1 Chapter 1 THE PROBLEM AND ITS SETTING

Introduction With the advent of a variety of effective childhood vaccinations, we now have very low rates of many of once deadly childhood diseases. However, they have not completely disappeared. The bacteria and viruses that cause them are still around so it is extremely important that children are immunized. A child who has not been adequately immunized may suffer from illnesses, a lifetime of disability or even death. Immunizations are used to protect the human body against preventable diseases. Immunizations are usually given in the form of a shot or vaccine. When one gets immunized, the body develops the ability to fight off a given disease. Immunizations safeguard the body from illnesses and death caused by certain infectious diseases. Some immunizations are given to prevent a single disease, while others will take care of two or three diseases. Immunizations help control infectious diseases that were once common. They have reduced, and in many cases, eliminated, diseases that routinely killed or harmed infants, children, and adults. As stated in Public Health Nursing (2007), immunization is the process by which vaccines are introduced into the body before infection sets in. Vaccines are administered to induce immunity thereby causing the recipients immune system to react to the vaccine that produces antibodies to fight infection.

2 Vaccinations promote health and protect children from disease-causing agents. Infants and newborns need to be vaccinated at an early age since they belong to vulnerable age group. They are susceptible to childhood diseases. Vaccination among infants and newborns (0-12months) against the seven vaccine preventable diseases. These includes: tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, measles and Hepatitis. The standard routine immunization schedule for infants is adopted to provide maximum immunity against the seven vaccine preventable diseases before childs first birthday. A child is said to be Fully Immunized Child when a child receives one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and one dose of measles before a childs first birthday. The primary goal of immunization is to prevent the contraction of disease. This is especially important for infants who are born without a fully developed immune system or the antibodies needed to fight of potentially dangerous illnesses. Target diseases include measles, tuberculosis, diphtheria, pertussis, poliomyelitis, neonatal tetanus and hepatitis B. For the children to receive vaccines mothers should submit them to the nearest health centers and have their shots. It is extremely necessary that mothers should follow the schedule for each shot to complete the immunization. Though vaccines are given free in health centers many still fail to get their child vaccinated, for that matter researchers got interested in the knowledge, attitudes and practices on childhood immunization among mothers in Purok 3, barangay Sto. Nio, Bian City, Laguna.

3 Background of the Study The study was done at Sto. Nio, Bian City, Laguna, located along the old national hi-way, the 14 th barangay in Bian City, Laguna with the total number of population of 7, 656 and a household number of 1, 310. It is currently led by Hon. Ceferino B. Mercado, the barangay captain of Sto. Nio, Bian CIty, Laguna. The number one leading cause of infant morbidity in the said barangay is acute respiratory infections (ARI), while pneumonia is the leading cause of mortality. The said area has no available health center, so the mothers and the residents go to the health center of Barangay San Vicente to gain access in immunizing their children which is located beside barangay Sto. Nio. This is the reason why we conducted the study on the knowledge, attitudes, and practices on childhood immunization among mothers.

Theoretical Framework To ensure the greatest quality of research, one must possess a strong foundation, as for the researchers title, researchers chose the Health Belief Model (HBM), It was developed in the 1950s by a group of U.S. Public Health Service social psychologists who wanted to explain why so few people were participating in programs to prevent and detect disease. HBM is a good model for addressing problem behaviors that evoke health concerns (e.g., parents do not like their children immunized because it is taking risks rather than not immunizing). The health belief model proposes that a person's health-related behavior depends on the person's perception of four critical areas: the severity of

4 a potential illness, the person's susceptibility to that illness, and the benefits of taking a preventive action, and the barriers to taking that action. HBM is a popular model applied in nursing, especially in issues focusing on patient compliance and preventive health care practices. The model postulates that health-seeking behavior is influenced by a persons perception of a threat posed by a health problem and the value associated with actions aimed at reducing the threat. HBM addresses the relationship between a persons beliefs and behaviors. It provides a way to understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies. The six major concepts in HBM are as follow: Perceived Susceptibility: refers to a persons perception that a health problem is personally relevant or that a diagnosis of illness is accurate; Perceived severity: even when one recognizes personal susceptibility; action will not occur unless the individual perceives the severity to be high enough to have serious organic or social complications; Perceived benefits: refers to the patients belief that a given treatment will cure the illness or help to prevent it; Perceived Costs: refers to the complexity, duration, and accessibility and accessibility of the treatment; Motivation includes the desire to comply with a treatment and the belief that people should do what; Modifying factors include personality variables, patient satisfaction, and socio-demographic factors. In this theory, peoples perception on health is divided among 6 concepts, these concepts explains how a person respond to their health care needs, as

5 related to the title, the researchers will want to know how these mothers respond regarding their childs immunization.

Conceptual Framework The researchers determined the knowledge, attitudes and practices on childhood immunization among mothers of Purok 3, barangay Sto. Nio, Bian City, Laguna. For the independent variable are the profile of the respondents as to age, educational attainment, employment status, number of children and combined family monthly income. On the other hand, the dependent variables are the problems being measured in terms of level of knowledge of the mothers on immunization, attitude of the mothers towards immunization, and practices of the mothers on immunization. Profile of the respondents in terms of: Age Attitude of the mothers Educational attainment Employment status Practices of the mothers Number of children on immunization towards immunization Level of knowledge of the mothers on immunization

Figure 1 The Knowledge, Attitudes and Practices of the Mothers on Immunization

6 Statement of the Problem This study aimed to determine the knowledge, attitudes and practices on childhood immunization among mothers of Purok 3, barangay Sto. Nio, Bian City, Laguna. The study sought to answer the following questions: 1. What is the demographic profile of the respondents in terms of: 1.1 Age 1.2 Educational attainment 1.3 Employment status 1.4 Number of children 1.5 Combined family monthly income 2. What is the level of knowledge of the mothers on childhood immunization? 3. What is the attitude of the mothers towards childhood immunization? 4. What are the practices of the mothers on childhood immunization? 5. Is there a relationship between the demographic profile of the mothers and: 5.1 Their level of knowledge on childhood immunization 5.2 Their attitude towards childhood immunization 5.3 Their practices on childhood immunization 6. Is there a relationship between the practices of the mothers on childhood immunization and: 6.1 Their level of knowledge on childhood immunization. 6.2 Their attitude towards childhood immunization

7 Statement of the Hypothesis Ho1: There is no significant relationship between the demographic profile

of the mothers and their level of knowledge, attitudes and practices on childhood immunization. Ho2: There is no significant relationship between the level of knowledge

and attitude of the mothers, and their practices on childhood immunization.

Scope and Delimitation Certain information was based on surveys and focused on fifty (50) mothers residing in Purok 3, barangay Sto. Nio, Bian City, Laguna and their knowledge, attitudes and practices on childhood immunization for their children.

Assumptions of the Study During the conduct of the study, the following assumptions were made by the researchers: 1. The respondents answered the questionnaire to the best of their knowledge and whatever personal opinion elicited was honest and true. 2. The statistical methods used in this study were accurate and reliable.

Significance of the Study The researchers conducted the study to know the knowledge, attitudes and practices of mothers that will signify their childrens health through immunization. These findings of the study will prove significant to the following:

8 Respondents. This study will educate the mothers regarding the diseases that can be prevented by their children in having immunization vaccine. Community. This research will give information for the whole community about the benefits of completing immunizations. Health Practitioner. This research will help minimize the prevalence of disease and decreasing mortality and morbidity rates among infants. Student Nurse. As a student nurse, this study will help us in providing appropriate health teachings and other interventions to help respondents complete their childrens immunization. Other Researchers. This study is also an advantage to other researchers for conducting further studies related to this research. They can differentiate the problems today and the near future to help enhance the wellness of newborns.

Definition of Terms For research purposes, the following terms were used extensively in the study, and the established definitions intended for the operational use of the terms in the study are as follows: Antibody. This is a protein produces by the immune system that help identify and destroy foreign germs (virus/bacteria) that attack the body. Attitude. Is the way of the respondents deal with the immunization of their children, the way they feel about immunization. Awareness.

9 Combined Family Monthly Income Is the total income of the family per month which is composed of the income of each member who is working. Disease. This refers to the condition that impairs some function of the body or one of its parts. Immunization. Is the process of conferring increased resistance to infection. It is the introduction of host or pathogen that is served as an antibody to the immune system. Practices. Actions taken by respondents in childhood immunization. Schedule. This refers to the age and/or intervals at which children should get various childhood immunizations. Vaccines. Is a preparation of killed, living attenuated microorganisms, or living fully virulent microorganism that is administered to produce artificially increased immunity. Chapter 2 REVIEW OF RELATED LITERATURE

This chapter includes different literatures and previous studies conducted by other researchers related to our problem. It consists of both local and foreign literatures and studies from related journals, books and other thesis.

State-of-the-Art This study was based on previous studies published and unpublished concerning individually the knowledge of, attitudes towards and practices on

10 childhood immunization in various locales. Additionally, citations were made of published articles relevant to the subject of this research. Data on immunization from previous journals, as well as epidemiologic data coming from the study locale were also utilized to lend further support to assertions made in the analysis of findings obtained by this research.

Related Literature As stated in Health and Education by Commission on Health (2009), educational attainment among adults is linked with childrens health as well, beginning early in life: babies of more-educated mothers are less likely to die before their first birthdays, and children of more-educated parents experience better health. Education can increase peoples knowledge and cognitive skills, enabling them to make better-informed choices among the health-related options available for themselves and their families, including those related to obtaining and managing medical care. Greater educational attainment has been associated with health-promoting behaviors. In addition, changes in healthrelated behaviors in response to new evidence, health advice and public health campaigns tend to occur earlier among more-educated people. More education can lead to higher-paying jobs, which enable people to obtain health care when needed, provide themselves and their families with more nutritious foods, and live in safer and healthier homes and neighborhoods with supermarkets, parks and places to exerciseall of which can promote good health by making it easier to adopt and maintain healthy behaviors. Lower-paid workers experience greater

11 stress because they have fewer financial resources to cope both with everyday challenges, including child care and other family responsibilities, and with unexpected challenges such as illness. Parents educational attainment is also linked to their childrens health and their childrens educational attainmentboth of which influence their childrens health as adults. When a child is immunized, the health worker should record the vaccine, which dose it is (first, second, etc.) and the date on an immunization or health card given to the parents or other caregiver. The immunizations should also be recorded and kept at the health clinic. It is important for the parents or other caregiver to keep the immunization card and bring it with them the next time the child is vaccinated. With it, the health worker can record which vaccines the child has received and the date they were given. The health worker can also provide information to the parents or other caregiver on vaccines that are missing or remaining. (Facts for Life Goal, 2007) All health care providers are legally required to keep a record of immunizations in their patient's chart. Some health care providers may also supply their patients with handy immunization record cards that allow you to keep track yourself of which vaccines have and have not been given. Child immunizations records are vital to ensuring your child receives all of their vaccines on time and that they do not need to repeat any shots. (Its A Moms World, Baby Health Immunization Schedule, 2010) Most vaccinations can be given if the child is not seriously ill or running a fever. If he has had a cough or cold for more than a few days, the doctor may

12 want to hear his breathing before deciding whether a vaccination may be given. (Baby Center India, 2008) According to Cunningham (2012) Despite an upward trend overall in most childhood vaccination rates, studies have shown changes in demographic characteristics in children who have not received the recommended number of vaccine doses. Historically, unvaccinated children were more likely to live in a household whose income was at or near the poverty level because their families could not afford to have them vaccinated. Ideally, children are vaccinated at birth and the parents are counseled about when and how the child should get the next vaccinations. The family receives a health card for the child with simple pictures that act as a reminder. The card also informs a health worker if the child visits the clinic and has missed a vaccination, which should then be given on the spot. The great majority of parents do value vaccinations. Research has shown that parents also value the health cards and surprisingly few lose them. If the system works right, both parents and providers have all the cues they need for these behaviors. In the past, many programs assumed parents needed to understand what their children were being immunized against before they would act. Some put great effort into teaching parents about the various killer diseases. However, because immunization is valued by families, most will take their children simply if told when and where to go. Parents equate vaccinations with good health (despite the short-term negative consequences of a child in tears). UNICEFs massive support for Universal Child Immunization in the 1980s also helped brand

13 vaccinations as a public health good. People often recognize the immunization logo. The key behavioral concepts for parents are the notion of completing a series of visits and (in most countries) finishing the series before the childs first birthday. In many communities, the under-one-year old is considered particularly vulnerable so parents may be reluctant to subject an infant to vaccinations early enough. In addition to the vaccination card, communication programs have therefore devised various creative ways of motivating completion in a timely way .Completion is made a cause for celebration. A central communication focus is to reward individual parents for finishing a childs series, and communities for covering large numbers of children by a particular age. On the surface, this does not sound like a difficult demand creation task. Nevertheless, immunization offers complex behavioral challenges (Global Health Communication, 2003). Knowledge (about when, where, and how often to get a child immunized) is a prime determinant of immunization. Any supplementary strategies add to the parents challenge of understanding how many vaccinations a child needs and when and how these should be obtained. Confusing or contradictory messages make it difficult for families to act, undermine trust in services, and even create doubts about the product itself. (Global Health Communication, 2003) Calame (16th January 2007) of New York Times said that a common argument perpetrated by pro-vaccine doctors is that parents don't vaccinate because they don't know anything, they are under-educated, poor and misinformed. However, the opposite is true. Those mothers, who have chosen to research the issue and read both sides of the argument in depth, often decide

14 not to vaccinate, or to choose only some vaccines and not others. A study in the journal The American Journal of Public Health, which surveyed 11,860 families, found that mothers who had not finished high school were 16% more likely to have completed the whole vaccination schedule for their children. Lower education levels and socio-economic status was associated with higher completion rates for vaccination. Rates of compliance were also higher in

Hispanic and black low income families. The researchers were puzzled as to why this was and suggested giving more vaccine information to university educated mothers, and they suggested a 'cultural' difference may be to blame. Dr. Kronenfeld, a professor of sociology in the School of Social and Family Dynamics at Arizona State University, said 'There is a controversy among more educated mothers about the safety of certain kinds of immunization, that may be part of what is going on here, but we dont know for sure. According to Tyler, Tom R. et al (1991), results shown that older people change in response to personal experience. As cited by Krosnick et al (1989), there are several ,major perspective on the relationship between age and openness to attitude change. Although health providers 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. Several factors can influence a parent's decision to

15 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. (Stevenson, 2009) 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. (Stevenson, 2009) 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 resulted in parental fears and concerns regarding the safety of vaccines. Such fears may cause families to delay immunizations or to decline

16 them altogether. 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. (Stevenson, 2009)

Related Studies According to Kim et al (2007) Some of the factors that affect whether or not children are up to date on immunizations include economic, provider, and parental variables; availability of vaccines; and vaccination policies. In addition, children in households with 2 or more other children, children with unmarried mothers having no postsecondary education, non-Hispanic Black children, children whose families use public immunization service providers, and children in families in which more than 1 physician provides immunizations are at increased likelihood of experiencing immunization delays (i.e., delays of 30 days or more above the recommended vaccination point). Improvements in rates of compliance with national immunization guidelines are imperative. Mell et al. showed that the rate of full compliance with recommended immunization guidelines was about 35.6%, and they showed that 29.7% of children had missed opportunities for immunizations. According to Awodele et al (2010) there were significant relationship between age of respondents; ethnicity; level of education; occupation and

17 attitude to immunization. However, there was no significant relationship between religion and attitude to immunization. Although majority of the mothers were aware of immunization services, their knowledge of immunization schedule as well as of vaccine preventable diseases is poor. A better understanding of routine immunization schedule is important in the design and implementation of immunization programmes. Educating mothers about the vaccines and vaccine preventable disease, and improving their performance are recommended. Markland and Durand, (1976); Marks et al., (1979) revealed that educational status of mothers has a strong association with a high vaccine uptake. This study also confirms this assertion from previous studies (Markland and Durand, 1976; Marks et al., 1979). There is an association between

education status of mothers and missed opportunities for vaccination. More than two-thirds (70.4%) of mothers with missed opportunities for vaccination had either primary school education or no formal education. This finding is in support of a report from Turkey study by Altinkaynak et al.,

(2004) that education of mothers increases the vaccination chance of a child and reduces missed opportunity. In the study, 33.4% of the children under one year of age have not completed their vaccination program because of missed opportunities. Factors identified for missed opportunities in these children are long trekking distance with bad terrain (27%), high cost of transportation (33%), poor staff attitude (11%), quality of health services provided (9%), lack of personnel (15%) and vaccine out of stock (5%).

18 According to Akesode, (1982) marital status and age of the mothers were not seen to be associated with the use of immunization services. In addition a study from Glenda (et al., 2004), in other settings, both younger and older age of mothers has been reported to be associated with incomplete vaccination. According to Klevens and Luman, 2001; Bates and Wolinsky, 1998; Zimmerman, 1996, Family income has previously been associated with immunization coverage levels, and low family income is also a risk factor for low immunization. Parents with lower household incomes are more likely to experience barriers, such as transportation or access to health care services that make staying up-to-date on immunizations difficult. The low-income parents in this study who had incomplete immunization for their children may have done so because of similar barriers. The indirect influence of economic factors on immunization at household levels is a more obvious explanation. When the mother/household is experiencing food and resource shortages, participating in an immunization exercise becomes a matter of lesser priority A study by Bennett and Smith (1992), which also focused on parental perceptions of vaccine safety and ranked their level of concern on a scale of 1 (lowest) to 5 (greatest), found that parents with a household income below $30,000 were 2.1 times more likely than parents with a household income greater than $75,000 to report their level of concern as a 5 (95% CI: 1.5, 3.2). According to Rahman et al (2003), in a case-control analysis of crosssectional data, 328 children aged 1235 months and their mothers were studied to identify the factors associated with delayed or non-immunization of their

19 children. Delayed or non-immunization was associated with low socio-economic status, maternal illiteracy, and lack of mothers' knowledge on vaccine preventable diseases as recommended by the Expanded Programme on Immunization (EPI). The association of this lack of mother's knowledge with no or delayed immunization persisted after adjusting the effects of others in logistic regression analysis. The results indicate that even in the presence of maternal illiteracy, educating mothers about the vaccines and vaccine preventable diseases may be highly effective in increasing the immunization coverage. According to the study of Nankabirwa et al (2008), infants whose mothers had a secondary education were at least 50% less likely to miss scheduled vaccinations compared to those whose mothers only had primary education. Strategies for childhood vaccinations should specifically target women with low formal education. Based from the study of Bofarraj (2008) the child's gender, education, residence and job of the mother did not affect the pattern of immunization, while negative attitude (mothers afraid from vaccination) significantly affected the immunization status. This signifies the incomplete knowledge and inappropriate practice of the people. Among educated mothers the percentage of completely immunized children was 71.4% whereas among illiterate mothers it was 88.3%, but the difference was not statistically significant (p>0.05). In a study conducted by Manjunath, Pareek (2003), majority of the mothers able to mention at least one benefit of immunization as preventing illness, paralysis, or death. Polio prevention was the most often mentioned

20 benefit as can be seen from the mothers of fully and partially immunized children mentioned more than one benefit in general. Average number of correctly identified diseases for which EPI vaccines are given was only 2.01 among the mothers of fully immunized children. Further analysis of the data showed that 75.3% named "polio" correctly. Only four mothers named "Diphtheria" and two correctly identified all the diseases.147 out of 166 (88.6%) expressed a favorable attitude towards the program, with 100% of the mothers of fully, 86.5% of the partially and 61.3% of the not immunized children showing favorable attitudes. 81.3% expressed satisfaction about the program. Clearly show that all the mothers of fully immunized children are satisfied and that the number decreased for partially and not immunized groups. 123 mothers said that interpersonal approach as the most effective way to improve the success of the existing program. According to Coreil (1987) reasons related to the characteristics of mother are the following: time constraints, other socio-economic constraints, lack of

knowledge of immunization, low motivation for immunization, fears of mothers on vaccines, and community opinion. Also included in her research is the availability of the vaccine, the accessibility, acceptability of vaccines and affordability. According to the study of Caingles and Lobo (2011). Twenty-nine (93%) out of 31 mothers claimed they knew what vaccines were to be given, but only 22 (75.86%) were correct. Twenty-one (68.75%) learned of the immunization through barangay health workers. With regard to adverse reactions: giving of

appropriate medication was applied by 18 (69.2%) respondents. Six mothers

21 (23%) preferred going to a physician; 29 (93.5%) were aware of the next scheduled dates of visit. Major reasons for missed vaccinations were sickness and long waiting time before vaccine was given: accounting for 9 (29.03%) each. During the times when vaccines were not available at the health center, 19 (61.29%) preferred to wait for it to become available. 20 respondents (64.5%) knew of other recommended vaccines which were not included in the EPI (NonEPI) vaccines, but only 3 (9.7%) availed of it from private physicians. Of this group, 14 (70%) were willing to avail of the vaccines; 17 (85%) were thought of these vaccines as expensive; 12 (71%) were willing to have their children vaccinated; and 3 (17.64%) opted to save money first prior to vaccination. Parents still lacked knowledge with regards to their childrens vaccination. The outcome of the child being fully immunized depends on the availability and affordability of vaccine, as well as, the willingness and effort of their parents. A study conducted by the UPHSL College of Nursing 2005, concluded that parents had very adequate knowledge in the importance and consequences of immunization. The parents were not sure on their knowledge on schedule and types of different immunization. Age and educational attainment were not strong intervening variables on the adequacy of knowledge and incidence of illness. Newell et al (2008) stated, on their study entitled Childhood Vaccination in Africa and Asia: The Effects of Parents Knowledge and Attitudes, that parents knowledge about vaccinations is poor, and the knowledge they do have is often wrong. It appears that there is no association between parents knowledge and vaccination coverage rates, and the public accept vaccination despite limited

22 knowledge about it .One thing is clear, however: when parents resist vaccination, it is because they want to protect their children from harm. According to one school of thought, the demand for vaccination is triggered by a general perception that vaccines are good for infants and/or a strong feeling of vulnerability to serious illness. A contrasting viewpoint is that the greatest determinant of vaccination uptake is the perceived quality of vaccination services. The situation is likely to differ depending on the context. Cultural receptivity to perceived modernity and education, as well as trust in health workers, was considered to be the most important factors influencing attitudes. In short, knowing little about vaccination does not necessarily translate into negative attitudes towards it; factors such as trust (e.g. in health-care providers or western medicine) and culture may be more influential. The impact of high levels of knowledge on subsequent attitudes towards vaccination is unknown. According to Schwarz et al (2009) distance from the facility appears to have been an important factor affecting adherence to EPI: transport costs, loss of time, clinic queues, social stigma and unfriendly, and even aggressive, responses by health staff towards latecomers, all interact to become a strong impediment to future adherence. Fear of rebuke by health staff has been reported in other studies as contributing to no adherence relating to routine clinic attendance. Insufficient communication, for example, health workers not explaining the purpose of vaccinations to mothers seem to be common in health centers and may deter mothers from coming back in the future. Some mothers do not return to clinic due to having bad experiences during a previous visit. Bad

23 experiences were often related to mothers feeling ashamed about their own or their childs appearance. There is evidence that mothers who felt that they could not dress smartly enough for the approval of other women at the clinic were less likely to attend. This has also been reported in other published. More worryingly, this shame also extended to the physical and health condition of the child. So, for example, if a mother thought that her child was malnourished, had skin rashes, or generally did not look healthy, she might not attend the clinic in order to avoid criticism from staff and being stigmatized as a bad mother by other women. As a result, mothers of children who most urgently need clinics may be the ones least likely to attend. It is likely that these are the poorest women who have least resources to enable them to dress smartly and whose children have the poorest health status. As cited by Pillsbury (1990) Reasons children don't get immunized are because of the following: Mothers have too many competing priorities, daily subsistence included, and too little time for them. Many dont understand immunization, have many misperceptions, and don't regard it as very important. Vaccines produce side-effects that mothers fear and about which they receive little effective information. In many countries, immunization services are not adequately and reliably available. Many health workers do not adequately inform mothers as to why and when they should return for additional doses. Missed opportunities many Facilities often fail to vaccinate children who have come at time when they should be vaccinated, even though supplies and trained health workers are all present.

24 According to Bernsen 2011. Older mothers were less likely to have a positive attitude towards immunization, regardless of education, knowledge or number of children. Perhaps, in older women, this reflects a higher prevalence of traditional nihilistic views, such as destiny being the cause of disease.

Synthesis of the State-of-the-Art Based on previous studies, mothers knowledge, attitudes and practices affects the immunization of their child. Many of them lack knowledge about immunization vaccine that can prevent their child from communicable diseases. Some of the factors that affect whether or not children are up to date on immunizations, children are up to date on immunizations include economic, provider, and parental variables; availability of vaccines and vaccination policies. There were significant relationship between age of respondents; ethnicity; level of education; occupation and attitude to immunization. However, there was no significant relationship between religion and attitude to immunization. Parental perceptions of vaccine safety and ranked their level of concern. Parental perceptions of vaccine safety and ranked their level of concern found that parents with a household income below $30,000 were 2.1 times more likely than parents with a household income greater than $75,000 to report their level of concern as a 5 (95% CI: 1.5, 3.2). The presence of maternal illiteracy, educating mothers about the vaccines and vaccine preventable diseases may be highly effective in increasing the immunization coverage. The child's gender, education, residence and job of the mother did not affect the pattern of immunization, while

25 negative attitude (mothers afraid from vaccination) significantly affected the immunization status. This signifies the incomplete knowledge and inappropriate practice of the people. The outcome of the child being fully immunized depends on the availability and affordability of vaccine, as well as, the willingness and effort of their parents. The effects of parents knowledge and attitudes, that parents knowledge about vaccinations is poor, and the knowledge they do have is often wrong. It appears that there is no association between parents knowledge and vaccination coverage rates, and the public accept vaccination despite limited knowledge about it. Distance from the facility and fear of rebuke by health staff has been reported in other studies as contributing to no adherence relating to routine clinic attendance and appears to have been an important factor affecting adherence to EPI. Reasons children don't get immunized are because of the following: Mothers have too many competing priorities, daily subsistence included, and too little time for them. Vaccines produce side-effects that mothers fear and about which they receive little effective information. Many health workers do not adequately inform mothers as to why and when they should return for additional doses. Older mothers were less likely to have a positive attitude towards immunization. Perhaps, in older women, this reflects a higher prevalence of traditional nihilistic views, such as destiny being the cause of disease.

26 Gaps Bridged by the Present Study Mothers compliance to immunization reflects on the immunization status of their child. Recent studies have shown that maternal illiteracy, low socioeconomic status, culture and beliefs had been stated to be factors that influence a childs immunization status. From the related studies presented it has been emphasized how mothers comply with only limited knowledge regarding immunization, studies concluded that knowledge doesnt influence mothers adherence to immunization for their general perception of it is good whats preventing them were fear of possible effects. The present study conducted primarily focuses on determining maternal knowledge, attitudes and practices and how maternal profile affects these. It is also focused on how knowledge and attitudes affects mothers practices on childhood immunization.

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Chapter 3 RESEARCH DESIGN AND METHODOLOGY

This chapter contains a discussion of the design plan of the study. It includes the components of methods of research, respondents of the study, sources of data and the statistical techniques and methods for data interpretation and analysis.

Research Design The descriptive type of research was utilized in the study. Descriptive research according to Ardales (2008) which aim to find out what prevail in the present: conditions or relationships, held opinions and beliefs, processes and effects, and developing trends. It seeks to determine relationships between variables, tests hypotheses and develops generalization, principles or theories on the basis of its findings. This helped the researchers determined knowledge, attitudes and practices on childhood immunization among mothers of Purok 3, barangay Sto. Nio, Bian City, Laguna. Descriptive research focuses on how person, group or thing behaves or function in the present.

Sources of Data Data obtained for this study were taken from two sources. Primary sources were the fifty (50) mothers residing from Purok 3, Barangay Sto. Nio, Bian City, Laguna. They provided vital information through self-developed

28 questionnaire issued to them. Secondary sources consisted of books, journals, internet and other pertinent record.

Population of the Study The respondents of the study comprised of fifty (50) mothers residing at Purok 3, Barangay Sto. Nio, Bian City, Laguna. The researchers used the purposive sampling technique. The researchers chose this kind of sampling based on who they think would be appropriate for the study.

Instrumentation and Validation The researchers gathered data from books, journals and other studies related to the study. Using these sources the researchers were able to formulate a checklist form of questionnaire that was used in the study. In order to determine the validity of the instrument, the self-developed questionnaire was then presented to the thesis adviser and was then validated by the three clinical instructors with masters degree approached. Corrections were made and the revised questionnaire was then given out to the respondents. After gaining the much needed data from the respondents, researchers personally scored and tallied the results and forwarded it to the statistician for statistical treatment.

Data Gathering Procedure In able to get the accurate population of Barangay Sto. Nio, Bian City, Laguna, specifically in Purok 3, a letter was sent to the population office of Bian

29 City Hall. The researchers were able to know the information about the morbidity and mortality rate of Barangay Sto. Nio, Bian City, Laguna, a letter was also sent to the Director of Rural Health Unit in barangay Sto. Domingo and to the Health Center of barangay San Vicente, Bian City, Laguna, where the residents of Sto. Nio gained their access for health assistance. Prior to the distribution of the questionnaires for data gathering, researchers asked permission to the barangay captain of the area. Upon approval, the questionnaires checklist were distributed to the respondents and were tabulated and analyzed.

Evaluation and Scoring The study utilized a self-developed questionnaire as a tool in data gathering and consisted of two parts. Part 1 consists of the demographic profile of the respondents in terms of age, educational attainment, employment status, number of children and combined family monthly income. Part II contains the problems determining the level of knowledge, attitudes, and practices among mothers towards childhood immunization. Respondents will be instructed to rate each. In measuring their level of knowledge the researchers used the four point likert scale namely: (4) highly knowledgeable, (3) knowledgeable, (2) slightly knowledgeable and (1) not knowledgeable. To measure their attitudes, the following were used as responses: (5) strongly agree, (4) agree, (3) undecided, (2) disagree, and (1) strongly disagree. For the practices of the respondents the researchers used the following: (5) always, (4) sometimes, (3) often, (2) seldom, and (1) never. The options and assigned points are as follows:

30 Option Highly knowledgeable 3 Slightly knowledgeable Not knowledgeable Option Strongly agree Agree Undecided Disagree Strongly disagree Option Always Sometimes Often Seldom Never Statistical Treatment of Data The researchers utilized the following statistical treatment such as percentage, frequency distribution, weighted mean, Pearson-r, t-test for significance of correlation and Chi square to answer the specific problems of this study. Assigned Points 4 Knowledgeable 2 1 Assigned Points 5 4 3 2 1 Assigned Points 5 4 3 2 1 Range 3.51 4.00 2.51 3.50 1.51 2.50 1.00 1.50 Range 4.51 - 5.00 3.51 -4.50 2.51 - 3.50 1.51 - 2.50 1.00 - 1.50 Range 4.51 - 5.00 3.51 -4.50 2.51 - 3.50 1.51 - 2.50 1.00 - 1.50

1. Percentage It is a fraction of a number or amount expressed as a particular number of hundredths of that particular number.

31 The corresponding percentage was used to describe the profile of the subjects

Where: % = percentage F = frequency N = number of respondents

2. Frequency Distribution Frequency Distribution is the organization of raw data in table form, using classes and frequencies. Categorical Frequency Distribution is a type of frequency distribution which is used for data that can be placed in specific categories such as nominal and ordinal. Steps in Constructing Distribution 1. Arrange the data in an array 2. Determine the range R = Highest observed value Lowest observed value 3. Decide on the number of class intervals K = 1 + 3.3 log N (Sturges Formula) Wherein: K = number of class intervals N = total number of observations

32 4. Determine the class size or width W = Range / class interval 5. Set-up the frequency table and tally 6. Solve for the class marks

3. Weighted mean

Wherein: Bar X = mean W = weight x = individual score

4. Pearson-r (Pearson product moment coefficient of correlation) It is used to determine if their exist a relationship between x and y (bivariate data)

Where: Coefficient of correlation (r) is the interpretation as to the degree or extent of relationship. r = degree of relationship between x and y x = observed data for the independent variable

33 y = observed data for the dependent variable n = sample size The degree of linear relationship can be interpreted through the use of range of values for the Pearson product moment correlation as shown below:

Range of Value 0

Decision No relationship

0.0001-0.2999

Negligible positive/ negative relationship

0.3000 -0.4999

Low/weak relationship

0.5000 - 0.6999

Moderate relationship

0.7000 - 0.8999

High/strong relationship

0.9000- 0.9999

Very high/very strong relationship

Perfect relationship

5. t-test for significance of correlation This is used to check for the significance of the Pearson-r. The t-test assesses whether the means of two groups are statistically different from each other.

34 The simplest formula for computing the appropriate t value to test significance of a correlation coefficient employs the t distribution:

Where: t = computed t value r = Pearson-r value n = number of respondents

6. Chi square Chi square is used for the test of homogeneity (concerned with two or more samples with only one criterion, two or more populations are homogenous) and for the test of independence (significant relationship or association between two variables).

Where: X2 = Chi square Fo = observed frequencies Fe = expected frequencies = summation

35 Chapter 4 PRESENTATION, ANALYSES, AND INTERPRETATION OF DATA

This section provides the findings that were obtained from the subjects of the study, together with it are the researchers interpretation and analysis.

1. The Profile of the Mothers The following section describes the demographic profile of the mothers included in the study in terms of their age, their educational attainment, their employment status, the number of children and their combined family monthly income.

1.1 The Profile of the Mothers in Terms of Age Table 1 shows the percentage and distribution of the mothers profile in terms of age. It is grouped into 12 to 20, 21 to 30, 31 to 40 and over 40.

Table 1 The Profile of the Mothers in Terms of Age Age (Years) 12 to 20 21 to 30 31 to 40 Over 40 TOTAL Frequency 6 19 16 9 50 Percentage (%) 12 38 32 18 100 Rank 4 1 2 3

As noted in the table, thirty eight percent (38%) of the respondents were 21 30 years old, showing that most of them were already considered as young

36 adult. Thirty two percent (32%) of the respondents were between 31 40 years old. Respondents aged over 40 years old were 18% of the total respondents. Lastly, there were 12% of respondents who are in the ages between 12 20 years old.

1.2 The Profile of Mothers in Terms of Educational Attainment Table 2 records the educational attainment of the respondents in the study that is classified as grade school, high school, college level and vocational training.

Table 2 The Profile of the Mothers in Terms of Educational Attainment Educational Attainment Grade School Level High School Level College Level Vocational Training TOTAL Frequency 13 29 7 1 50 Percentage (%) 26 58 14 2 100 Rank 2 1 3 4

The table shows the highest percentage of fifty eight percent (58%) were the respondents from the high school level. Twenty six percent (26%) of the respondents finished grade school level. Fourteen percent (14%) were in college level and lastly, the two percent (2%) of the respondents in the study were in vocational training. The survey indicates that most of the respondents finished high school level.

37 1.3 The Profile of Mothers in Terms of Number of Children Table 3 indicates mothers profile in terms of number of children. Number of children is grouped into three ranges which are 1 to 3, 4 to 6, and 7 to 9. The table also shows the frequency and percentage and was ranked in ascending order.

Table 3 The Profile of the Mothers in Terms of Number of Children Number of Children 1 to 3 4 to 6 7 to 9 TOTAL Frequency 34 13 3 50 Percentage (%) 68 26 6 100 Rank 1 2 3

The respondents with highest percentage of sixty eight percent (68%) have 1 3 children. Twenty six percent (26%) of the respondents have 4 6 children. Lastly, with only six percent (6%) of the respondent have 7 9 children.

38 1.4 The Profile in Terms of Employment Status Table 4 refers to the mothers profile in terms of employment status whether they are employed or unemployed, the number of frequency and its percentage Table 4 The Profile of the Mothers in Terms of Employment Status Employment Status Employed Unemployed TOTAL Frequency 14 36 50 Percentage (%) 28 72 100

Researchers classified employment status as employed and unemployed. Seventy two percent (72%) of the respondents were unemployed and the remaining twenty eight percent (28%) were employed.

39

1.5 The Profile of Mothers in Terms of Combined Family Monthly Income Table 5 indicates the profile of the mothers in terms of combined family monthly income which ranges from 4,999 and less, 5,000 to 9,999, 10,000 to 14,999, 15,000 and above.

Table 5 The Profile of the Mothers in Terms of Combined Family Monthly Income Combined Family Monthly Income (PhP) 4,999 and less 5,000 to 9,999 10,000 to 14,999 15,000 and above TOTAL Frequency 18 26 3 3 50 Percentage (%) 36 52 6 6 100 Rank 2 1 3 3

The table shows that fifty two percent (52%) of the respondents have monthly income of Php 5,000 to 9,999. Thirty six percent (36%) of the respondents have monthly income of Php 4,999 and less. The remaining twelve percent of the respondents are equally divided into two, the first six percent (6%) have monthly income of Php 10,000 to 14,999 and the other six percent (6%) have monthly income of Php 15,000 and above.

40

2 The Knowledge of the Mothers on Childhood Immunization This section shows the following indicators of knowledge each with weighted mean ranked in numerical order and their corresponding

interpretations.

Table 6 The Knowledge of the Mothers on Immunization Indicators Mothers should bring their children on the appointed schedule for vaccination. Mothers should not bring their children for vaccination during times that the children are acutely ill. Vaccines may produce expected side effects, like fever. Vaccination prevents communicable diseases. Vaccines may be less effective in the prevention of communicable diseases over time. Overall Weighted Mean Weighte d Mean 3.92 2.38 3.66 3.14 3.02 3.22 Qualitative Interpretation Highly knowledgeable Slightly knowledgeable Highly knowledgeable Knowledgeable Knowledgeable Knowledgeable Rank 1 5 2 3 4

Respondents showed highly knowledgeable with Mothers should bring their children on the appointed schedule for vaccination which gathered a score of 3.92. Mothers should not bring their children for vaccination during times that the children are acutely ill scored the lowest with a score of 2.38, respondents were slightly knowledgeable. With the Vaccines producing expected side effects, it scored 3.66, respondents were highly knowledgeable followed by Vaccinations prevents communicable diseases with a score of 3.14 and

41 Vaccines may be least effective over time scored 3.02, respondents for both were knowledgeable. The above data shows that all respondents are knowledgeable to childhood immunization. It is a good indication that respondents are aware of what immunization is and its possible effects. According to Global Health Communication 2003, parents equate vaccinations with good health (despite the short-term negative consequences of a child in tears). And the great majority of parents do value vaccinations.

42

3 The Attitudes of the Mothers Towards Immunization This section shows the following indicators of attitudes each with weighted mean ranked in numerical order and their corresponding interpretations.

Table 7 The Attitude of the Mothers on Immunization Indicators It is important for me to follow and complete the schedule of my childs immunization. I feel it is important to ask for clarification when I dont understand the health staffs explanation regarding my childs vaccination and its schedule. I do not fear vaccines and their common side effects. I believe that having my child immunized is an important obligation and responsibility every mother should observe. I believe distance or lack of finances should not be a hindrance to complying with my childs immunization schedule. Overall Weighted Mean Weighted Mean 4.88 Qualitative Interpretation Strongly agree Neither agree nor disagree Neither agree nor disagree Strongly agree Rank 1

2.94 2.7 4.88

3 4 1

4.26 3.93

Agree Agree

The indicators It is important for me to follow and complete the schedule of my childs immunization and I perceived that having my child immunized is an important obligation and responsibility every mother should observe obtained the highest score of 4.88 in which respondents were strongly agree. Second that scored the highest with a score of 4.26, in which respondents were agree, was the indicator I believe distance or lack of finances should not be a hindrance to

43 complying with my childs immunization schedule. Two indicators got the lowest score which were I feel it is important to ask for clarification when I dont understand the health staffs explanation regarding my childs vaccination and its schedule which obtained 2.94 and I do not fear vaccines and their common side effects which gathered 2.7 only, responses for both of the indicators was neither agree nor disagree. From the data given, evidently, most of the respondents had a positive attitude towards immunization. But for some reason few of them were left undecided to the two indicators that rank the lowest. Distance from the facility appears to have been an important factor affecting adherence to EPI: transport costs, loss of time, clinic queues, social stigma and unfriendly, and even aggressive, responses by health staff towards latecomers, all interact to become a strong impediment to future adherence. (Schwarz et al, 2009) According to Stevenson 2009, 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. 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.

44 When parents resist vaccination, it is because they want to protect their children from harm. The demand for vaccination is triggered by a general perception that vaccines are good for infants and/or a strong feeling of vulnerability to serious illness. (Newell et. Al., 2008)

4 The Practices of the Mothers on Immunization This section shows the following indicators of practices each with weighted mean ranked in chronological order and their corresponding interpretations.

Table 8 The Practices of the Mothers on Immunization Weighted Indicators Mean I follow the schedule of immunization visits. I keep the immunization card for the next vaccination schedule. I seek information from a health care provider when there is a missed dose. I prepared medications for possible side effects of the vaccine. I make sure that my child has no serious illness before visiting the health center for immunization Overall Weighted Mean 4.86 4.72 4.54 4.82 4.38 4.66 Interpretation Always Always Always Always Often Always 1 3 4 2 5 Qualitative Rank

Indicators I follow the schedule in immunization visits. obtained the highest score of 4.86. Second that scored the highest was the indicator I prepared medications for possible side effects of the vaccine. with a score of

45 4.82. Third that scored the highest was I keep the immunization card for the next vaccination schedule. with the score of 4.72. Two indicators got the lowest score which were I seek information from a health care provider when there is a missed dose. which obtained 4.54 and I make sure that my child has no serious illness before visiting the health center for immunization which gathered 4.38 only. It is important to follow the vaccination schedule in accordance with national guidelines. Children should be immunized at the recommended ages and should receive subsequent doses at recommended intervals. When a child is immunized, the health worker should record the vaccine, which dose it is (first, second, etc.) and the date on an immunization or health card given to the parents or other caregiver. The immunizations should also be recorded and kept at the health clinic. It is important for the parents or other caregiver to keep the immunization card and bring it with them the next time the child is vaccinated. With it, the health worker can record which vaccines the child has received and the date they were given. The health worker can also provide information to the parents or other caregiver on vaccines that are missing or remaining. (Facts for Life Goal, 2007) All health care providers are legally required to keep a record of immunizations in their patient's chart. Some health care providers may also supply their patients with handy immunization record cards that allow to keep track of which vaccines have and have not been given. (Its A Moms World, Baby Health Immunization Schedule, 2010)

46 Most vaccinations can be given if the child is not seriously ill or running a fever. If he has had a cough or cold for more than a few days, the doctor may want to hear his breathing before deciding whether a vaccination may be given. (Baby Center India, 2008)

5 The

Relationship

between

the

Knowledge

of

the

Mothers

on

Immunization and their Profile in Terms of Age, Number of Children and Combined Family Monthly Income This section presents the correlation of knowledge of the mothers on immunization and their profile in terms of age, number of children and combined family monthly income with each are the numerical results of the statistical tools utilized and their corresponding interpretations.

Table 9 The Relationship Between The Knowledge of the Mothers on Immunization and their Profile in Terms of Age, Number of Children and Combined Family Monthly Income Pearson r t computed t tabular Interpretation Negligible negative correlation; not a significant predictor Negligible negative correlation; not a significant predictor Negligible positive correlation; not a

Age and Knowledge

-0.0104

0.0718

2.021

Number of Children and Knowledge Combined Family Monthly Income and

-0.0094

0.0649

2.021

0.1016

0.7076

2.021

47 significant predictor

Knowledge

The relationship between age and knowledge, with age, from the table, Pearson r resulted -0.0104 which is negative, therefore the strength of relationship as the mother gets older, their knowledge decreases in compliance to immunization. Since the t computed (0.0718) is lower than the t tabular (2.021), the age is not a significant predictor of the knowledge of mothers in immunization According to Awodele et al (2010) there were significant relationship between age of respondents; ethnicity; level of education; occupation and attitude to immunization. Although majority of the mothers were aware of immunization services, their knowledge of immunization schedule as well as of vaccine preventable diseases is poor. A better understanding of routine immunization schedule is important in the design and implementation of immunization programmes. Educating mothers about the vaccines and vaccine preventable disease, and improving their performance are recommended. The relationship between number of children and knowledge, with the number of children, from the table, Pearson r resulted -0.0094 which is negative therefore the strength of relationship as the mother tends to have more children, their knowledge decreases in compliance to immunization. Since the t computed (0.0649) is lower than the t tabular (2.021), the number of children is not a significant predictor of the knowledge of mothers in immunization

48 According to Kim et al (2007) Children in households with 2 or more other children, children with unmarried mothers having no postsecondary education, non-Hispanic Black children, children whose families use public immunization service providers, and children in families in which more than 1 physician provides immunizations are at increased likelihood of experiencing immunization delays (i.e., delays of 30 days or more above the recommended vaccination point). Improvements in rates of compliance with national immunization guidelines are imperative. With the combined family monthly income and knowledge, with the combined monthly income, form the table, the computed Pearson r is 0.1016 which means that the higher the family income, the mothers knowledge towards immunization increases. The t computed (0.7076) is lower that the t tabular (2.021) which indicates the combined family income is not a significant predictor in the knowledge of mothers in immunization. According to Klevens and Luman, 2001; Bates and Wolinsky, 1998; Zimmerman, 1996, Family income has previously been associated with immunization coverage levels, and low family income is also a risk factor for low immunization. Parents with lower household incomes are more likely to experience barriers, such as transportation or access to health care services that make staying up-to-date on immunizations difficult. The low-income parents in this study who had incomplete immunization for their children may have done so because of similar barriers. The indirect influence of economic factors on immunization at household levels is a more obvious explanation. When the

49 mother/household is experiencing food and resource shortages, participating in an immunization exercise becomes a matter of lesser priority

6 The

Relationship

Between

the

Knowledge

of

the

Mothers

on

Immunization and their Profile in Terms of educational Attainment and their Employment Status This section shows the correlation of knowledge and profile of mothers in terms of educational attainment and employment status. It also describes the computed numerical results and interpretation in whether to reject or accept H o.

Table 10 The Relationship Between the Knowledge of the Mothers on Immunization and their Profile in Terms of Educational Attainment and their Employment Status Indicator Knowledge Educational Attainment Employment Status Df 6 2 2 Computed 47.5473 33.1736 Tabular 2 Interpretation 10.64 4.6 Reject Ho Reject Ho

In educational attainment, the degree of freedom is 6, the 2 computed is 47.5473 and its corresponding tabular 2 is 10.64 which indicate reject hypothesis. The knowledge and educational attainment is related and is significant. The higher the educational attainment the more knowledgeable the mother is. In employment status, the degree of freedom is 2, the 2 computed s 33.1736 and the tabular 2 is 4.6 which indicate reject hypothesis that means the

50 knowledge and employment status is related and is significant. Therefore, the employed one is highly knowledgeable than the unemployed. As stated in Health and Education by Commission on Health (2009), Education can increase peoples knowledge and cognitive skills, enabling them to make better-informed choices among the health-related options available for themselves and their families, including those related to obtaining and managing medical care. Greater educational attainment has been associated with healthpromoting behaviors. More education can lead to higher-paying jobs, which enable people to obtain health care when needed, provide themselves and their families with more nutritious foods, and live in safer and healthier homes and neighborhoods with supermarkets, parks and places to exerciseall of which can promote good health by making it easier to adopt and maintain healthy behaviors. Lower-paid workers experience greater stress because they have fewer financial resources to cope both with everyday challenges, including child care and other family responsibilities, and with unexpected challenges such as illness.

51

7 The Relationship Between the Attitude of the Mothers Towards Immunization and their Profile in Terms of Age, Number of Children and Combined Family Monthly Income This section presents the correlation of attitudes of the mothers on immunization and their profile in terms of age, number of children and combined family monthly income with each are the numerical results of the statistical tools utilized and their corresponding interpretations.

Table 11 The Relationship Between the Attitude of the Mothers Towards Immunization and their Profile in Terms of Age, Number of Children and Combined Family Monthly Income Pearson r Age and Attitude 0.1287 t computed 0.8997 t tabular 2.021 Interpretation Negligible positive correlation; not a significant predictor Negligible positive correlation; not a significant predictor Negligible negative correlation; not a significant predictor

Number of Children and Attitude

0.0394

0.2733

2.021

Combined Family Monthly Income and Attitude

-0.1368

0.9568

2.021

With age, from the table, Pearson r resulted 0.1287 which is positive therefore the strength of relationship as the mother gets older, their attitude also

52 increases in compliance to immunization. Since the t computed (0.8997) is lower than the t tabular (2.021), the age is not a significant predictor of the attitude of mothers in immunization. According to Tyler, Tom R. et al (1991), results shown that older people change in response to personal experience. According to Bernsen 2011. Older mothers were less likely to have a positive attitude towards immunization, regardless of education, knowledge or number of children. Perhaps, in older women, this reflects a higher prevalence of traditional nihilistic views, such as destiny being the cause of disease. (Eto link http://hamdanjournal.org/journal/files/journals/1/issues/18.pdf ) With the number of children, the computed Pearson r resulted 0.394 being positive means that as the number of children increases, the attitude also increases in compliance to Immunization. However the t computed (0.2733) is lower than the t tabular (2.021), therefore the number of children is not a significant predictor of mothers attitude towards immunization. As the most number of children in a household in Purok 3, Barangay Sto. Nio reaches to 3, as resulted in Table 3, the feelings of mothers for the importance of immunization increases. The researchers assume that this is due to diseases that develop in our environment over time. When one of the children gets sick related to incomplete immunization, the mother would presume the need for vaccination is essential in prevention of that sickness to other children. But since it is not a significant predictor, the researchers only have 50

53 respondents that affect the significance of the relationship between the number of children and their attitude. With the combined family monthly income, the computed Pearson r is 0.1368 which means that the higher the family income, the mothers attitude towards immunization decreases. The t computed (0.9568) is lower that the t tabular (2.021) which indicates the combined family income is not a significant predictor in the attitude of mothers in immunization. According to Cunningham (2012). Unvaccinated children were more likely to live in a household whose income was at or near the poverty level because their families could not afford to have them vaccinated. However, more recent studies show that, due in large part to programs like the WIC Immunization Action Plan, lower income families have had increasing rates of childhood vaccinations. This upward trend has had a positive effect on vaccination rates in the U.S. overall, despite the decreases in childhood vaccination rates in more affluent communities. Furthermore, a study by Bennett and Smith (1992), which also focused on parental perceptions of vaccine safety and ranked their level of concern on a scale of 1 (lowest) to 5 (greatest), found that parents with a household income below $30,000 were 2.1 times more likely than parents with a household income greater than $75,000 to report their level of concern as a 5 (95% CI: 1.5, 3.2).

54 8 The Relationship Between the Attitude of the Mothers Towards Immunization and their Profile in Terms of Educational Attainment and their Employment Status This section shows the correlation of attitude of the mothers in terms of educational attainment and their employment status. It also describes the numerical results and its corresponding interpretation.

Table 12 The Relationship Between the Attitude of the Mothers Towards Immunization and their Profile in Terms of Educational Attainment and their Employment Status Indicator Attitude Educational Attainment Employment Status Df 9 2 2 Computed 14.1845 3.8311 Tabular 2 Interpretation 14.68 4.6 Accept Ho Accept Ho

In educational attainment, the degree of freedom is 9, the 2 computed is 14.1845 and its corresponding tabular 2 is 14.68 which indicate accepted hypothesis and signifies no relationship between the educational attainment of mothers and their attitude towards immunization. According to Borrafaj (2008). Among educated mothers the percentage of completely immunized children was 71.4% whereas among illiterate mothers it was 88.3%, but the difference was not statistically significant (p>0.05). According to our contingency table the most number of respondents answered that they strongly agree and agree on the indicators in the attitude part of the questionnaire. These most numbers were also at their different level of

55 educational attainment which only means that these mothers have a positive attitude in childhood immunization even if they have lower or higher educational attainment. In employment status, the degree of freedom is 2, the 2 computed s 3.8311 and the tabular 2 is 4.6 which mean that the hypothesis is accepted and signifies no relationship between the employment status of mothers and their attitude towards immunization. According to Borrafaj (2008). Child gender; education, residence and job of mothers do not significantly affect the pattern of immunization. According to our contingency table, the greater number of respondents either employed or unemployed has agreed on the indicators of attitude. Therefore, mothers have a positive feeling towards immunization even if they are employed or not.

56

9 The Relationship Between the Practices of the Mothers on Immunization and their Profile in Terms of Age, Number of Children and Combined Family Monthly Income This section presents the correlation of practices of the mothers on immunization and their profile in terms of age, number of children and combined family monthly income with each are the numerical results of the statistical tools utilized and their corresponding interpretations.

Table 13 The Relationship Between the Practices of the Mothers on Immunization and their Profile in Terms of Age, Number of Children and Combined Family Monthly Income Pearson r t computed t tabular Interpretation Negligible negative correlation; not a significant predictor Negligible positive correlation; not a significant predictor Negligible negative correlation; not a significant predictor

Age and Practices

-0.1814

1.2774

2.021

Number of Children and Practices

0.0023

0.0163

2.021

Combined Family Monthly Income and Practices

-0.1630

1.1545

2.021

Since the age is negative and negligible, it implies that the age of mother does not directly affect their practices which are supported by the result of t-test

57 wherein the computed value was lower (1.2774) than the tabular value (2.021) as a result level of compliance is not significant correlate or a strong predictor. According to Akesode, (1982) marital status and age of the mothers were not seen to be associated with the use of immunization services. In addition a study from Glenda (et al., 2004), in other settings, both younger and older age of mothers has been reported to be associated with incomplete vaccination. In terms of number in children, it showed a low value of 0.0023 on the Pearson r, but since it is positive it showed a direct relationship and that the more the child a mother has, the higher level of compliance, this was however not supported by the result of the t-test with a computed value of 0.0163 which is lower than the tabular value of 2.021 as a result it is not significant or a strong predictor when it comes to the level of compliance. As the most number of children in a household in Purok 3, Barangay Sto. Nio is from 1 to 3, as showed in Table 3, the knowledge of mothers for the importance of right practices on immunization increases. The researchers assume that when the mother has one or more children, she has more experienced about the compliance of immunization, therefore doing the right practice. But since it is not a significant predictor, the researchers only have 50 respondents that affect the significance of the relationship between the number of children and their practices. Combined family monthly income does not significantly affect the level of compliance as it showed that a computed Pearson r of -0.1630 that indicates it is negative and negligible, this was also supported by the result of t-test ,with a

58 computed value of 1.1545 was lower than the value on the t-test table of significance which is 2.021. The result indicated that it is not significant correlate or a strong predictor. According to Klevens and Luman, 2001; Bates and Wolinsky, 1998; Zimmerman, 1996, Family income has previously been associated with immunization coverage levels, and low family income is also a risk factor for low immunization. Parents with lower household incomes are more likely to experience barriers, such as transportation or access to health care services that make staying up-to-date on immunizations difficult. The low-income parents in this study who had incomplete immunization for their children may have done so because of similar barriers. The indirect influence of economic factors on immunization at household levels is a more obvious explanation. When the mother/household is experiencing food and resource shortages, participating in an immunization exercise becomes a matter of lesser priority.

59

10 The Relationship Between the Practices of the Mothers on Immunization and their Profile in Terms of Educational Attainment and Employment Status This section shows the correlation of educational attainment and employment status of mothers and their practices on immunization. It also describes the computed numerical data and its interpretation.

Table 14 The Relationship Between the Practices of the Mothers on Immunization and their Profile in Terms of Educational Attainment and Employment Status Indicator Practices Educational Attainment Employment Status Df 6 2 2 Computed 4.4811 8.0027 Tabular 2 Interpretation 10.64 4.6 Accept Ho Reject Ho

In terms of educational attainment, the degree of freedom is 6, the 2 computed s 4.4811 and the tabular 2 is 10.64 which mean that the hypothesis is accepted and signifies no relationship between the educational attainment of mothers and their practices towards immunization. Most mothers in Purok 3, Barangay. Sto. Nio, Bian City, Laguna, whose educational attainment is either grade school, high school, college level, or vocational, has agreed upon the portion in the questionnaire meaning right practices are observed towards their childs immunization.

60 In addition Markland and Durand, (1976); Marks et al., (1979) revealed that educational status of mothers has a strong association with a high vaccine uptake. This study also confirms this assertion from previous studies (Markland and Durand, 1976; Marks et al., 1979). There is an association between

education status of mothers and missed opportunities for vaccination. More than two-thirds (70.4%) of mothers with missed opportunities for vaccination had either primary school education or no formal education. This finding is in support of a report from Turkey study by Altinkaynak et al.,

(2004) that education of mothers increases the vaccination chance of a child and reduces missed opportunity. In our study, 33.4% of the children under one year of age have not completed their vaccination program because of missed opportunities. Factors identified for missed opportunities in these children are long trekking distance with bad terrain (27%), high cost of transportation (33%), poor staff attitude (11%), quality of health services provided (9%), lack of personnel (15%) and vaccine out of stock (5%). In the employment status, the degree of freedom is 2, the 2 computed is 8.0027 and the tabular 2 is 4.6 which mean that the hypothesis is rejected and signifies relationship between the employment status of mothers and their practices towards immunization. The mothers of Purok 3, barangay Sto. Nio, Bian City, Laguna who is unemployed who focuses their attention their child is more compliant in terms of practices for the immunization. Mostly, the mothers of Purok 3, barangay Sto. Nio, Bian City, Laguna were unemployed, leaving them mostly at the house doing most of the chores, so

61 it focuses their attention to their childs needs, making them more compliant in terms of observing the right practices for the immunization. 11 The Relationship Between the Knowledge and Attitudes of the Mothers and their Practices on Immunization This section presents the correlation of practices of the mothers on immunization and their knowledge and attitudes on immunization with each are the numerical results of the statistical tools utilized and their corresponding interpretations.

Table 15 The Relationship Between the Knowledge and Attitudes of the Mothers and their Practices on Immunization Pearson r Knowledge and Practices on Immunization Attitudes and Practices on Immunization 0.1834 t computed 1.2925 t tabular 2.021 Interpretation Negligible positive correlation; not a significant predictor Negligible positive correlation; not a significant predictor

0.0602

0.4178

2.021

Since the interpreted result in the Pearson r of knowledge and practices is positive with a value of 0.1834 even though negligible it showed a direct relationship meaning the greater the knowledge of the mother, the better the practices on immunization, however this was not a significant correlate or a strong predictor as computed t-test, the value was 1.2925 lower than in the table with a value of 2.021.

62 Since most of the mothers in Purok 3 finished high school with a population percentage of 58%, it is assumed by the researchers that they showed comprehension or understanding of health providers instructions on the dos and donts of immunization, leaving the mothers doing the right practices. But since it is not a significant predictor with only fifty (50) respondents, it affects the relationship of significance between the knowledge of mothers to their practices. According to the study of Mapatano, Kayembe, Piripiri, Nyandwe (2008) A survey conducted in 2001 Out of 1 613 children aged from zero to four years, 86.1% were fully immunised, However,
only the mothers of 75.7% of the children declared that

they possessed an immunisation card. The interviewers could only observe cards for 57.4% of the children more in the HCZ(High Coverage Zone) (70.9%) than in the LCZ(Low Coverage Zone) (46.9%) (p = 0.000), implying that the mothers in the HCZ looked after the card much better. The card was not available because it was lost (46%) or kept at the health centre (16.4%). The interviewers noted that when a mother could produce the vaccination card, it was likely that the child was fully immunised. This was the case in both the LCZs (96.2%) and the HCZs (94.1%). Based on the card, the immunisation coverage was nearly the same in both strata, namely around 37%. The childrens full immunisation status according to the mothers, which it estimated at 45.7%,23 suggesting that the actual coverage in 2001 remained very low. Therefore, high coverage regarding BCG, which is administered at birth, is not a guarantee for completing the vaccination schedule. Thus all sites, whether of low or high coverage, need to improve their complete vaccination coverage.

In terms of attitudes and practices the result of the Pearson r indicated a negligible correlation with a value of 0.0602 but since it is positive, it implies a direct relationship meaning a greater positive attitude of mother the better she practices on her childs immunization, but then it is not a significant predictor

63 where in the computed t-test value was 0.4178 which is lower than in the table of significance with a value of 2.021 Most of the mothers of the said Purok showed a positive attitude whether in terms of educational attainment and employment statuses. It is assumed by the researchers to think that when it comes to the health of the mothers children, they are willing and attentive, maybe because they would not want any crisis regarding their childrens health in the future. But since fifty (50) respondents were only chosen, this was not a significant predictor, thus implying a weak relationship regarding the attitudes of mothers when it comes to immunization. According to the study of Mapatano, Kayembe, Piripiri, Nyandwe (2008) Mothers have positive attitudes towards immunisation, which the majority regarded as an important intervention (98%). In our data, no attitudinal variable was a strong predictor of child immunisation, as also observed by some other researchers.17,18 However, these researchers worked in private clinics in the United States. Furthermore,
as Zelaya et al. have warned, a positive attitude is not a guarantee for full immunisation.19 Mothers may sometimes not complete the vaccination schedule despite their positive attitude because of their poor understanding of the concept of vaccination, which health personnel do not take time to explain to them clearly.19

Yawn et al., studying an affluent community in the USA, identified fear of side effects as an important factor for under-immunisation. 20 Taylor et al.,21 however, could not
find the association, which, possibly as in our study, was confounded by unmeasured socio-cultural factors. Moreover, as observed in Malawi, Ethiopia, Bangladesh, the Philippines and India, mothers might understate side effects. Some mothers view them as a normal occurrence, some expect them to disappear anyway and some see in them a sign that the vaccine is working

www.ajol.info/index.php/safp/article/download/13442/64240

64

65

Chapter 5 SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the findings of the study, the researchers conclusion and recommendation.

Summary of Findings I. Profile of the respondents in terms of: 1.1 Age Thirty eight percent (38%) of the respondents were 21 30 years old, showing that most of them were already considered as young adult. Thirty two percent (32%) of the respondents were between 31 40 years old. Respondents aged over 40 years old were 18% of the total respondents. Lastly, there were 12% of respondents who are in the ages between 12 20 years old. 1.2 Educational Attainment The highest percentage of fifty eight percent (58%) was the respondents from the high school level. Twenty six percent (26%) of the respondents finished grade school level. Fourteen percent (14%) were in college level and lastly, the two percent (2%) of the respondents in the study were in vocational training. The survey indicates that most of the respondents finished high school level.

66

1.3 Number of Children The respondents with highest percentage of sixty eight percent (68%) have 1 3 children. Twenty six percent (26%) of the respondents have 4 6 children. Lastly, with only six percent (6%) of the respondent have 7 9 children. 1.4 Employment Status Majority of the respondent have work gaining a percentage of seventy two percent (72%) and the remaining percentage of 28% are unemployed. 1.5 Combined Family Monthly Income Fifty two percent (52%) of the respondents have monthly income of Php 5,000 to 9,999. Thirty six percent (36%) of the respondents have monthly income of Php 4,999 and less. The remaining twelve percent of the respondents are equally divided into two, the first six percent (6%) have monthly income of Php 10,000 to 14,999 and the other six percent (6%) have monthly income of Php 15,000 and above.

2. Level of Knowledge of Mother on Childhood Immunization Data shows that all respondents are knowledgeable to childhood immunization where the over-all weighted mean was 3.22. It is a good

67 indication that respondents are aware of what immunization is and its benefits. 3. Attitude of Mothers Towards Childhood Immunization Most of the respondents had a positive attitude towards immunization. But for some reason few of them were left undecided to the two indicators that rank the lowest which were I feel it is important to ask for clarification when I dont understand the health staffs explanation regarding my childs vaccination and its schedule which obtained 2.94 and I do not fear vaccines and their common side effects which gathered 2.7 only. The over-all weighted mean is 3.93 which is interpreted as agree.

4. Practices of Mothers on Childhood Immunization Majority of the mothers do follow the immunization schedule with the score of 4.86. Second that scored the highest was the indicator I prepared medications for possible side effects of the vaccine. with a score of 4.82. Third that scored the highest was I keep the immunization card for the next vaccination schedule. with the score of 4.72. Two indicators got the lowest score which were I seek information from a health care provider when there is a missed dose. which obtained 4.54 and I make sure that my child has no serious illness before visiting the health center for immunization which gathered 4.38 only.

68

5. Relationship Between the Demographic Profile of the Mothers and: 5.1 Level of Knowledge on Childhood Immunization The demographic profile in terms of age, number of children and combined monthly family income showed no significant factor with regards to the knowledge of the mothers. Educational attainment and employment status were found significant and related to level of knowledge. It appears that the higher the educational attainment of the respondents, the more they are knowledgeable and employed respondents displays highly

knowledgeable compared to those who are unemployed. 5.2 Attitudes Towards Childhood Immunization The demographic profile in terms of age, number of children, combined monthly family income, educational attainment, and employment status showed no significant factor with regards to the attitude of the mothers on their childs immunization. 5.3 Practices on Childhood Immunization The demographic profile in terms of age, number of children combined monthly family income, and educational attainment showed no significant factor with regards to the practices of the mothers on their childs immunization. Employment status of the respondents posed a significant relationship with their practices.

69 6. Relationship Between the Practices of the Mother on Childhood Immunization and 6.1 Level of Knowledge on Childhood Immunization In terms of knowledge in immunization of their child it showed that it does not have a significant predictor and a relationship when it comes to practices. 6.2 Attitude Towards Childhood Immunization In terms of attitude in immunization of their child it showed that it is not a significant predictor and has indirect relationship when it comes to practices.

Conclusions In the light of the above findings of the study, the following were the researchers conclusion: 1. Respondents in general belonged to the age group 21 to 30, had secondary education, and had a number of children of 1 to 3, unemployed and with incomes ranging from 5000 to 9999 pesos a month. 2. Respondents have knowledge on childhood immunization especially in the importance of bringing their children on the appointed schedule of vaccination and on the fact that vaccines produces side effects like the most common, fever. They were less knowledgeable on whether child should not be brought for vaccination when ill.

70 3. Respondents showed positive outlook toward childhood immunization. They expressed doubt on whether asking for clarification is important when they dont understand health staffs explanation and evidently unsure of what vaccines do for they were left undecided whether they fear effects of vaccines and its common side effects. 4. Following the schedule of immunization was noted on majority of the respondents, this indicate mothers concern for their childrens health and their willingness to have their child vaccinated. Respondents are reluctant in submitting their children for immunization when severely ill. 5. The demographic profile of the respondents in terms of educational attainment and employment status affects the level of knowledge of the respondents. The demographic profile and attitudes of the respondents displayed no significant relationship. Employment status has an effect on the practices of the respondents in childhood immunization. 6. Mothers knowledge and attitudes in immunization showed that it does not have a significant predictor and a relationship when it comes to practices

Recommendations 1. The community should put effort in understanding the importance of immunization, not only the mothers should be educated and be informed, but also the elders and fathers, with this they can also contribute to the optimum state of health and help lower the rate of childhood diseases that can spread in their community through vaccination.

71 2. The finding presented should be further developed by future researchers involving a great number of respondents in order to compare and validate the present findings done by the researchers. This will help assist health care providers in designing and implementing more effective health education among people. 3. Government should provide health center for Barangay Sto. Nio to accommodate all mothers for immunization as well as other health problems. By having this, it grants them easy accessibility of the place and medicines. 4. Health providers should provide detailed education to the community and correct the wrong beliefs of people regarding immunization. They should also assess and evaluate whether the health teachings provided has been understood and properly followed. They must encourage mothers in a proper way so as not to make them fear of visiting the health center. They must also entertain questions regarding immunizations to prevent misconception among mothers. 5. Mothers should be informed and properly educated on the importance of immunization and its effects on their childrens health 6. The researchers can benefit from this study by enlightening them how mothers perceived and practice immunization of their child; it will also serve as a guide on providing health education to mothers in the future.

72

BIBLIOGRAPHY

A. Books 2007. Public Health Nursing in the Philippines 10 th Edition B. Journals Abdulrahem et. al. (2011).Journal of Public Health and Epidemiology Vol 3(4), pp 194-203. Bennett, P., & Smith, C. (1992). Parents attitudinal and social influences on childhood vaccination. Health Education Research, 7(3), 341-348. Krosnick et. Al.(1989).Journal of Personality & Social Psychology. Aging and Susceptibility to Attitude Change, 57, 416-425. Pillsbury, Barbara. (1990). Immunization: The Behavioral Issues Tyler, Tom R. et. al. (1991). Aging and Attitude Change C. Published and Unpublished Researches Bofarraj Mabrouka A.M. (2008). Knowledge, Attitudes and Practices of Mothers Regarding immunization of Infants and Preschool Children at Al Beida City, Libya. Caingles, Slvia E. et al.(2011). Survey on Knowledge, Attitude and Practices of Parents in Barangay 8A, District 1, Davao City Regarding their Childrens immunization.

73 Coreil, Jeannine. (1987). Use of Ethnographic Research for Instrument Development in a Case-Control Study of Immunization Use in Haiti Cunningham, Andrea.(2012). Demographic Characteristics Related to Vaccination Status in Children Aged 19 to 35 Months. Kim, Sam. (2007). Effects of Maternal and Provider Characteristics on Up-toDate Immunization Status of Children Aged 19 to 35 Months Manjunath,U .(2003) . Maternal Knowledge and Perceptions About the Routine Immunization Programm--a study in a semiurban area in Rajasthan. Nankabirwa, Victoria. (2008). Maternal Education is Associated with Vaccination Status of Infants less than 6 Months in Eastern Uganda: a cohort study Newell, J. (2008). Childhood Vaccination in Africa and Asia: the effects of parents knowledge and attitudes O. Awodele et. al. (2010). The Knowledge and Attitude towards Childhood Immunization amongst Mothers Attending Antenatal Clinic in Lagos University Teaching Hospital Rahman et al. (2003). Mothers' Knowledge about Vaccine Preventable Diseases and Immunization Coverage of a Population with High Rate of Illiteracy. Schwarz, Norbert G. (2009). Reasons for Non-adherence to Vaccination at Mother and Child care Clinics (MCCs) in Lambarn, Gabon. D. Electronic Resources

74 BabyCenter India. (2008). Accessed at http://www.babycenter.in/baby/health/immunisations/misseddose_expert/ Commission on Health.(2009). Education and Health. Accessed at http://www.commissiononhealth.org/PDF/c270deb3-ba42-4fbd-baeb2cd65956f00e/Issue%20Brief%206%20Sept%2009%20-%20Education %20and%20Health.pdf Facts for Life fourth edition. (2007). Accessed at http://www.factsforlifeglobal.org/06/7.html Global Health Communication. (2003). Childhood Immunization. Accessed at http://www.globalhealthcommunication.org/tool_docs/76/behavior_c hange_persp ectives...-_chap._3_-_childhood_immunization.pdf Stevenson, Audrey M. (2009). Factors Influencing Immunization Rates. Accessed at http://www.clinicaladvisor.com/factors-influencing-

immunization-rates/article/

75

APPENDICES (Communication Letters)

76

University of Perpetual Help System Laguna COLLEGE OF NURSING

Old National Highway, Bian City, Laguna _____________________________________________________________

Date

You are hereby designated as THESIS ADVISER of _______________________ candidates for the degree BS in Nursing. Their thesis title is ________________________________________________________________________ __________________. They intend to graduate on _____________. Below are the duties and responsibilities of an Adviser. 1. The adviser will plan with the advisee/s a schedule of advising. The partner, for mutual satisfaction and convenience, will respect the schedule. 2. The research adviser shall log his/her advising activities. 3. The adviser is responsible for safeguarding the integrity of the thesis of the advisee/s by checking the various parts of the research output/material for possible duplication from other sources. 4. The adviser is advised not to accept a finished product to prevent the submission of research report/manuscript authored by someone else or a ghost writer. 5. The adviser shall assume responsibility for the appropriateness of the research design, statistical treatment of data, and the institutional format and style of the research.

Very truly yours,

77 ESTRELLA A. SAN JUAN, MAN Dean CONFORME UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA Sto. Nio, Bian City, Laguna COLLEGE OF NURSING

To whom it may concern Greetings in the name of Christ, Our Lord. We, the fourth year nursing students, Group 7A of the University of Perpetual Help System Laguna, are undertaking a research study entitled Knowledge, Attitudes and Practices on Childhood Immunization among Mothers of Purok 3, Barangay Sto. Nio, Bian City, Laguna. The purpose of this research is for the researchers to comply with the requirements of our course it should also serve general purposes. Among others, this research can serve as a baseline data for the students, future researchers, clinical instructors, and school administrators. In connection with this, we would like to seek your kind permission to allow us to conduct a survey to the mothers in your barangay for us to determine the knowledge, attitude, and practices. Rest assured that their response will be kept confidential and that you will be furnished with the results and findings once the research study is complete. We are hoping for your favorable response regarding this matter. Thank you. Respectfully yours, Sayson, Mary Joyce M. Leader Noted by: Dr. Arni Magdamo

78 Thesis Adviser Barangay Captain of Sto. Nio, Bian City, Laguna

79

UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA Sto. Nio, Bian City, Laguna COLLEGE OF NURSING

Greetings in the name of Christ, Our Lord We are the group 7A year nursing students of the UPH-DJGTMU you are selected by our group as a respondents into our research study entitled Knowledge, Attitudes and Practices on Childhood Immunization among Mothers of Purok 3, Barangay Sto. Nio, Bian City, Laguna. The purpose of our research is to improve knowledge, attitudes & practices among mothers regarding immunization for their child. Rest assured the information that you will share with us will be confidential & will be contributed to the fulfillment of our research, may we ask you to answer a set of questions with honesty to eradicate any biases. Thank you & God Bless. The Researchers Sayson, Mary Joyce M. Leader, BSN Level IV Thesis Group 7A Members: Casupang, Adrian Laurence L. Somes, Christian I. Tesoro, Johnrey J. Toledo, Mary Felinne A.

80 Ugay, Mary Grace C.

81 UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA Sto. Nio, Bian City, Laguna COLLEGE OF NURSING

_______________________ Dr. Mirabelle Benjamin RHU Bian City Laguna Dear Maam, Greetings in the name of Christ, Our Lord. We, the fourth year nursing students, Group 7A of the University of Perpetual Help System Laguna, are undertaking a research study entitled Knowledge, Attitudes and Practices on Childhood Immunization among Mothers of Purok 3, Barangay Sto. Nino, Binan City, Laguna. In connection with this, we would like to ask your good office the permission to have the total population of mothers residing at Purok 3 Sto. Nio Bian City Laguna who submit their child for immunization in your Rural Health Unit. We are also asking your permission to conduct a survey on these selected mothers to determine their knowledge, attitude, and practices on immunization. Rest assured that their response will be kept confidential and that you will be furnished with the results and findings once the research study is complete. We are hoping for your favorable response regarding this matter. Thank you. Respectfully yours, Mary Joyce M. Sayson Leader, BSN Level IV Thesis Group 7A Members: Casupang, Adrian Laurence L. Somes, Christian I. Tesoro, Johnrey J. Toledo, Mary Felinne A. Ugay, Mary Grace C. Noted by: Dr. Arni Magdamo Thesis Adviser

82

UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA Sto. Nio, Bian City, Laguna COLLEGE OF NURSING

_________________ Dear Maam/Sir, Good day! We, the fourth year nursing students of UPH-DGTMU, as part of our requirement we are conducting a research entitled Knowledge, Attitudes and Practices on Childhood Immunization among Mothers of Purok 3, Barangay Sto. Nio, Bian City, Laguna. In order for us to complete the study, we would like to gain permission to have a copy of the total population and the latest statistics in Purok 3, Barangay Sto. Nio, Bian City, Laguna. This will serve as a valid data for our thesis and our reference on how many families comprising the said barangay needed for our data gathering. Thank you for your time and consideration.

Respectfully yours, Mary Joyce M. Sayson Leader, BSN Level IV Thesis Group 7A Members: Casupang, Adrian Laurence L. Somes, Christian I. Tesoro, Johnrey J. Toledo, Mary Felinne A. Ugay, Mary Grace C. Noted By: Dr. Arni Magdamo

83 Thesis Adviser UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA Sto. Nio, Bian City, Laguna
COLLEGE OF NURSING

_______________________ Brgy. San Vicente Bian City, Laguna Dear Maam/Sir Greetings in the name of Christ, Our Lord. We, the fourth year nursing students, Group 7A of the University of Perpetual Help System Laguna, are undertaking a research study entitled Knowledge, Attitudes and Practices on Childhood Immunization Among Mothers of Purok 3, Sto. Nino, Binan City, Laguna. In connection with this, we would like to ask your good office the permission to have the total mortality and morbidity in Purok 3, Barangay Sto. Nio, Bian City, Laguna needed for our study. We would also like to have the total population of mothers who submit their child for immunization. Rest assured that this information will be only used for our study. We are hoping for your favorable response regarding this matter. Thank you. Respectfully yours, Mary Joyce M. Sayson Leader, BSN Level IV Thesis Group 7A Members: Casupang, Adrian Laurence L. Somes, Christian I. Tesoro, Johnrey J. Toledo, Mary Felinne A. Ugay, Mary Grace C. Noted by: Dr. Arni Magdamo

84
Thesis Adviser

85

APPENDICES (Survey Questionnaires)

86

UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA Sto. Nio, Bian City, Laguna COLLEGE OF NURSING
Greetings in the name of Christ, Our Lord. We are the group 7A year nursing students of the UPH-DJGTMU you are selected by our group as a respondents into our research study entitled Knowledge, Attitudes and Practices on Childhood Immunization among Mothers of Purok 3, Barangay Sto. Nio, Bian City, Laguna. The purpose of our research is to improve the knowledge, attitudes and practices among mothers regarding immunization for their child. Rest assured the information that you will share with us will be confidential & will be contributed to the fulfillment of our research, may we ask you to answer a set of questions with honesty to eradicate any biases. Thank you & God Bless. ______________________________________________________________________________________ I. Name (optional):_________________________ Demographic Profile

Age: 12 20 21 30 31- 40 40 and above Educational attainment: Gradeschool level Highschool level College level Number of children: 13 46 79 10 and above Employment status: Unemployed Employed Vocational

87
Combined family monthly income: <5,000 5,000 10,000 10,000 15,000 15,000 20,0

II.

Knowledge, Attitudes and Practices on Childhood Immunization among Mothers Instruction: Kindly check one of the following if you are: 1 - Not knowledgeable 4 3 2 1

4 - Highly knowledgeable

3 Knowledgeable 2 - Slightly knowledgeable Knowledge

1. 2. 3. 4. 5.

Mothers should bring their children on the appointed schedule for vaccination. Mothers should not bring their children for vaccination during times that the children are acutely ill. Vaccines may produce expected side effects, like fever. Vaccination prevents communicable diseases. Vaccines may be less effective in the prevention of communicable diseases over time.

5 Strongly agree disagree

4 Agree

3 Neither agree nor disagree

2- Disagree

1 Strongly

1. 2. 3. 4. 5.

Attitudes It is important for me to follow and complete the schedule of my childs immunization. I feel it is important to ask for clarification when I dont understand the health staffs explanation regarding my childs vaccination and its schedule. I do not fear vaccines and their common side effects. I perceive that having my child immunized is an important obligation and responsibility every mother should observe. I believe distance or lack of finances should not be a hindrance to complying with my childs immunization schedule.

5 Always

4 Often

3 Sometimes

2 Seldom

1 - Never 5 4 3 2 1

1. 2. 3. 4. 5.

Practices I follow the schedule of immunization visits. I keep the immunization card for the next vaccination schedule. I seek information from a health care provider when there is a missed dose. I prepared medications for possible side effects of the vaccine. I make sure that my child has no serious illness before visiting the health center for immunization

UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA Sto. Nio, Bian City, Laguna COLLEGE OF NURSING

Pagbati at magandang araw sa pangalan ng ating Panginoon. Kami ang BSN ng NCM-106 Group 7A ng Unibersidad ng Perpetual D.J.G.T.M.U. ay magsasagawa ng pananaliksik na may titulong Knowledge, Attitude, and Practices on Childhood Immunization among Mothers of Purok 3, Barangay Sto. Nio, Bian City, Laguna. Ang aming layunin ay mapabuti ang kaalaman, saloobin, at mga kasanayan ng ina tungkol sa pagbabakuna para sa kanilang anak. Aming titiyakin na ang impormasyon na iyong ibabahagi sa amin ay magiging pribado at lubos na maiaambag sa katuparan ng aming pananaliksik. Hinihiling po namin sa inyo na sagutin ang mga tanong ng buong katapatan para sa katumpakan ng mga datos at upang matanggal ang anumang mga pagkiling. Maraming salamat sa inyo at Pagpalain kayo ng Diyos.

Mga Tagapagsaliksik ______________________________________________________________________________________ I. Demographic Profile

Pangalan(opsyonal):__________________ Edad: 12 20 21 30 31 - 40 40 at pataas Antas ng edukasyon: Gradeschool level Highschool level College level Vocational Bilang ng mga anak: 13 46 79 10 at pataas Pinagsamahang buwanang kita ng pamilya: <5,000 5,000 10,000 Trabaho: WalangTrabaho May Trabaho

10,000 15,000 15,000 20,0

I.

Knowledge, Attitudes and Practices on Childhood Immunization among Mothers Panuto: Lagyan ng tsek ang mga sumusunod kung ikaw ay: 2 - May kaunting kaalaman 1 Walang kaalaman 4 3 2 1

4 Lubos na may kaalaman

3 - May kaalaman

1. 2. 3. 4. 5.

Knowledge Alam ang araw ng pagpapabakuna ayon sa Health Center Dapat ipabakuna ng nanay ang bata kahit may sakit ito. Maaaring magkalagnat ang bata matapos mapabakunahan Mganakakahawang sakit ay naiiwasan sa pagbabakuna. Ang epekto ng bakuna ay nawawala din sa paglipas ng araw.

5 Lubos na sang-ayon 2 - Hindi sang-ayon 1. 2. 3. 4. 5.

4 - Sang-ayon

3- Hindi makapagpasiya

1Lubos na hindi sang-ayon Attitudes 5 4 3 2 1

Ang aking pagsunod at pagkukumpleto ng mga Iskedyul sa pagbabakuna ayon sa tamang oras ay mahalaga. Natatakot ako na mag tanong sa mga kawani ng kalusugan kung hindi malinaw ang tagubilin para sa susunod na iskedyul ng bakuna. Takot ako sa epekto ng bakuna katulad ng lagnat Naiintindihan kong ang bakuna ay isang obligasyon. Naniniwala akong hindi handlang ang distansiya sa pagkukumpleto ng bakuna.

5- Palagi

4 Malimit

3 Minsan Practices

2 - Bihira

1 - Hindi Kailanman 5 4 3 2 1

1. 2. 3. 4. 5.

Sinusunod ko ang iskedyul para sa takdang pagbalik. Tinatago ko ang kard ng bakuna para sa susunod na iskedyul. Humihingi ako ng impormasyon sa mga tagapagbigay ng pangangalagangkalusugan kapag may nakalimutan ako ng dosis ng bakuna. Naghahanda ako ng mga gamut para sa maaring epekto ng bakuna. Sinisigurado kong ang bata ay walang malubhang sakit bagodalhin sa center para sa bakuna.

CONTINGENCY TABLES The Relationship Between the Demographic Profile of the Mothers in Terms of Educational Attainment and their Knowledge on Immunization HK K SK NK TOTAL O E O E O E O E Grade School Level 0 7.54 3 2.86 10 2.6 0 0 13 High School Level 22 16.82 7 6.38 0 5.8 0 0 29 College Level 7 4.06 0 1.54 0 1.4 0 0 7 Vocational 0 0.58 1 0.22 0 0.2 0 0 1 TOTAL 29 11 10 0 50 HK = Highly knowledgeable K = Knowledgeable SK = Slightly knowledgeable NK = Not knowledgeable The Relationship Between the Demographic Profile of the Mothers in Terms of Educational Attainment and their Attitude Towards Immunization SA A NAND D SD TOTAL O E O E O E O E O E Grade School Level 0 3.12 8 7.02 5 2.34 0 0.52 0 0 13 1 High School Level 5 6.96 15.66 4 5.22 2 1.16 0 0 29 8 College Level 6 1.68 1 3.78 0 1.26 0 0.28 0 0 7 Vocational 1 0.24 0 0.54 0 0.18 0 0.04 0 0 1 TOTAL 12 27 9 2 0 50 SA = Strongly agree A= Agree NAND = Neither agree nor disagree D= Disagree SD = Strongly disagree

The Relationship Between the Demographic Profile of the Mothers in Terms of Educational Attainment and their Practices on Immunization A O So Se N TOTAL O E O E O E O E O E Grade School Level 8 8.84 4 3.38 1 0.78 0 0 0 0 13 1 High School Level 19.72 9 7.54 2 1.74 0 0 0 0 29 8 College Level 7 4.76 0 1.82 0 0.42 0 0 0 0 7 Vocational 1 0.68 0 0.26 0 0.06 0 0 0 0 1 TOTAL 34 13 3 0 0 50 A = Always O = Often So = Sometimes Se = Seldom N = Never The Relationship Between the Demographic Profile of the Mothers in Terms of Employment Status and their Knowledge on Immunization HK K SK NK TOTAL O E O E O E O E Employed 13 4.48 1 6.16 0 3.36 0 0 14 Unemployed 3 11.52 21 15.84 12 8.64 0 0 36 TOTAL 16 22 12 0 50 HK = Highly knowledgeable K = Knowledgeable SK = Slightly knowledgeable NK = Not knowledgeable The Relationship Between the Demographic Profile of the Mothers in Terms of Employment Status and their Attitude Towards Immunization SA A NAND D SD TOTAL O E O E O E O E O E Employed 1 2.24 13 10.36 0 1.4 0 0 0 0 14 Unemployed 7 5.76 24 26.64 5 3.6 0 0 0 0 36 TOTAL 8 37 5 0 0 50 SA = Strongly agree A= Agree NAND = Neither agree nor disagree D= Disagree

SD =

Strongly disagree

The Relationship Between the Demographic Profile of the Mothers in Terms of Employment Status and Their Practices on Immunization A O So Se N TOTAL O E O E O E O E O E Employed 12 7.56 2 5.6 0 0.84 0 0 0 0 14 Unemployed 15 19.44 18 14.4 3 2.16 0 0 0 0 36 TOTAL 27 20 3 0 0 50 A = Always O = Often So = Sometimes Se = Seldom N = Never