColumnHo SignificantWithin

Column1.17 16 0.073

The critical value is equal to 3.24 and the computed F is equal to 0.55 this means

that the hypothesis is accepted and there is no significant difference among the

respondents level of satisfaction with the health care services. (See appendix for

computation).

38

Chapter 5

SUMMARY OF FINDINGS, CONCLUSIONS, AND RECOMMENDATION

The purpose of the study was to determine the resident’s level of satisfaction with

the health care services of the health center of Brgy Pansol Calamba City.

SUMMARY OF FINDINGS:

1. Profile of the respondents:

The conducted study showed that the residents who frequently visit the health

center are those whose age ranges from 22 – 26. Also it showed that female,

married respondents visit more often in the health center than the male and

single respondents.

2. Level of Satisfaction

2.1. Maternal Check Up = it showed that referral to health facilities gained the

lowest weighted mean. The basic prenatal services gained the highest

weighted mean. In addition other questions from this category gained a

weighted mean of 3.24, 3.18, and 3.15 which meant that residents are

satisfied with the maternal checkup.

2.2. Immunization Services = it showed that enough supplies gained the lowest

weighted mean The health teachings about the risk and benefit of

immunization gained the highest weighted mean

2.3. Family Planning Services = it showed that the completeness of the options of

family planning gained the lowest weighted mean The counseling for family

planning acceptance gained the highest weighted mean

39

2.4 Sanitation Services = the result of the study showed that conducting health

programs gained the lowest weighted mean Informed about campaigns gained

the highest weighted mean of 3.13

CONCLUSION

Based on the above study, the researchers have come up with the conclusion

that even though the residents were satisfied with the health care services given by the

health center it is still important for the barangay health workers to improve their referral

to health facilities, completing the options for immunization and family planning, make

sure that there are enough supplies for all the clients of the health center.

RECOMMENDATION

In the light of the following findings in this study, we, the researchers, would like

to recommend the following:

1. Maternal Check up:

1.1 Barangay health Workers should coordinate more with other Government or non

Government agencies to improve their system for referral to attain a very satisfied

resident.

1.2 The Barnagay Health Workers should conduct a seminar once in a while to

inform pregnant women about complications in pregnancy so that pregnant women

can gain more knowledge about the complications.

2. Immunization Services:

2.1 Head of the health centers should seek help from government officials to have

an enough supply for immunization services.

40

2.2 Health Center administrators should conduct seminar so that the residents

especially the mothers will be more informed of the risk and benefit of immunization.

3. Family Planning Services:

3.1 Health Center administrators should conduct seminar so that the residents can

cope or accept the right family planning technique suitable to them.

3.2 BHW should coordinate more with other Government or non Government

agencies so that they can provide the residents proper family planning services.

4. Sanitation Services:

4.1 Health Center administrators should conduct more programs to make the

environment clean to attain very satisfied residents.

4.2 Health Center administrators should conduct seminar with proper campaign

materials so that the residents can be informed correctly and attain very satisfied

residents.

41

BIBLIOGRAPHY

A. BOOKS

Kozier, Barbara, Erb, Glenora, Berman, Audrey, and Snyder, Shirlee; Fundamentals of

Nursing; New Jersey; Pearson Education Inc; c. 2008

Maglaya, Araceli; Nursing Practice in the Community; Marikina City; Argonauta

Corporation; 2004

Nareno-Martinez, Fe and Galicano-Adanza, Estela; Methods of Research for the Health

Professionals 1 st edition ; Addison Wesley Longman Inc; c.2000

Reyala, Nisce, Martinez, Hizon, Ruzol, Dequina, alcantara, Bermudez and Estipona;

Community Health Nursing Services in the Philippines; Manila; c. 2000

B. NEWSPAPER

Amojelar, Darwin; “Poor Sanitation Cost Pinoy P78B Yearly” The Manila Times;

February 15, 2008

Lagman, Edcel; “Reproductive Health Bill” Philippine Daily Inquirer; August 03, 2008

C. REFERENCES

Republic Act 7160 (Local Government Code)

Republic Act 7305 (The Magna Carta of Public Health Workers) Section 3

Presidential Decree No. 856 (Sanitation Code of the Philippines)

Presidential Decree No. 996 (Providing for Compulsory Basic Immunization for Infants

and Children below Eight Years of Age)

42

APPENDICES

43

APPENDIX ACalamba Doctors’ College

Km 49 National Highway, Brgy. Parian, Calamba City, Laguna

Ms. Sally M. Dela Cruz:Barangay ChairmanBrgy. Pansol

Dear Maam:

We students of Calamba Doctors’ College are conducting a study regarding the

residents’ level of satisfaction in your health center as part of our course requirement in

research.

In connection with this we would like to ask the permission of your good office to allow

us to conduct a study at your barangay making your residents as our respondents.

We would highly appreciate your favorable response to this request of ours.

THANK YOU AND GODBLESS YOU!

Respectfully yours,

Tampis, Maria Lourdes A.

Sta. Agueda, John Philip

44

APPENDIX B

Dear Respondents:

Greetings of peace and all goodness!

We, the students of Calamba Doctors’ College taking up nursing are making a

research regarding the residents’ level of satisfaction in your health center.

In connection with this, we would like to ask your help to answer the questions

below. Be assured that your answers will be strictly confidential and will be used for the

sole purpose of this research.

Thank you very much!

Respectfully yours,

Tampis, Maria Lourdes Sta. Agueda, John Philip

Please provide the necessary informations:

AGE ______ CIVIL STATUS _________

GENDER_______ FAMILY INCOME LEVEL___________

How often do you visit the health center?

IN CASE OF EMERGENCY________ ONCE A WEEK______

ONCE A MONTH______ ONCE A YEAR_______

Direction: Encircle the best answer that suits your response. The options are the

following:

4 – Very satisfactory

3 – Satisfactory

2 – Needs Improvement

1 – Poor

45

MATERNAL CHECK UP

1. Basic prenatal service

(Physical examination, TT immunization) 4 3 2 1

2. Informed of pregnancy complications 4 3 2 1

3. Referral to health facilities 4 3 2 1

4. Confidentiality of examination results 4 3 2 1

5. Quality of service 4 3 2 1

IMMUNIZATION SERVICES

1. Assessment and evaluation

of the immunization program 4 3 2 1

2. Health teachings about the

Risk and benefits of immunization 4 3 2 1

3. Quality of service 4 3 2 1

4. Completeness of immunizations offered 4 3 2 1

5. Enough Supplies 4 3 2 1

FAMILY PLANNING SERVICES

1. Counseling for family planning acceptance 4 3 2 1

2. Provide basic family planning services 4 3 2 1

3. Informed of family planning techniques 4 3 2 1

4. Family Planning Programs 4 3 2 1

5. Complete options 4 3 2 1

46

SANITATION SERVICES

1. Informed about the campaign on health

and environmental hazards 4 3 2 1

2. Policy and practical programs 4 3 2 1

3. Program on health risk minimization 4 3 2 1

4. Cleanliness of the Environment 4 3 2 1

5. Conducts programs to make environment 4 3 2 1

clean

Thank you very much!

47

APPENDIX C

To determine the frequency of the demographic profile of the respondents,

percentage is used.

% = F X 100 N

Age

17 – 21 years old = 17/100 x 100 = 17%22 – 26 years old = 30/100 x100 = 30%27 – 31 years old = 23/100 x 100 = 23%32 – 36 years old = 12/100 x 100 = 12%37 – 41 years old = 8/100 x 100 = 8542 – 46 years old = 3/100 x 100 = 3%47 – 51 years old = 3/100 x 100 = 3%52 above = 4/100 x 100 = 4%

Gender

Female = 90/100 x 100 = 90%Male = 10/100 x 100 = 10%

Civil Status

Single = 36/100 x 100 = 36%Married = 64/100 x 100 = 64%

Income Level

Below 5,000 = 72/100 x 100 = 72%Above 5,000 = 28/100 x 100 = 28%

Frequency of Consultation

In case of emergency = 11/100 x 100 = 11%Once a week = 22/100 x 100 = 22%Once a month = 65/100 x 100 = 65 %Once a year = 2/100 x 100 = 2%

48

To determine the level of satisfaction Weighted mean was used:

WM = VS (4) + S (3) + NI (2) + P (1)

N

1. Maternal check up:

WM1 = 63(4) + 33(3) + 4(2) 100

= 252 + 99 + 8100

= 359 100

= 3.59

WM2 = 29(4) + 60(3) + 11(2)100

= 116 + 180 + 22100

= 318100

= 3.18

WM3 = 30(4) + 50(3) + 20(2)100

= 120 + 150 + 40100

= 310100

= 3.1

WM4 = 25(4) + 65(3) + 10(2)100

= 100 + 195 + 20100

= 315100

49

= 3.15

WM5 = 40(4) + 44(3) + 16(2)100

= 160 + 132 + 32100

= 324100

= 3.24

2. Immunization Services

WM1 = 32(4) + 61(3) + 7(2)100

= 128 + 183 + 14100

= 325100

= 3.25

WM2 = 39(4) + 50(3) + 11(2)100

= 156 + 150 + 22100

= 328100

= 3.28

WM3 = 38(4) + 46(3) + 16(2)100

= 152 + 138 + 32100

= 322100

= 3.22

WM4 = 25(4) + 60(3) + 15(2)100

= 100 + 180 + 30100

= 310100

= 3.1

50

WM5 = 22(4) + 46(3) + 32(2)100

= 88 + 138 + 64100

= 290100

= 2.9

3. Sanitation Services

WM 1 = 37(4) + 51(3) + 12(2)100

= 148 + 153 + 24100

= 325100

= 3.25

WM2 = 31(4) + 58(3) + 11(2)100

= 124 + 174 + 22 100 = 320

100 = 3.20

WM3 = 22(4) + 62(3) + 16(2)100

= 88 + 186 + 32100

= 306100

= 3.06

WM4 = 18(4) + 58(3) + 24(2)100

= 72 + 174 + 48100

= 294100

= 2.94

51

WM5 = 25(4) + 38(3) + 37(2)100

= 100 + 114 + 74100

= 288100

= 2.88

4. Sanitation Services

WM1 = 38(4) + 37(3) + 25(2)100

= 152 + 111 + 50100

= 313100

= 3.13

WM2 = 18(4) + 59(3) + 23(2)100

= 72 + 177 + 46100

= 295100

=2.95

WM3 = 20(4) + 43(3) + 37(2) 100 = 80 + 129 + 74

100 = 283

100 = 2.83

WM4 = 14(4) + 47(3) + 39(2)100

= 56 + 141 + 78 100 = 275

100 = 2.75

52

WM5 = 10(4) + 45(3) + 45(2)100

= 40 + 135 + 90 100 = 265

100 = 2.65

Hypothesis testing: (ANOVA)A A2 B B2 C C2 D D2

3.59 12.88 3.25 10.56 3.25 10.56 3.13 9.803.18 10.11 3.28 10.76 3.20 10.24 2.95 8.703.1 9.61 3.22 10.37 3.06 9.36 3.83 14.673.15 9.92 3.10 9.61 2.94 8.64 2.75 7.563.24 10.50 2.90 8.41 2.88 8.29 2.65 7.02∑= 16.26 ∑= 53.01 ∑= 15.75 ∑= 49.69 ∑= 15.33 ∑= 47.09 ∑= 15.31 ∑= 47.75

∑x = 16.26 + 15.75 + 15.33 + 15.31 = 62.65∑x2 = 53.01 + 49.69 + 47.09 + 47.75 = 197.54N = 4 x 5 = 20Column – 1 = 3N – Column = 16Critical Value = 3.24

SSbet = 16.262 + 15.752 + 15.332 + 15.312 – 62.652

5 20 = 0.12

SStot = ∑x2 – (∑x) 2

N = 197.54 – 62.652

20 = 1.29

SSw = SStot -- SSbet

= 1.29 – 0.12 = 1.17MSbet = SSbet

Column – 1 = 0.12

53

3 = 0.04

MSw = SSw

N – Column = 1.17 16 = 0.073

F = MSbet

MSw

= 0.04 0.073 = 0.55

F = 0.55 < critical value = 3.24∆ ACCEPT Ho Interpretation: Not significant

54

CURRICULUM VITAE

MARIA LOURDES A. TAMPIS

Blk 11 Lot 1 Centennial Homes Brgy. Pulo Cabuyao, Laguna

09109025899

[email protected]

PERSONAL DATA:

Date of Birth: November 24, 1989

Place of Birth: Guinayangan, Quezon

Civil Status: Single

Citizenship: Filipino

Weight: 98 lbs

Height: 5”

Religion: Roman Catholic

Father’s name: Benjamin I. Tampis

Occupation: Seaman

Mother’s name: Nieves A. Tampis

Occupation: Teaching

EDUCATIONAL BACKGROUND:

Elementary Guinayangan Elementary School 2000

High School Guinayangan Academy 2006

College UPH- Dr. Jose G. Tamayo Medical University 2006-2007

Calamba Doctors’ College

55

CURRICULUM VITAE

JOHN PHILIP R. STA. AGUEDAVilla Veronica Kamagong St. Miramonte Subd. Brgy. Pansol Calmaba Laguna

[email protected]

PERSONAL DATA:

Date of Birth: July 6, 1989

Place of Birth: Parañaque City

Civil Status: Single

Citizenship: Filipino

Weight: 100 lbs

Height: 5” 2’

Religion: Roman Catholic

Father’s name: Felipe D.L. Sta. Agueda

Occupation:

Mother’s name: Norma R. Sta. Agueda

Occupation: EDUCATIONAL BACKGROUND:

Elementary Letran 2000

High School Letran 2006

College Calamba Doctors’ College

56