STAKEHOLDERS’ COMPLAINCE ON THE DEPARTMENT

OF HEALTH’S DENGUE PREVENTIVE MEASURES

A Thesis Presented to the Pangasinan State University

School of Advance Studies
Urdaneta City, Pangasinan

In Partial Fulfillment of the Requirements for the Degree

MASTER OF ARTS IN EDUCATION
Major in Science Education

ANTONNETE T. MELEGRITO

July 2020

i
 APPROVAL SHEET

In partial fulfillment of the requirements for the degree of Master of Arts in

Education, Major in Science Education, this thesis entitled “STAKEHOLDERS’

COMPLAINCE ON THE DEPARTMENT OF HEALTH’S DENGUE

PREVENTIVE MEASURES” has been prepared and ANTONETTE T.

MELEGRITO is hereby recommended for approval and acceptance.

ELIZABETH F. EPISCOPE, EdD HONELLY MAE S. CASCOLAN,

PHD
Critic Reader Adviser

Approved by the Committee on Oral Examination

ADONIS S. BAUTISTA, DBA

Chairman

CRISTETA C. DULOS, PhD RAQUEL C. PAMBID, PHD

Member Member

WILMA M. DE VERA, PhD

Member

Accepted in partial fulfillment of the requirements for the degree of Master

of Arts in Education.

ADONIS S. BAUTISTA, DBA DEXTER R. BUTED, DBA

ii
 Executive Director University President
ABSTRACT

Researcher: Antonette T. Melegrito

Degree: Master of Arts in Education

Specialization: Science Education

Institution: Pangasinan State University

School of Advanced Studies

Date: July 2020

Adviser: Dr. Honelly Mae S. Cascolan

Title: Stakeholders’ Complaince on the

Department of Health’s Dengue
Preventive Measures

Keywords: dengue, policy compliance, preventive

measures, stakeholders, public health

This quantitative research determined and described the the level of

awareness and the level of compliance of different healthcare stakeholders to the

Department of Health’s implemented programs for dengue awareness and

prevention. Specifically, it looked into the profiles of the DOH stakeholders in the

Municipality of Pura along type of organization, number of officials, number of

members, and source of funds. It also determined the level of awareness and

level of compliance of the stakeholders to the DOH dengue preventive measures.

Additionally, it also determined the significant difference between the level of

compliance of the stakeholders when they are grouped according to their profile

variables. And finally, the study also determined the significant relationship

between the stakeholders’ level of awareness on the DOH dengue preventive

iii
measures and the level of compliance to the same policy. Based on the statistical

findings, a plan of action was proposed to enhance the implementation of the

DOH dengue preventive measures.

A descriptive-correlational and causal comparative method of research

was used. The main instrument of the study is a researcher-made electronic tool

based on the DOH dengue prevention policy. The respondents were the DOH

stakeholders of the municipality of Pura, Tarlac. The actual sample size is 512

respondents.

Frequency count and percentage, weighted mean, MANOVA and

Pearson’s r were the statistical tools.

The following conclusions were drawn based on the result of the statistical

analysis: (1) Majority of the respondents are from the teachers’ group with less

than 5 officers, and with 11 to 20 members and is funded by the government. (2)

The respondents are aware of the Department of Health’s dengue preventive

measures. (3) The respondents complied to all the DOH dengue preventive

measures along the search and seek components, self-protection measures,

early consultation policy and the systematic supporting fogging, spraying and

misting program of the DOH’s dengue preventive measure. (4) The level of

compliance varies significantly by stakeholder affiliation, number of members in

the stakeholder group and the group’s source of fund. Post hoc test suggests the

respondents belonging to the DSWD 4Ps group, the local business group, the

group with less than 5 members, and the group whose funding is based on

solicitation and member initiative have significantly lower level of compliance. (5)

iv
The level of awareness affects the level of compliance to the DOH dengue

preventive program. (6) There is a plan of action to standardized the

implementation of the DOH dengue preventive measures.

Based on the conclusions, the following recommendations were

formulated: Teachers from the municipality may be tapped by the local

government as an instructional support unit that will help barangay health officials

in the promulgation of the DOH dengue preventive measures. Strict group

monitoring should be conducted by the municipal health unit to determine the

extent to which the DOH dengue preventive is being observed in the barangay

level, as well as in business and in private and public schools. An extensive re-

orientation program should also be conducted by the municipal health unit to

address the differences in the level of compliance of the different stakeholders

group giving special attention to those who belong in the 4Ps group and business

group. The municipal health office should also focus in enhancing the level of

awareness of the stakeholders on the DOH dengue preventive measures by

providing seminars in the community-level as well since it was found out the

these will have an impact on the respondent’s level of compliance to the DOH

dengue preventive programs. The recommended plan of action should also be

adopted by the municipal health unit as a way to enhance the implementation og

the DOH dengue preventive measures. Further research should also be

conducted by other researchers taking into consideration the level of readiness of

the municipality during dengue outbreaks.

v
 ACKNOWLEDGEMENT

The completion of this thesis was made possible through the full support,

encouragement, guidance, sacrifices, prayers and other forms of assistance of

many people to whom I am greatly blessed and I wish to express my sincerest

appreciation and deepest gratitude, more particularly to:

Dr. Honelly Mae S. Cascolan, my adviser, for selflessly rendering

assistance and guidance and extra patience in carrying out this study, as well as

consistently showing competence and professionalism;

Dr. Elizabeth F. Episcope, my critic reader, for thoroughly reviewing and

editing my manuscript and for providing constructive criticism throughout the

process;

Dr. Adonis S. Bautista, the chairman of the Committee on Oral

Examination and Executive Director of PSU School of Advanced Studies, for

providing invaluable suggestions in the refinement of this research work;

Dr. Raquel C. Pambid, member of the oral examination committee, for

sharing her intellectual expertise for the improvement of this study;

Dr. Cristeta C. Dulos, another member of the oral examination

committee, for giving her intellectual inputs for the enhancement of this work;

Dr. Wilma M. De Vera, a member also of the oral examination committee,

for providing constructive feedback and unconditional sharing of his expertise

and precious time for the improvement of this research work;

vi
 To the content validators, for sharing their insights, as well as the

respondents, for sharing their time and effort in answering the needed data in the

questionnaire;

Dr. Raquel G. Bautista and the rest of the faculty and staff of Gerona

Western National High School, for the immense support and considerations

during the conduct of this study;

Mr. Antonio M. Torres and Corazon C. Torres, my parents, for their

selfless love, incomparable care, understanding and patience, and constant

unconditional moral, emotional, and physical support, as well as my siblings,

Annalissa, Analyn and Fredrick, for supporting and encouraging me throughout

my study;

And most of all, I owe thanks to a very special person, my husband,

Manny for his continued and unfailing love, support and understanding during my

pursuit of this Master’s degree that made the completion of thesis possible and

to my son Lhanz Melegrito this study is dedicated to you.

To my friends and relatives, for their immense assistance and advice and

their words of comfort and encouragement to finish my study; To some

acquaintances, for sparing some of their time in giving answers on my queries;

Above all, to God my Father, the Highest and Almighty one, for giving a

precious life, strength, wisdom, guidance, endless blessings and for everything

He has done beyond measure to let me through this journey of life.

MELEGRITO, AT

vii
 DEDICATION

This study is wholeheartedly dedicated to

my beloved parents, Antonio and Corazo,

to my son Mark Anthony Lhanz

and to my very supportive husband Manny,

who have been my source of inspiration

and gave me strength when I thought of giving up,

who have continually provided me moral,

spiritual and emotional support.

To my siblings, Annalissa, Analyn and Fredrick

who are very supportive and for boosting my morale.

Moreover, to my friends, relatives, and mentor

who shared their words of advice and

encouragement to finish this study.

And lastly, I dedicate this study to the Almighty God,

who serves as my savior and light,

for giving me strength, courage,

and power of mind to complete this study.

A.T.M.

viii
 TABLE OF CONTENTS

Page

TITLE PAGE i

APPROVAL SHEET ii

ABSTRACT iii

ACKNOWLEDGEMENT vi

DEDICATION viii

TABLE OF CONTENTS ix

LIST OF TABLES xii

LIST OF FIGURES xiii

I. THE PROBLEM 1

Background of the Study 1

Statement of the Problem 4

Research Hypothesis 5

Scope and Delimitation of the Study 5

Significance of the Study 6

Definition of Terms 7

II. REVIEW OF RELATED LITERATURE 9

Related Literature 9

Epidemiology of Dengue in the Philippines 9

Current Status of Dengue Disease

in the Philippines 11

Department of Health’s Dengue Prevention and

Control Policies 16

ix
 Stakeholders in Healthcare Sector 18

Role of Stakeholders in Dengue Prevention 21

Related Studies 22

Theoretical Framework 28

Conceptual Framework 30

III. RESEARCH METHODOLOGY 32

Research Design 32

Respondents and the Locale of the Study 33

Research Instrument 33

Validation of the Instrument 34

Data Gathering Procedure 34

Statistical Treatment of Data 35

IV. PRESENTATION, ANALYSIS AND

INTERPRETATION OF DATA 36

Profile of the Respondents 36

Level of Awareness to the DOH

Dengue Preventive Measures 42

Level of Compliance to the DOH

Dengue Preventive Measures 46

Difference in the Level of

Compliance of the Stakeholders 51

Relationship Between Level of

Awareness and Level of Compliance 54

Plan of Action to enhance the

implementation of the DOH dengue

x
 preventive measure 58

V. SUMMARY OF FINDINGS, CONCLUSIONS

AND RECOMMENDATIONS 59

Summary of Findings 59

Conclusions 62

Recommendations 63

BIBLIOGRAPHY 65

APPENDICES 71

A Research Questionnaire 71

B Electronic Form of the Research Questionnaire 75

C Questionnaire Validation Tool 86

D Letters to the Validators 90

CURRICULUM VITAE 95

xi
 LIST OF TABLES

Table No. Page

1 Profile of the Respondents 37

Level of awareness of the stakeholders on the DOH

2 43
dengue preventive measures

Level of Compliance to the DOH Dengue Preventive

3 47
Measures

Difference in the Level of Compliance of the Stakeholders

4 52
when Grouped Along their Profile Variables

Relationship Between the Stakeholders’ Leve of

5 Awareness and Level of Compliance to the DOH Dengue 54
Preventive Measures

6 Plan of Action 58

xii
 LIST OF FIGURES

Figure No. Page

1 Paradigm of the Study 31

xiii
 1

Chapter 1

THE PROBLEM

Background of the Study

Better health is central to human happiness and well-being. It also makes

an important contribution to economic progress, as healthy populations live

longer, are more productive, and save more. Many factors influence health status

and a country's ability to provide quality health services for its people. Healthcare

offices, such as the Department of Health and its underlying bureaus, are

important actors, but so are other government departments, donor organizations,

civil society groups, communities and educational institutions themselves.

Government offices invests in roads that can improve access to health services,

inflation targets can constrain health spending, and civil service reform can

create opportunities - or limits - to hiring more health workers. But the

interconnectedness of the community and the health offices is one of the greatest

measures in which the country will be kept healthy and safe. Thus, the

stakeholders play a great role in keeping their community healthy and this role

can be further enhanced by providing them information on their role in the

healthcare practices.

With 106,630 dengue cases reported through the Philippines Integrated

Disease Surveillance and Response (PIDSR) system from 1 January to 29 June

2019, including 456 deaths, the current dengue incidence is 85% higher than in

2018, in spite of a delayed rainy season. Whereas the Case Fatality Rate (CFR)
 2

of 0.43% as of 29 June 2019 is lower than in the same time period in 2018

(0.55%), this is still significantly higher than the regional average of 0.22% in the

Western Pacific (IFRC, 2019).

Stakeholders plays an important in the promotion of health and safety

awareness in the community. In a parlance, the term stakeholder, according to

Freeman (1984) is “an organization… [or] any group or individual who can affect

or be affected by the achievement of the organization’s objectives”. In the

healthcare services, the term stakeholder typically refers to those entities that are

integrally involved in the healthcare system and would be substantially affected

by reforms to the system. The major stakeholders in the healthcare system are

patients, physicians, employers, insurance companies, pharmaceutical firms and

government (Rodriguez-Osorio & Dominguez-Cherit, 2018). In some cases, the

term may be used in a more narrow or specific sense — say, in reference to a

particular group or committee — but the term is commonly used in a more

general and inclusive sense.

Dengue control can be effectively addressed with stakeholder

involvement. Combatting and spreading awareness regarding dengue is a

responsibility shared by many, and intersectoral cooperation is a strategic

approach for successful interventions. (Suwanbamrung, 2010; Khun &

Manderson, 2008; Sanchez, Perez, Perez, et al, 2015; Heintze, Velasco-Garrido

& Kroeger, 2017). Community-based programs have aimed at modifying health-

risk behaviors and the conditions that produce and support them. These

programs have included community-wide health education, risk factor

 3

intervention, and efforts designed to change laws or regulatory policy in areas

where health is affected. These undertakings rely on community organization

techniques to boost community leadership and resources, and to plan

interventions (Wickizer, Von Korff, Cheadle, et al, 2013). Most community-based

programs for dengue control have focused on eliminating domestic repositories

of the mosquito vector and ensuring that they are free of Aedes mosquitous.

Stakeholder participation research has concentrated on neighborhoods which are

subject to intervention and/or are vulnerable communities; such research has not

considered groups who implement and could sustain these interventions, or are

responsible for disease control (Espino, 2014).

Societal sectors that have some interest in, or responsibility for the control

of dengue have been identified: national control programs, local governments,

environment and urban planning, education, science and technology, the media,

the private sector, and communities in endemic areas (Heintze, et al, 2017;

Halstead, 2011; Erlanger, Keiser & Utzinger, 2008). These stakeholders at

community level (e.g. households, primary health care workers) need to interact

with technical officers at the local government level (e.g. sanitation inspectors) in

order to create positive effects.

In the province of Tarlac, a reported cases of 2989 individuals are

contacted with the disease last July 2, 2018 and 1,629 individuals for the same

period last year. Most of the victims are school children based on the report of

the Provincial Epidemiology and Surveillance Unit (PESU). This quarter alone a

total eleven deaths were reported by the PESU, six of which came from the town
 4

of Paniqui, three from Gerona, one each from Concepcion and Mayantoc. This

alarming state needs not only prevention but an increased awareness regarding

the disease.

The researcher, therefore, aims to describe the level of aware and levl of

compliance of different healthcare stakeholders to the Department of Health’s

implemented measures in controlling and combating the dengue disease. The

researcher also aims to determine the interrelatedness of the respondents’ level

of awareness and level of compliance to the DOH’s dengue preventive measures

A framework for a more intensive dengue awareness program will then be

proposed by the researcher as an output of this study.

Statement of the Problem

This study determined and described the level of awareness and the level

of compliance of different healthcare stakeholders to the Department of Health’s

implemented programs for dengue awareness and prevention.

Specifically, it will also seek answers to the following questions:

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

a. Stakeholder affiliation;

b. number of officers;

c. number of members, and

d. source of funds?

2. What is the level of awareness of the stakeholders on the DOH dengue

preventive measures?
 5

3. What is the level of compliance of the stakeholders to the DOH dengue

preventive measures?

4. Is there a significant difference between the level of compliance to the DOH

dengue preventive measures of the stakeholders when they are grouped

according to their profile variables?

5. Is there a significant relationship between the stakeholders’ level of

awareness on the DOH dengue preventive measures and the level of

compliance to the DOH dengue preventive measures?

6. What plan of action can be proposed to enhance the implementation of the

DOH dengue preventive measure?

Research Hypothesis

Aside from the aforementioned questions, the research also tested the

following hypotheses using appropriate statistical test with a 0.05 level of

significance:

1. There is a significant difference between the level of compliance to the DOH

dengue preventive measures of the stakeholders when they are grouped

according to their profiles.

2. There is a significant relationship between the stakeholders’ level of

awareness on the DOH dengue preventive measures and the level of

compliance to the DOH dengue preventive measures.

Scope and Delimitation of the Study

 6

The study is quantitative in nature and will focus on the difference

stakeholders in the municipality of Pura, Tarlac. Stakeholders were limited public

and private healthcare stakeholders such as those in the education sector, local

government sectors, local community/barangay sectors, private business

sectors, health and safety sectors and others that are within the scope of the

Department of Health’s policies on dengue awareness and prevention.

The study is also limited to the responses of the respondents to the

questionnaires intended for the study. The items in the survey questionnaires are

limited to the DOH’s dengue prevention and control program, specifically the

Enhanced 4S (Search and Destroy, Seek Early Consultation, Self-Protection

Measures, and Systematic Fogging During Outbreaks) Strategy.

Significance of the Study

Dengue imposes significant economic and societal burdens on countries

where the disease is endemic and, as such, estimating the associated disease

impact can help inform policymakers and assist them in setting priorities for

disease control and management strategies (Martelli, et al 2015; Ibarra, et al,

2014). The effects of dengue on health and preventive care, its economic burden

and social impact on populations have not been clearly studied. Understanding

dengue burden from societal and socio-economic perspectives is crucial for

allocation of limited scarce public health resources among competing health

threats, as well as ensuring cost-effectiveness of integrated dengue prevention

and control methods. Thus, effective coordination with schools and different

stakeholders will broaden the network in combating dengue.

 7

The findings of the study will therefore be beneficial to the following

groups.

Lawmakers. The findings of this study will help lawmakers in

promulgating law regarding the importance of linkages between public and

private sectors regarding dengue. They may be able to write laws that will

oversee these linkages so that abuses may not developed in the duration of such

linkages.

Stakeholders. This study will provide relevant data regarding the

importance of stakeholder awareness and compliance to the DOH’s dengue

preventive measures. With enhanced awareness and compliance, stakeholders

will be able to identify and internalize their part in keeping their community

dengue free.

Local Health Officers. The findings of this study will provide relevant data

regarding the importance of imparting the knowledge of the stakeholders

regarding dengue prevention and control. They may use the information gathered

from this study as a baseline in conducting health awareness protocol in their

respective communities.

Other researchers. This study will also benefit researchers that will

undertake projects similar to the present study by providing them with valid data

and information that they can utilize.

Definition of Terms
 8

For a clearer understanding of the study, the following terms are defined

conceptually and operationally. The definitions shall provide a cleared

understanding of the variables that will be used in the study.

Awareness. Chalmers (1997) defined awareness as the state of being

conscious of something. More specifically, is the ability to directly know and

perceive, to feel, or to be cognizant of events. In this study, awareness is defined

as the ability of an individual belonging to a particular group to recognize dengue

preventive measures laid upon by the Department of Health.

Compliance. This term is defined as the act or process of complying to a

desire, demand, proposal, or regimen or to coercion or the conformity in fulfilling

official requirements (Merriam-Webster, n.d.). In this study, compliance is defined

as the act to which an individual belonging to a particular group in conforming to

the dengue preventive measures laid upon by the Department of Health.

Level of Awareness. Level of consciousness in which sense data can be

confirmed by an observer without necessarily implying understanding. More

broadly, it is the state or quality of being aware of something (Definition.net, n.d.).

Level of Compliance. This term indicates the degree of compliance that

an individual has achieved for a program or a requirement.

Stakeholders. In the health care sector, stakeholders typically refers to

those entities that are integrally involved in the healthcare system and would be

substantially affected by reforms to the system.

 9

Chapter 2

REVIEW OF RELATED LITERATURE

This chapter focuses on related literature regarding dengue, stakeholder

participation and compliance to the healthcare system and community linkages

which will be used to develop the research theoretical and conceptual framework.

Also related foreign and local studies parallel to the current study will also be

presented to further the research gap.

RELATED LITERATURE

Epidemiology of Dengue in the Philippines

Dengue is considered by the World Health Organization (WHO) as a

major global public challenge in the tropic and subtropic nations such as the

Philippines (Wilder-Smith & Macary, 2014). The dengue virus, a member of the

Flavivirus of the family Flaviviridae, is an arthropode-borne virus that includes

four different serotypes: dengue virus (DENV) -1, DENV-2, DENV-3 and DENV-4

(Halstead, 2007; Moi & Kurane, 2013). These four viruses are called serotypes

because each has different interactions with the antibodies in human blood

serum. The four dengue viruses are similar — they share approximately 65% of

their genomes — but even within a single serotype, there is some genetic

variation. Despite these variations, infection with each of the dengue serotypes

results in the same disease and range of clinical symptoms. The acute viral

illness spread by Aedes mosquitoes.

 10

Due to increased population growth rate, global warming, unplanned

urbanization, inefficient mosquito control, frequent air travel, and lack of health

care facilities, dengue has seen a 30-fold upsurge worldwide between 1960 and

2010 (Gubler, 2002; WHO, 2009; Guzman, et al., 2010). Two and a half billion

people reside in dengue-endemic regions (Guzman, et al., 2010) and roughly

400 million infections occuring per year, with a mortality rate surpassing 5–20%

in some areas (Linares, Panuti & Kubota, 2013). Dengue infection affects more

than 100 countries, including Europe and the United States (San Martín,

Brathwaite, Zambrano, Solórzano, Bouckenooghe, Dayan, & Guzman, 2010).

In the Philippines, outbreaks reported in1926 (Siler, Hall & Hitchens, 1926;

Simmons, St John & Reynolds, 1931), and the first recorded epidemic in

Southeast Asia occurred in Manila in 1954 (Ooi & Gubler, 2009; Gubler, 1997).

Further epidemics occurred in 1966, 1983, and 1998, with increasing reported

cases of dengue disease (DOH Report, 2010; WHO-Western Pacific Region,

2008; Songco, Leus & Manaloto, 1987; Venzon, Rudnick, Marchette, Fabie &

Dukellis, 1972). The 1998 epidemic had the highest recorded incidence rate

(60.9 cases per 100,000 population) and case fatality rate (CFR; 2.6%) (DOH

Report, 2010). The rising incidence of dengue disease can be explained by

several factors. Dengue is caused by one of four dengue viruses (DENV-1, -2, -3,

or -4) transmitted primarily by the Aedes aegypti (Linnaeus) mosquito, which

breeds in open water containers, and can survive year round in tropical and

subtropical climates. During World War II, the movement of people and

equipment expanded the geographic distribution of Ae. Aegypti and dengue

 11

disease in Southeast Asia (Ooi & Gubler, 2009). Since then, virus propagation in

the region has been facilitated by rapid urbanization, environmental degradation,

the lack of a reliable water supply, and improper management and disposal of

solid waste (Ooi & Gubler, 2009; HSLP, 2009). In the Philippines, the percentage

of the population living in urban areas increased from 27.1% in 1950 to 58.5% in

2000 (UN DESA Population Division, 2008).

Current Status of Dengue Disease in the Philippines

According to the United Nations Office for the Coordination of

Humanitarian Affairs office (OCHA) in the Philippines more than 77,000

suspected cases of dengue and 300 deaths were reported in the first 20 weeks

of 2019 in the Philippines. This is almost double the number of reported cases

during the same time period last year. Dengue cases remain high as the rainy

season approaches, with the Department of Health declaring a dengue outbreak

in four villages in the province of Negros Oriental in the Central Visayas region.

City and municipal health officials, working with local authorities, have launched

information campaigns in the affected provinces. They are conducting house-to-

house visits and distributing treated mosquito nets (OCHA, 2019).

According to the latest report of the DOH Epidemiology Bureau, there

were 3,610 dengue cases reported from June 16 to 22. This number brings the

cases recorded, from all over the country since January 1 to June 22, to a

cumulative total of 98,179, with 428 deaths. The reported cases for June 16 to 22

alone is eight percent (8%) higher compared to the same period last year (3,330

cases). Since January, the highest number of cases came from Western Visayas
 12

(11,285), CaLaBaRZon (10,313), Central Visayas (8,773), SOCCSKSARGEN

(8,297), and Southern Mindanao (8,289). Meanwhile, the DOH clarified that the

alleged outbreak in the Ilocos province were confined to specific barangays only

and not the whole province. The DOH Center for Health Development Office in

Region 1, Northern Luzon, reported a total of 353 dengue cases from Ilocos

Norte from January 1 to June 29, this is 47.7% higher than the number of cases

reported for the same period in 2018. Most of the cases came from Laoag City

(94), Badoc (43), Batac City (29), Pagudpud (21), and Dingras (20). There were

no deaths reported (DOH, 2019).

With 106,630 dengue cases reported through the Philippines Integrated

Disease Surveillance and Response (PIDSR) system from 1 January to 29 June

2019, including 456 deaths, the current dengue incidence is 85% higher than in

2018, in spite of a delayed rainy season. Whereas the Case Fatality Rate (CFR)

of 0.43% as of 29 June 2019 is lower than in the same time period in 2018

(0.55%), this is still significantly higher than the regional average of 0.22% in the

Western Pacific. The Philippines Department of Health (DOH) declared a

National Dengue Alert on 15 July 2019, urging regional DOH offices to step up

dengue surveillance, case management and outbreak response in primary health

facilities and hospitals, as well as through community and school-based health

education campaigns, clean-up drives, surveillance activities, case

investigations, vector control, and logistics support for dengue control. The

National Disaster Risk Reduction Management Council (NDRRMC), raised the

code blue alert, activating the national Health Cluster, led by DOH (WHO, 16
 13

July, 2019). Between 1 January to 6 July, 115,986 dengue cases including 456

deaths were reported through the DOH routine surveillance system, with a CFR

of 0.42%. With a median age of 12 years, the most affected age group among

dengue cases is 5-9 years (30%). Similarly, the most affected age group among

dengue deaths is 5-9 years (40%). The majority of dengue cases are male

(55%), whereas the majority of dengue deaths are female (53%). CFR is highest

in regions V (1%), BARMM (1%), VI (0.6%), and VII (0.7%), whereas incidence is

highest in regions IX, CARAGA, VI, XII, X, and II (WHO, 25 July, 2019)

The Department of Health (DOH) declared a national dengue epidemic to

enable the local government units to use their Quick Response Fund to address

the epidemic situation. Based on the DOH Dengue Surveillance Report, there are

146,062 cases recorded from January to July 20 this year, 98% higher than the

same period in 2018. There were 622 deaths (Government of the Philippines, 6

August, 2019). During 1 January to 27 July, there are 167,607 dengue cases

reported, including 720 deaths. The number of cases reported is 97% higher than

in 2018, in spite of a delayed rainy season. Case Fatality Rate (CFR) as of 27

July is 0.43%, which is lower than in the same time period in 2018 (0.54%), but

still significantly higher than the regional average of 0.22% in the Western

Pacific. The most affected age group among dengue cases is 5-9 years (23%),

with a median age of 12 years. Similarly, the most affected age group among

dengue deaths is 5-9 years (42%). The majority of dengue cases are male

(52%), whereas the majority of dengue deaths are female (54%). CFR is highest
 14

in regions XI (.58%), BARMM (.87%), and V (0.57%), whereas incidence is

highest in regions VI, IV-A, XIII, IX, X. (WHO, 13 Aug 2019)

As dengue cases continue to rise in Eastern Visayas, the Department of

Health's blue alert in Region 8 remains in effect. Based on the data released by

DOH-8, a total of 16,526 dengue cases with 50 deaths were reported from

January 1 to August 23, 2019. The majority of the cases are from the province of

Leyte with 4,262 cases and 13 deaths. Ages ranged from one-month old to 88

years old. The DOH noted a clustering of cases in 95 municipalities and 585

barangays in Eastern Visayas. (DOH, 2019)

Between 1 January and 17 August, 229,736 dengue cases including 958

deaths were reported through the DOH routine surveillance system, with a CFR

of 0.42%. With a median age of 12 years, the most affected age group among

dengue cases is 5-9 years (23%). Similarly, the most affected age group among

dengue deaths is 5-9 years (40%). The majority of dengue cases are male

(52%), whereas the majority of dengue deaths are female (54%). Between 11

and 17 August, 13,327 cases and 40 deaths were reported, compared to 17,137

cases and 36 deaths in the preceding week, but still 40% higher than in 2018

(WHO, 2 Sep 2019). Between 1 January and 31 August 2019, 271,480 dengue

cases including 1,107 deaths were reported through the DOH routine

surveillance system, with a CFR of 0.41%. With a median age of 12 years, the

most affected age group among dengue cases is 5-9 years (23%). Similarly, the

most affected age group among dengue deaths is 5-9 years (39%). The majority

of dengue cases are male (52%), whereas the majority of dengue deaths are
 15

female (53%). Between 25 and 31 August, 12,526 cases and 41 deaths were

reported, compared to 13,192 cases and 38 deaths in the preceding week, but

still 52% higher than in 2018. Similarly, the weekly CFR of 0.33% in

epidemiological week 35 is lower than in the same time period in 2018 (0.40%)

(WHO, 2019).

During week 36, 2019, a total of 13,059 dengue cases were reported

nationwide. As of 31 August 2019, the cumulative number of cases was 292,076

with 1,184 deaths. This is higher compared to 135,490 cases with 690 deaths

reported during the same period in 2018 (WHO, 26 Sep 2019). Between 1

January and 21 September 2019, there were 322,693 dengue cases including

1,272 deaths reported through the DOH routine surveillance system, with a CFR

of 0.39%. During week 38, 8,856 cases and 15 deaths were reported, compared

to 9,815 cases and 37 deaths in the preceding week, but still 25% higher than in

2018. Similarly, the weekly CFR of 0.17% in epidemiological week 38 is lower

than in the same time period in 2018 (0.45%) (WHO, 4 Oct 2019). As of 24

October, approximately 350,000 dengue cases were recorded and 1,342 deaths,

the current dengue epidemic is the largest in the last ten years, or since the

disease has been monitored in the Philippines (OCHA, 2019).

This year, most countries in Asia and South-East Asia are reporting a

large increase in the number of detected dengue cases. The Philippines is

among the highest of these, and have reported over 371,500 cases as of

November 2019 (ECHO, 25 Nov 2019). 371,717 cases were recorded between

January to October 2019 compared to 180,072 for the same period last year (106
 16

per cent increase). With 1,407 deaths recorded compared to 927 for the same

period last year (62 percent increase). The case fatality rate (CFR) is 0.38 per

cent, lower than 0.51 per cent in the same period last year. There are 16

provinces which have declared state of calamity due to dengue: Aklan, Albay,

Cavite, Capiz, Catanduanes, Eastern Samar, Guimaras, Iloilo, Leyte, Mountain

Province, North Cotabato, Paranaque, South Cotabato, Southern Leyte, Western

Samar and Zamboanga Sibugay (IFRC, 2019).

Department of Health’s Dengue Prevention and Control Policies

The dengue problem in the Philippines has been confronting the country

since 1953 when hemorrhagic fever was reported for the first time in this part of

Asia. From then on, sporadic cases of dengue have been reported in several

parts of the country and control measures were instituted as necessary.

It was in 1993 when the Communicable Disease Control Service, as

mandated by Executive Order 119, formulated the National Dengue Prevention

and Control Programme for the control of DF/DHF (Dengue Fever/Dengue

Hemorrhagic Fever). Being a low budget program – US$16 million in 1993;

US$1.6 million in 1997 – it was implemented in only two regions of the country,

namely, Region 7 and the National Capital Region (NCR) which were high

incidence regions.

The program aims at reducing the morbidity and mortality rates of dengue

infection to a level wherein it will no longer be a public health problem. Its general

objective is to prevent and control the transmission of dengue virus and obtain

reduction by 90% by the end of a 15-year period. It also have the following
 17

specific objectives: (1) to create a dengue technical working group; (2) to develop

an integrated vector control approach for prevention and control; (3) to develop

capability on diagnosis and management; (4) to intensify health education/IEC

activities, and (5) to operationalize an effective surveillance system and to

develop a dengue epidemic contingency plan for emergency response.

The current National Dengue Prevention and Control Program (NDPCP)

of the Department of Health has the following program components: (1)

Surveillance; (2) Case Management and Diagnosis; (3) Integrated Vector

Management (IVM); (4) Outbreak Response; (5) Health Promotion and

Advocacy; and Research. Dengue Case Surveillance was being conducted by

the Philippine Integrated Disease Surveillance and Response (PIDSR) and

laboratory-based surveillance/ virus surveillance through Research Institute for

Tropical Medicine (RITM) Department of Virology, as national reference

laboratory, and sub-national reference laboratories. On the other hand, Vector

Surveillance was through DOH Regional Offices and RITM Department of

Entomology.

For the Case Management and Diagnosis, Dengue Clinical Management

Guidelines training was being conducted to all hospitals in the Philippines. The

Dengue non-structural protein 1 Rapid Diagnostic Test (Dengue NS1 RDT) was

also established as the forefront diagnosis at the health center/Rural Health Unit

level. Molecular testing or polymerase chain reaction (PCR) as dengue

confirmatory test available was also made available at the sub-national and

national reference laboratories. Also, the Nucleic Acid Amplification Test-Loop

 18

Mediated Isothermal Amplification Assay (NAAT-LAMP) as one of confirmatory

tests will be available at district hospitals, provincial hospitals and DOH retained

hospitals.

Training on Vector Management, Basic Entomology for Sanitary Inspector,

and Integrated Vector Management (IVM) were facilitate to national health

workers in order to support the IVM thrust of the NDPCP. Insecticide Treated

Screens (ITS) as dengue control strategy in schools was also introduced.

For Outbreak Response, continuous augmentation of insectides, such as

adulticides and larvicides, to LGUs for outbreak response was enriched by the

department. In addition to this, to promote health and Dengue Awareness

advocacy, the county adopted the celebration of ASEAN Dengue Day every June

15.

As of this date, the Department of Health is conducting its strategic policy

program in combating the dengue disease. The program is entitled Enhance 4S.

These 4S strategy consists of: Search and destroy mosquito breeding places,

Secure self-protection, Seek early consultation and Support fogging/ spraying

only in hotspot areas where increase in cases is registered for two consecutive

weeks to prevent impending outbreak.

Stakeholders in the Healthcare Sector

Stakeholder involvement can help to ensure a guideline’s acceptability

and feasibility to the end users. They can also ensure that equity and human

rights issues are taken into consideration and support the adoption of its

recommendations into policy and practice. There are many stakeholder groups
 19

equally affected by recommendations in guidelines, for example, patients,

consumers, providers, general public, researchers, and policymakers. However,

engagement with patients/public/community stakeholder groups dominates the

literature, and guidance of the engagement with patient/public stakeholders is the

most prominent (Armstron & Bloom, 2017; Lavis, Paulsen, Oxman & Moynihan,

2008; van de Bovenkamp, 2015).

In a review of guideline methodologies conducted by Armstrong and

Bloom (2017), patients/public stakeholders were consulted by 101 different

guideline developers. Many guideline groups that have sought to involve

stakeholders have utilized limited numbers of participants or utilized slow and

labor-intensive processes for example, time and resources needed to administer,

collate, and respond to over 200 stakeholder views and comments (Cluzeau F,

Wedzicha, Kelson, Corn, Kunz, Walsh, et al, 2012).

It is recognized that successful guideline development and implementation

requires the engagement of multiple stakeholders (Dunston, Lee, Boud, Brodie &

Chiarella, 2009) and “shared solutions” (input from patients, clinicians, and

policymakers) improve health outcomes (Suman, Dikkers, Schaafsma, van

Tulder & Anema, 2016; Dunston, Lee, Boud, Brodie, Chiarella, 2009;

Kumarasamy & Sanfilippo, 2015). Patient/public stakeholders may potentially feel

intimidated to contribute if they are only one voice among many. Keeping patient

and public stakeholder voices separate from other stakeholder groups potentially

shortchanges the input and influence that this group may offer. Equitable
 20

engagement of multiple stakeholder groups can help to ensure that guidelines

contribute to reducing health disparities.

However, there is a lack of consensus on how to identify and recruit

relevant stakeholders, how they should be engaged, what their roles and

responsibilities should be, how to evaluate the impact of their engagement in

guideline development, and how to best collect and manage conflicts of interest

as part of the engagement and guideline development process.

Engaging the stakeholders in policy formation for healthcare situation like

dengue awareness empower the community in guided decision-making and

policy engagement. The more stakeholder knew or are engage in policy

formation the more they will engage in the implementation of the policy (Suman,

Dikkers & Schaafsma, et al, 2016).

Stakeholder Engagement Framework of the Department of Health outlines

the models for engagement, key actions, capability improvement agenda,

approach to risk oversight and management, and performance framework,

drawing each back to the department’s strategic priorities: (1) better health

outcomes and reduced inequality through greater stakeholder engagement; (2)

affordable, accessible, efficient, and high quality health system through

collaborating and partnering with others, and (3) better sport outcomes.

The framework sets out a strategic approach to stakeholder engagement

that includes, principles to guide our engagement approach, a five-step model for

conducting engagement activities, a matrix to support tailoring the level of

engagement to the task, recognizing that tools and strategies must be fit-for-
 21

purpose, and appropriate to the issues on which we are seeking to engage,

challenges to consider, and strategies for success.

The stakeholder engagement framework is supported by detailed

guidance, tools and templates, together with learning and development and a

stakeholder management system to support staff throughout the department in

planning, designing, undertaking and evaluating stakeholder engagement

activities.

The Department of Health has adopted five-key principles to guide

stakeholder engagement activities. The principles set the standards to which we

aspire in building consistent, open and respectful working relationships and were

agreed to following extensive consultation within the department.

Role of Stakeholders in Dengue Prevention

As public participation becomes increasingly embedded in national and

international public health policy, it becomes ever more crucial for decision-

makers to understand who is affected by the decisions and actions they take,

and who has the power to influence their outcome: the stakeholders. The

stakeholder concept has achieved widespread popularity among academics,

policy-makers, the media and corporate managers. Within the field of strategic

management the stakeholder concept has become firmly embedded (Friedman &

Miles, 2016).

References to stakeholders are commonplace and the requirement to

engage stakeholders in public sector organizational strategy and project design

is a key priority in current government policy both within the local government
 22

sectors. Many of these organizations recognize that stakeholder engagement is

not about giving the public a list of options to choose from – it’s about drawing

them in right from the start, so that their views, needs and ideas shape those

options and the services that flow from them (Markwell, 2010).

Literature regarding stakeholders’ participation in dengue prevention,

particularly in education, is limited though there are various literature written

regarding stakeholders’ participation in clinical health care provision.

RELATED STUDIES

The study conducted by Zahir, Ullah, Shah and Mussawar (2016)

determined the role of community participation in prevention of dengue fever in

The Swat district located in the Northern area of Khyber Pakhtunkhwa, Pakistan,

which experienced a dengue fever outbreak in August, 2013. A total number of

8,963 dengue cases with 0.4% case fatality ratio were registered during the

outbreak. Results regarding perception of practices for dengue control with

community participation showed that: practices for control had significant

association with organization of people to eradicate dengue mosquitoes (p =

0.00), community leaders (p = 0.04), community efforts (p ≤ 0.01), use of

insecticides by community people (p = 0.00) and involvement of community

people in awareness campaign (p=0.00). Similarly, significant associations were

found between practices for control and community shared information during

dengue outbreak (p = 0.00), community link with health department, NGO, Other

agencies (p = 0.02). It was concluded that the spread of dengue epidemic was

aided by the ignorance, laziness of the community people and government

 23

agencies. However, the people, religious scholars, leaders and government

agencies were not organized to participate in dengue prevention and eradication,

hence, the chances of dengue infection increased in community. The study

recommends mobilizing local communities and activating local leadership with

active participation of Government and non-government organizations for

initiation of preventive strategies.

Chacon & Peraza (2013) examined the people’s perception of community

participation, the priorities and the problems related to Aedes aegypti control, as

well as the existing organizational structures and the main training needs. The

findings helped determine the participatory strategy that was not appropriate for

controlling the proliferation of Aedes aegypti in the research locale. The

researcher used a series of quantitative and qualitative methods: interviews with

key informants and a general survey. The study was conducted in the District of

La Playa in the neighborhood of Mariano, located in the northwest part of Havana

City, Cuba. The findings of the study showed that community participation was

very high, and that at least 90% of the community leaders (elected or appointed

community members) attended intersectoral meetings with the health council.

Leaders encouraged members of the community, especially children and elder

people, to participate in social mobilization activities such as cultural and artistic

presentations that focused on messages that motivated people in eliminated

unused containers or cover up water-holding recipients.

The study of Ayala, Perez, Rigau, Clark and Barrera (2015) aimed at

developing Aedes aegypti Aedes aegypti a novel approach to community

 24

participation by developing a model that involves the active participation of

community residents in the planning and conduction of activities to reduce Aedes

aegypti infestations. Initial steps in project development included identification of

intervention and control communities with similar community environment and

organizational level capable of supporting a community participation project,

entomologic inspections of 20% of the houses (comparable baseline Breteau

Index ≥ 50 was required), and determination of community characteristics. To

promote community participation we also required a community inventory,

partnership identification, and in-depth and informal interviews with gatekeepers

and community leaders in the intervention community to determine project

viability. The researcher evaluated communities in 22 of the 78 municipalities of

Puerto Rico. Thirteen communities were selected for further evaluation. From

these, two communities (≈200 houses in each) with similar organizational level

and comparable larval indices (house index 67.5% and 75%, respectively; p-

value = 0.46) were chosen. Three informal and 7 in-depth interviews were

conducted during December 2013. Content analysis of these interviews indicated

that interviewees viewed dengue as a disease of interest but only when there

were cases in the community. Correct dengue knowledge was mixed with

misconceptions and the community had a well-organized health committee.

Tapia-Conyer, Mendez-Galvan and Burciaga-Zuñiga (2013) determined

the effectiveness of the patio limpo (clean backyard) method as a community

participation strategy in the prevention and control of dengue in Mexico. Through

the patio limpio campaign, the concept of community participation has been
 25

employed in Mexico to raise awareness of the consequences of dengue. Patio

limpio consists of training local people to identify, eliminate, monitor and evaluate

vector breeding sites systematically in households under their supervision. A

community participation programme in Guerrero State found that approximately

54% were clean and free of breeding sites. Households that were not visited and

assessed had a 2·4-times higher risk of developing dengue than those that were.

However, after a year, only 30% of trained households had a clean backyard.

This emphasises the need for a sustainable process to encourage individuals to

maintain efforts in keeping their environment free of dengue.

Rakseenil and Phatisena (2018) conducted a study with the objective of

developing the participation of the community in the prevention and control of

dengue hemorrhagic fever by the theory of social marketing in Wichianburi Buri

Municipality, Phetchaboon Apply the social marketing of Philip Kotle (1984),

using the 4P's (Products, Pricing, Place and Promotion) in order to build the

audience participation and behavior modification to prevent and control dengue

hemorrhagic fever. It was conducted during July-September 2018, the sample

was applied health of 35 people, community leaders, one person community

committee, two headmen first person staff for Disease Control Hospital. Data

collection is divided into three phases, (1) study in the urban context, (2)

developed process with the participation of the community in the application of

the theory of social marketing, and (3) results of the development process. The

content analysis compared the results before and after the test developed by the

researcher. The results showed that the development of community participation

 26

in prevention and control of dengue fever, the sample had an average score in

terms of awareness and participation in the implementation of activities to

prevent and control the disease in the community. It was higher than before the

development of statistical significance (p <.05) and the index of the prevalence of

mosquito larvae in homes fell 50 percent after conducted the research.

Therefore, the development of community participation on the prevention and

control of dengue fever can reduce the incidence of the disease can be

sustainable.

The study of Carandang, Valones, Valderama, Cotoco and Asis (2015)

determined the knowledge, attitudes and preventive behaviors (KAP) of adults in

relation to dengue vector control measures in the communities of Sta. Cruz,

Laguna. A total of 207 respondents were actively participated in the cross-

sectional descriptive study in 2015. Representatives of households were

interviewed face-to-face by six trained interviewers using a structured

questionnaire. KAP reliabilities of 0.89, 0.91 and 0.95 were reported in the pilot

sample of 30 cases. The associations between each independent variable and

prevention behavior were tested with chi-square tests. Multiple logistic regression

was used to determine the factors that were significantly associated with

preventive behavior while controlling for the other variables. The results revealed

that 51.69% of the respondents had a high level of knowledge. More than 94% of

the respondents knew that dengue fever is a dangerous communicable disease

and that dengue fever is transmitted from person to person via mosquitoes. More

than half (56.52%) of the participants had positive attitudes toward vector control
 27

measures, and 52.17% exhibited a high level of preventive behavior in terms of

dengue vector control measures. Preventive behaviors were significantly

associated with information provided from sources that included health personnel

(p = 0.038) and heads of villages (p = 0.031) and with knowledge levels (p <

0.001). This study suggests that proactive health education through appropriated

mass media and community clean-up campaigns should strengthen and

encourage community participation, particularly in terms of addressing mosquito

larvae in overlooked places, such as the participants’ own homes, for example, in

flower vases and ant traps.

Prior to community involvement in averting the spread of the dengue

disease, members of the society must be first educated and must acquire

pertinent knowledge in dengue prevention. Yboa and Labrigue (2013) evaluate

the knowledge and practices regarding dengue infections among rural residents

in Samar Province, Philippines. A cross sectional design was adopted for this

investigation. Convenience samples of six hundred forty six (646) residents who

were visiting the rural health units in different municipalities of Samar, Philippines

were taken as participants in study. More than half of the respondents had good

knowledge (61.45%) on causes, signs and symptoms, mode of transmission, and

preventive measures about dengue. More than half of the respondents used

dengue preventive measures such as fans (n = 340, 52.63%), mosquito coil (n =

458, 70.90%), and bed nets (n = 387, 59.91%) to reduce mosquitoes while only

about one third utilized insecticides sprays (n = 204, 31.58%) and screen

windows (n = 233, 36.07%) and a little portion used professional pest control (n =
 28

146, 22.60%). There was no correlation between knowledge about dengue and

preventive practices (p=0.75). Television/Radio was cited as the main source of

information on dengue infections. Findings suggest that better knowledge does

not necessarily lead to better practice of dengue measures. Educational

campaigns should give more emphasis dengue transmissions and on cost

effective ways of reducing mosquito and preventing dengue such as

environmental measures and control. Furthermore, wide range of information,

skills and support must be provided by the government to increase dengue

awareness among residents.

Theoretical Framework

This study is based on the following theories: transformational leadership

theory (Burns, 1978), Joyce Epstein’s (1987, 1996) theory of overlapping

spheres, and Kania and Kramer’s (2011) theory of collective impact outlines the

conditions for effective collaboration for positive, community change.

Among the theories that have significantly changed thinking about

organizational behavior are those that build on the concepts of transformational

leadership. The transformational leader assesses the needs, values and

aspirations of his/her followers, is clear about his/her own values, needs, and

vision, and acts in a manner that promotes the needs of both (Burns, 1978).

There is a recognition of the relationship between the well-being of the individual,

the work group, and the larger organization. Recognizing the social context of

behavior, this type of leadership supports intellectual stimulation by attending to

individual styles and needs for development, while creating a culture in which
 29

employees enhance their own satisfaction while working to promote the good of

the organization. Consequently, workers are likely to invest more energy and

time in the organization than they initially intended. Support for creative problem-

solving takes place in an atmosphere in which mistakes are accepted in the

context of team involvement, commitment and support. Leadership reinforces

activities that contribute to the vitality of the work community by actively

participating followers (workers). The leadership creates an organizational culture

based on openness, trust, and respect, and inspires team spirit (Bass and Avolio,

1993, Bass, 1985). Transformational leadership is empowering and participatory

as it promotes input into decision-making, delegation of tasks and responsibility,

and fosters local leadership. The context of the leadership and followership is

seen as indispensable to understanding organizational problems and building on

individual and group strengths. The acknowledgment of "followership" as a

significant and reciprocal role in relation to "leadership" provides a unique

organizational insight. Leaders cannot be studied in isolation from followers,

constituents, or group members. The leader is a product of group history, culture,

and interactions, and is shaped by such. The organization is envisioned as a

system of interacting members with shared goals, values, and beliefs working

together in a common effort toward mutually agreed on outcomes. The

organization as functional community resounds.

Though community-building takes time, its impact is long-lasting. In order

to implement change in a school environment, creating a common vision is

paramount. The biggest challenge for school leadership is handling different

 30

kinds of people, with various goals and interests. A school leader has to ensure

that students are following curricula, excelling academically, and becoming

outstanding members of society. In comparison, teachers are focused on

meeting curricula deadlines and ensuring that students keep up with class work.

The leader must confront student deviance, as well as teachers’ possible

cynicism and lack of motivation.

Collective Impact (CI) theory posited on the commitment of a group of

actors from different sectors to a common agenda for solving a specific social

problem, using a structured form of collaboration. The concept of collective

impact was first articulated in the 2011 by John Kania and Mark Kramer. The

concept of collective impact hinges on the idea that in order for organizations to

create lasting solutions to social problems on a large-scale, they need to

coordinate their efforts and work together around a clearly defined goal (Kania &

Kramer, 2011). The approach of collective impact is placed in contrast to

“isolated impact,” where organizations primarily work alone to solve social

problems (Schmitz, 2012) and draws on earlier works on collaborative

leadership, focused on collective goals, strategic partnerships, collective and

independent action aligned with those goals, shared accountability, and a

backbone "institutional worrier" (Hank, 2009). Collective impact is based on

organizations forming cross-sector coalitions to make meaningful and

sustainable progress on social issues (Bornstein, 2011). Within the realm of

education, the collective impact strategy has shown persuasive promise.

Conceptual Framework
 31

This study was premised from the concept of the participation of the

community stakeholders on the directives of the Department of Health with

respect to its policy on dengue prevention and control.

The variables of the study are the profiles of the stakeholders in terms of

type of organization, scope of responsibility, number of officials, number of

members and source of funds. Another variable is the respondents’ level of

awareness and compliance to the Department of Health’s dengue preventive

measures. These variables will be gathered through the use of a researcher-

made questionnaire.

Input Process Output

Profile of the Statistical Analysis

respondents in term and Interpretation of
of: Data.
a. stakeholder
affiliation; Significant difference
b. number of on the level of
officials; compliance to DOH’s
c. number of dengue preventive Proposed Plan of
members, and measures according Action to enhance
d. source of funds. to profile variables. the implementation
of the DOH’s
Level of Awareness Significant Dengue Preventive
on the DOH’s dengue relationship between Measures
preventive measures. the level of
awareness and
Level of Compliance compliance to DOH’s
to the DOH’s dengue dengue preventive
preventive measures. measure.

Figure 1. Paradigm of the Study

 32

Chapter 3

RESEARCH METHODOLOGY

This chapter presents the research design, the respondents of the study,

the sampling technique, the instrument to be used, the validation of the

instrument, the administration of the instrument and the statistical treatment of

the data.

Research Design

To be able to answer the problems stated in this research the researcher

made used the quantitative research design. Quantitative research is mostly

conducted in the social sciences using the statistical methods used above to

collect quantitative data from the research study. In this research method,

researchers and statisticians deployed mathematical frameworks and theories

that pertain to the quantity under question. The researcher used the quantitative

approach to describe the level of awareness of the respondents and their level of

compliance to the Department of Health’s dengue preventive measures.

Moreover, the researcher also utilized the causal-comparative method to

compare the significant differences the level of compliance to the DOHs dengue

preventive measure when the respondents were grouped according to their

profile variables. Also, the researcher utilized the correlational design. A

correlational study is a type of research design where a researcher seeks to

understand what kind of relationships naturally occurring variables have with one
 33

another. In simple terms, correlational research was used to figure out if two or

more variables are related and, if so, in what way. This design was used to

determine the between the stakeholders’ level of awareness and level of

compliance to the DOH’s dengue preventive measures.

Respondents and the Locale of the Study

The research was conducted at Pura, Tarlac and the research population

was all the stakeholders of the said locale. The stakeholders were classified

according to the type of stakeholder group they belong to. The groups are (1)

school administrators, (2) teachers, (3) school nurses, (4) medical practitioners,

(5) DSWD 4Ps, (6) barangay local government unit, (7) barangay health workers,

(8) municipal local government unit, (9) municipal health workers, (10) local

business groups, (11) law enforcement, (12) social safety and others. Purposive

convenient sampling was facilitated to determine the samples that will be

considered in the study.

Research Instrument

To gather pertinent data needed to answer the problems of the study, the

researcher developed a self-made instrument. The instrument has three parts.

The first part of the instrument is a checklist which will gather relevant information

regarding the demography of the stakeholders such as type of stakeholder group

they belong, the numbers of officers and members of the group as well as the

group funding.
 34

The second part of the questionnaire is a 5-point Likert scale while will

gather information regarding the stakeholders’ level of awareness to the DOH’s

dengue preventive measure. The third part is also a 5-point Likert scale which

will determine the level of compliance of the stakeholders to the DOH’s dengue

preventive measures. This part of the questionnaire was developed in cognizant

with the existing DOH Policies on dengue prevention. The questionnaire was

then transcribed as an electronic tool using Google Forms.

Validation of the Instrument

After the instruments were constructed, it was submitted for content

validation by five (5) validators that are in the medical field using Bolarinwa’s

pooled-judgment validation. Comments and suggestions will be considered for

the final draft. It was evaluated and approved by the adviser and critic reader

before it was be administered to the respondents. They were provided with a

copy of the instruments and score card for them to rate each question item with

reference to the criteria stipulated in the score card. This activity was done in five

(5) working days. With reference to the score cards accomplished by the

evaluators, the instruments were improved by incorporating their suggestions

and corrections.

Data Gathering Procedure

Prior to data gathering, the researcher first asked permission from the

Schools’ Division Superintendent of the Schools’ Division of Tarlac Province for

the conduct of the study. Upon approval the researcher encoded the
 35

questionnaire into an online survey form using Google Forms. The form was then

sent to target respondents for them to accomplish. The researcher also posted

the link of the online survey form the Municipality of Pura social media page on

Facebook to facilitate data gathering. Raw survey responses were automatically

coded in Google sheet and was then processed and encoded to Microsoft Excel.

Statistical Treatment of Data

Data obtained from the respondent was analyzed using suitable statistical

methods. For the first problem, the researcher will use frequency counts and

percentage distribution for the profile of the respondents according to stakeholder

type, internal funding, distance of office from school and intent of participation.

The researcher used weighted mean to describe the level of awareness

and compliance of the stakeholders to the DOH’s dengue preventive measures.

The Likert Scale below was used for the verbal interpretation

Description Description
Limits of Scales
(Level of Awareness) (Level of Compliance)
4.51 – 5.00 Very Aware Highly Complied
3.51 – 4.50 Aware Complied
2.51 – 3.50 Somewhat Aware Moderately Complied
1.51 – 2.50 Unaware Slightly Complied
1.00 – 1.50 Very Unaware Did Not Complied

To determine the significant difference between the level of participation

when the respondents was grouped according to stakeholder’s type, number of

officials and members of the group, and their groups source of funds the

research used the multiple analysis of variance (MANOVA).

 36

The Pearson product-moment correlation coefficient (Pearson’s r) was

also utilized to determine the relationship between the stakeholders’ level of

awareness on the DOH dengue preventive measures and level of compliance to

the DOH’s dengue preventive measures.

Chapter 4

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter presents the data gathered, the results of the statistical

analysis done and interpretation of findings. These are presented in tables

following the sequence of the specific research problem regarding the level of

awareness and level of compliance of the different stakeholders of Pura, Tarlac

to the Department of Health’s dengue preventive measures.

PROFILE OF THE RESPONDENTS

The success of any program, particularly in the promulgation of health

awareness, rely greatly upon the participation of the groups involve (Haldane,

Chuah, Srivasta, et al, 2019). Community participation is widely believed to be

beneficial to the development, implementation and evaluation of health services.

However, many challenges to successful and sustainable community

involvement remain. Importantly, there is little evidence on the effect of

community participation in terms of outcomes at both the community and

individual level.
 37

This study aims to provide an empirical data regarding the stakeholders’

level of awareness and compliance the Department of Health’s dengue

preventive measure. The data gathered may then be used as a baseline for

dengue awareness program that will benefit the whole community.

The first problem stated in the first chapter of this study is to determine the

profiles of the stakeholders in terms of the type of stakeholder group they belong

in, their responsibility in the group, the numbers of officials in the group, the

number of members in the group and the group funding. All of this data where

presented using the frequency-percentage procedure.

Table 1
Profile of the Respondents
N = 512

Stakeholder Affiliation Frequency Percentage

Teacher 73 14.26
Barangay Health Worker 45 8.79
Municipal Health Worker 41 8.01
School Nurse 39 7.62
School Administrators 38 7.42
Local Business 37 7.23
Public Safety (Fire Protection, Road
37 7.23
Safety, etc)
Barangay LGU 35 6.84
Medical Practitioner 33 6.45
Municipal LGU 32 6.25
Law Enforcement 32 6.25
DSWD 4Ps Recipient 28 5.47
SK Federation 15 2.93
Senior Citizens’ Group 14 2.73
BPO 7 1.37
Pastoral Fellowship 6 1.17
Number of Officers Frequency Percentage
Less than 5 153 29.88
6 to 10 126 24.61
10 to 15 116 22.66
More than 15 117 22.85
Number of Members Frequency Percentage
 38

less than 10 95 18.55

11 to 20 105 20.51
21 to 30 72 14.06
31 to 40 63 12.30
41 to 50 84 16.41
more than 50 93 18.16
Number of Officers Frequency Percentage
Government Fund 407 79.49
Private Corporation 81 15.82
Solicited fund 14 2.73
Member Initiative 10 1.95

The data in Table 1 shows that 73 or 14.26% of the respondents re

affiliated to the teacher’s stakeholder group. These teachers are both from the

public and private schools and are engaged in teaching elementary and

secondary students. Most of the teachers are assigned as health leaders in their

respective schools. School health leaders are teachers who are in-charge of

monitoring and reporting students’ nutritional status, provides programs and

activities which promotes health and nutrition. Teachers are in the forefronts of

combating the menace of the dengue fever. As repository of learning, teachers

can complement community awareness regarding dengue by promoting school-

based dengue programs. It has been found out that school-based dengue control

program can increase the knowledge of students both the cause of dengue and

the vector life cycle, leading to increased participation in controlling larval

breeding sites and the consequent reduction of the number of sites (Montes,

2014).

Dengue reduction programs of the DOH are being cascaded and

implemented in the education sector and that school-based health education is a

commendable tool to enhance knowledge and create awareness among school

 39

children about the seriousness of dengue since this disease is particularly

prevalent among them. In fact, Sam and Omar (2013) recognized that dengue is

most prevalent in the community among the age group of 13 to 35 years old, this

being the age range including school children as well as young adults. School

age children have been encouraged to participate in ongoing household dengue

control activities, such as source reduction, as part of dengue control efforts in

the Philippines (Samuel, 2016).

Forty-five (45) or 8.79% of the respondents are from the barangay health

unit. These group are composed of barangay nurses, midwives and barangay

health worker. This group represents the barangay unit as a component of the

DOH dengue preventive measures. Dengue control can be effectively addressed

with community involvement, especially in the barangay level. In this level,

barangay officials and health workers, in-close coordination with the municipality

health office, implements program such as “Aksyon Barangay Kontra Dengue” or

ABaKaDa. The program is a collaborative project of the DOH and the DSWD in

an effort to stir up community action that will be sustainable, target-driven, and

that can be adopted by LGUs with perennial threats of a dengue epidemic.

ABaKaDa seeks to reinforce the country’s drive against dengue by going back to

the basics of comprehensive vector control supported by environmental

manipulation and modification. The program calls for regular weekly clean-up

drives spearheaded by the barangay leaders and includes the active participation

of community volunteers, civil society and others in government.

 40

Forty-one (41) or 8.01% of the respondents are from the municipal health

workers group. This group is consist of municipal doctors, nurses, pharmacists

and those who works directly under the municipal health office. This group

represent the municipal sector stakeholders. This sector encompasses the whole

municipality and is in-charge in promulgating and cascading the DOH dengue

policies in the barangay and education sector and in mobilizing the community to

combat dengue. Mobilization of community at the municipal level has been found

effective in dengue prevention and control (Aro, 2018). Community mobilization,

however, requires decentralization of resources and powers and high level of

coordination among all stakeholders. Lack of coordination in line agencies and

communities may lead to ineffectiveness of all efforts. Therefore, understanding

community daily problems and developing effective coordination for dengue

prevention is the need of the day.

Consequently, for other stakeholders, 14 or 2.73% of the respondents

composed the Senior Citizen’s group. This group are composed of retired

professionals but are still active in community works. Seven (7) or 1.37% belongs

to the Business Process Outsourcing or call center agent’s group. This group is

composed of respondents who works at call centers. Six (6) or 1.17% of the

respondents belongs to the local pastoral fellowship. This group is composed of

priests, pastors and clerics that caters religious gathering in the locale.

The data in Table 1 further shows that 153 or 29.88% of the respondents

belongs to a group whose officers are less than 5. Majority of these respondents

belongs to the local business group and the medical practitioners’ group, mostly
 41

of which are owned by private individuals. One hundred twenty-six (126) or

24.61% of the respondents belong to a group who have 6 to 10 officers, 117 or

22.85% belongs to a group with more than 15 officers and 116 (22.66%) belongs

to a group with 10 to 15 officers. This data shows that the respondents are, at

most, evenly distributed in terms of the numbers of officers in their respective

groups. Membership in important social groups can promote a positive identity

(Jetten, Branscombe, Haslam, et al, 2015) and communal awareness of health

precautions and procedures (Frank, 2015). The more member a group have, the

more likely dengue awareness might be shared within the group (Wong &

AbuBakar, 2013).

The data in the table also shows that 105 or 20.51% of the respondents

belong to a group who have 11 to 20 members. Ninety-five (95) or 18.55% of the

respondents belong to a group who have less than 10 members. Moreover, 93 or

18.16% of the respondents belong to a group who have more than 50 members,

84 or 16.41% belong to a stakeholder group who have 41 to 50 members, 72

(14.06%) belong to a group with 21 to 30 members and 63 (12.30%) of the

respondents belong to a group who have 31 to 40 members.

The last profile in which the respondents where distributed was according

to the funding source of the stakeholder group they belong to. To be able to

comply with the dengue policy of the Department of Health, each stakeholder

group must have an available fund to sustain and promote the group’s

compliance to DOH policies. The data in Table 5 shows the distribution of the

respondents in terms of their respective group’s source of fund. The data in

 42

Table 1 shows that 407 or 79.49% of the respondents belong to a group who is

being funded by the government. This finding is true to those stakeholders who

belong to the local government units, public school and hospitals, law

enforcement and public safety. Eighty-one (81) or 15.82% of the respondents

belong to a group who have private funding. This is particularly true to those who

belong to the local business owners group, those who work in private hospitals

and companies. There are 14 or 2.73% respondents who belong to a group

whose funding came from solicitations while 10 or 1.95% of the respondents

belong to a group whose funding is from its member’s initiative.

LEVEL OF AWARENESS TO THE DOH’S

DENGUE PREVENTIVE MEASURES

Success of dengue control depends largely on adequate knowledge and

good practices of preventive measures. The Department of Health, through its

Dengue Prevention and Control Program, has enumerated its new dengue

prevention policies. Through the use of the questionnaire specifically constructed

for the study, the respondents’ level of awareness regarding the DOH’s dengue

preventive measure were identified. The data is presented in Table 2.

The data on the table shows that the respondents are aware of the DOH’s

enhanced 4S program (WM = 4.04). This means that the respondents, wherever

group they belong, are aware of the department’s main program in combating the

dengue disease. Majority of the respondents are also aware of the meaning of

the program and how each of the program’s component is facilitated. Majority of

the respondents are aware of the DOH’s 4’o clock habit (WM = 4.03), the
 43

implementation of the “Search and Seek” program (WM = 3.99) and the

importance of checking and eliminating mosquito breeding grounds in my house

and in the community (WM = 4.14). The respondents are aware of the DOH’s

policy of conducting search, seek and destroy possible mosquito breeding places

everyday at 4’o clock in the afternoon. This means that they are aware of the

importance of searching and eliminating breeding grounds of mosquito in their

respective community. Knowledge regarding vector control, when practiced at

the community and household level, is the most effective method in eliminating

dengue carrying mosquitoes. Thus, awareness in this policy will help reduce

dengue transmission.

Table 2
Level of awareness of the stakeholders on
the DOH dengue preventive measures

Frequency WM VI
I am aware of. . . 5 4 3 2 1

The importance of checking and eliminating

mosquito breeding grounds in my house 214 158 140 0 0 4.14 A
and in the community.

Dengue prevention through the use of

implements such as mosquito nets, long
210 151 150 0 1 4.11 A
sleeves clothing and the like.

The importance of seeking medical attention

on the onset of fever with possible dengue
200 166 144 1 1 4.10 A
symptoms.

The DOH’s policy of fogging, spraying and

misting areas which are identified as
195 172 143 1 1 4.09 A
dengue hotspot.

The DOH’s Policy regarding self-protection

measures. 189 163 159 0 1 4.05 A

The importance of sustained hydration 188 170 151 0 3 4.05 A

when having a fever for more than 2 days.
 44

The DOH’s enhanced 4S program.

176 188 143 3 2 4.04 A
The DOH’s 4’o clock habit.
171 195 140 4 2 4.03 A
The importance of using organic and non-
chemical mosquito repellent. 180 167 164 0 1 4.03 A

The implementation of the “Search and

Seek” program. 155 202 145 3 3 3.99 A

Average Weighted Mean 4.06 Aware

Legend:
4.51 – 5.00 = Very Aware (VA); 3.51 – 4.50 = Aware (A); 2.51 – 3.50 = Somewhat Aware (SA); 1.51 – 2.50 =
Unaware (U); 1.00 – 1.50 = Very Unaware (VU); WM = Weighted Mean; VI = Verbal Interpretation

The respondents are also generally aware that dengue can be prevented

by using implements such as using mosquito nets during the night, wearing long

sleeve clothing and pajamas while sleeping can help prevent dengue (WM =

4.11). Furthermore, majority of them are aware of the DOH’s Policy regarding

self-protection measures (WM = 4.05). Also, the respondents are also aware of

the importance of using organic and non-chemical mosquito repellent (WM =

4.03). One sure way of averting contacting the dengue disease is by preventing

mosquito bites. Hence, the best way to prevent dengue is knowledge of

protecting one’s self. Since mosquitoes are most active dusk and early dawn,

knowledge of using such implements will prevent dengue transmission. The use

of mosquito repellents is also important in preventing mosquito bites.

Majority of the respondents are also aware of the importance of seeking

medical attention on the onset of fever with possible dengue symptoms (WM =

4.10). Early diagnosis and adequate supportive care are of great importance in

the management of dengue so as to avoid the development of complications and

 45

severe disease. Thereby, early treatment intervention can reduce the case

fatality rate from 20% to 1% or less (WHO, 2009; Stephenson, 2015).

The respondents are generally aware of the DOH’s policy of fogging,

spraying and misting areas which are identified as dengue hotspot (WM = 4.09).

Thermal fogging of insecticides is a vector control strategy used by the

Department of Health to combat dengue. This method is employed during

outbreaks to curb populations of potentially infectious adult mosquitoes and

interrupt transmission cycles. But though most of the respondents are aware of

the importance of fumigation, the most common reasons why the respondents

reject fumigation is the perception that fumigation affects health or is

unnecessary due to lack of mosquitoes in the home. Thus, awareness of this

policy must be discussed keenly the importance of fumigation during outbreaks.

In general, the respondents are aware of the Department of Health’s

dengue preventive measure evident in the computed average weighted mean of

4.06.

In order to reduce the burden of dengue, the most important method is to

enhance the knowledge, improve the attitude and practice of specific vector

control methods. In this regard, it is advisable to find out the existing level of

awareness of the stakeholders involve on the government’s preventive measures

against the disease. The findings abovementioned implied that the stakeholders

are generally aware of the DOH preventive measures. This suggest that they

have adequate knowledge regarding basic vector controls, self-protection

methods and early consultation. It also shows that the respondents are aware
 46

that g ood knowledge on the mosquito vector and signs and symptoms of dengue

is essential in identifying the disease and in seeking early and appropriate

medical treatment to save lives.

These findings are parallel to the findings of the study conducted by Abiva,

Acain, Arbois, Baluran, Beloy and dela Cruz (2012). This study determined the

level of awareness towards dengue of the residents of Kauswagan, Lanao del

Norte. The findings showed that The respondents have more knowledge about

using mosquito nets as their way of preventing dengue because this practice

has always been a tradition for most Filipinos for it is accessible, affordable and

convenient to use. Mosquito net have been passed down from generations to

generations and people in the communities have always been using it because

for them it is very effective. Synonymously, the current study showed that the

respondents are also aware of the importance of such dengue prevention

implements.

Labrague (2013) also found out in his study conducted in Samar Province

showed that level of knowledge about dengue and preventive practices among

the study population is rather high. However, they face challenges such as

greater access to correct information on dengue. In view of this result, Labgrague

(2013) suggested that government agencies and other non-government

organizations should strengthen its programs on massive educational campaign

to increase awareness and knowledge regarding dengue and preventive

measures to reduce mosquito and prevent dengue.

LEVEL OF COMPLIANCE TO THE DOH’S

 47

DENGUE PREVENTIVE MEASURES

The importance of complying to health policy, particularly with dengue

preventive policies, is one of the biggest factors in keeping the community safe. It

is not only important that stakeholders of the DOH are aware of the dengue

policies, but it is more important that they should practice each. The data in Table

3 detailed the level of compliance of the respondents with regards to the

Department of Health’s dengue preventive measures.

Table 3
Level of Compliance to the DOH Dengue Preventive Measures

Search and Seek Measure 5 4 3 2 1 WM VI

I always convince others to always put all garbage into
252 247 10 0 3 4.46 C
closed bins.
I change the water in plant pots or jars every week.
249 244 14 2 3 4.43 C

I search for containers and other possible mosquito

breeding sites. 238 259 11 1 3 4.42 C

I comply with the DOH’s 4’o clock habit.

228 260 18 2 4 4.38 C

I clean the drain for blockages every 7 days.

224 260 14 2 3 4.38 C

Average Weighted Mean 4.41 Complied

Self-Protection Policy 5 4 3 2 1 WM VI
I don’t usually go to places that are identified as dengue
hotspot. 267 235 7 2 1 4.49 C

I clean the surroundings of my house to eliminate

mosquitoes breeding grounds. 243 260 6 1 2 4.45 C

I wear long pants and long sleeves shirt early in the morning
and late in the afternoon. 239 244 21 6 2 4.39 C

I use mosquito repellant to reduce the possibility of getting

bitten. 234 249 19 17 3 4.38 C

I use mosquito nets when sleeping.

244 239 13 6 10 4.37 C

Average Weighted Mean 4.42 Complied

Seeking Early Consultation Component of the

5 4 3 2 1 WM VI
DOH Dengue Preventive Program
 48

If a household has a fever for two to three days already, I

bring him/her immediately to the health center or hospital for 281 225 3 0 3 4.53 HC
a rapid test to know if it is dengue or not.
If diagnosed with dengue, I follow the recommendations of
doctors to prevent further complications. 269 239 1 2 1 4.51 HC

If a family member has a suspected dengue fever, I usually

recommend sustained hydration. 268 235 5 1 3 4.49 C

I immediately bring family members who have fever and

symptoms of dengue to the nearest health station. 255 252 2 0 3 4.48 C

I educate my household and neighbors about the early

symptoms of dengue fever. 261 240 8 1 2 4.48 C

Average Weighted Mean 4.50 Complied

Support Fogging, Spraying and Misting

Component of the DOH’s Dengue Preventive 5 4 3 2 1 WM VI
Measure
I support the information campaign of the DOH regarding the
importance of fogging, spraying and misting. 271 236 2 2 1 4.51 HC

I support the local health unit’s method of identifying places

that are in need of fogging, spraying or misting. 269 235 5 2 1 4.50 C

I support fogging, spraying and misting in designated

dengue hotspot areas.
257 245 7 2 1 4.47 C

I report immediately to the local health unit areas that are in

need of fogging, spraying or misting. 236 269 3 3 1 4.44 C

I allow health authority to inspect and fog my house anytime.

232 269 7 4 1 4.42 C

Average Weighted Mean 4.47 Complied

Legend:
4.51 – 5.00 = Highly Complied (HC); 3.51 – 4.50 = Complied (C); 2.51 – 3.50 = Moderately Complied (MC);1.51
– 2.50 = Slightly Complied (SC); 1.00 – 1.50 = Not Complied (NC); WM = Weighted Mean; VI = Verbal
Interpretation
It can be gleaned from Table 3 that the respondents complied to the

dengue policy of convincing others to always put all garbage into closed bins

(WM = 4.46), changing the water in plant pots or jars every week (WM = 4.43),

and searching for containers and other possible mosquito breeding sites (WM =

4.42). The respondents also believe that they have complied with the

department’s 4’o clock habit. In general, the respondents believe that they have

complied to the search and seek component of the Department of Health’s

 49

dengue preventive measures evident in the computed average mean of 4.41

which is interpreted as complied.

The findings show that the respondents have complied to the to the

search and seek components of the DOH’s dengue preventive measures. This

means that they practice the 4’o clock habit of seeking and eliminating possible

mosquito breeding sites. Not only that, they also engaged their co-workers and

neighbors of the importance of looking and eliminating possible mosquito

breeding area. Vector control of limiting or preventing the possibility of mosquitos

breeding ground is the most basic and manageable way of controlling dengue

outbreaks (Cardenas, 2019). The primary preventative measure to reduce

dengue infections is the control of mosquito populations. Because the

transmission of dengue requires mosquitoes as vectors, the spread of dengue

can be limited by reducing mosquito populations.

One prominent program of the local LGU in the locale is an environmental

management strategy of eliminating unnecessary container habitats that collect

water (such as plastic jars, bottles, cans, tires, and buckets) in which Aedes

aegypti can lay their eggs. This strategy is called source reduction where

container habitats are removed and water storage containers are covered with a

fine mesh to prevent mosquitoes from getting inside them, mosquitoes have

fewer opportunities to lay eggs and cannot develop through their aquatic life

stages. This program is cascaded to the community and other units of the society

and is regularly monitored since source reduction can be effective when

 50

performed regularly, especially when members of a community are mobilized and

educated about vector control.

The data on Table 3 presents the level of compliance to the self-protection

measures included in the Department of Health’s dengue preventive measures. It

can be gleaned from the table that the respondents complied to the DOH’s policy

of prohibiting themselves in going to places that are identified as dengue hotspot

(WM = 4.49), cleaning the surroundings of their house to eliminate mosquitoes

breeding grounds (WM = 4.45), wearing long pants and long sleeves shirt early in

the morning and late in the afternoon (WM = 4.39), using mosquito repellant to

reduce the possibility of getting bitten (WM = 4.38) and using mosquito nets

when sleeping (WM = 4.37). In general, the respondents believe they have

complied to the self-protection measures included in the DOH’s dengue

preventive measures evident in the computed mean of 4.42 interpreted as

complied.

The findings abovementioned shows that the respondents have complied

to the DOH’s dengue preventive guidelines with respect to self-protection

measures. Complying with dengue preventive practice has been found effective

in reducing the number of infection and fatality (Yboa & Labrague, 2013).

Another important finding was the utilization of dengue preventive measures

such as the bed or mosquito nets, mosquito coils and other control measures.

However, based on follow-up interviews, only a little portion of the respondents

utilize insecticide sprays, professional pest control, and screen windows as ways
 51

to reduce mosquito and prevent dengue. These strategies may be considered as

costly considering that most of the respondents have limited financial capabilities.

The data in Table 3 also shows that the respondent’s level of compliance

to the DOH’s dengue preventive measures in terms of seeking early consultation.

The respondents highly complied to the policy that when one in their household

has a fever for two to three days already, they bring them immediately to the

health center or hospital for a rapid test to know if it is dengue or not (WM = 4.53)

and they also highly complied that when a family member or themselves are

diagnosed with dengue, the follow the doctor’s recommendations to prevent

further complications (WM = 4.51). Furthermore, the respondents also complied

to the policy of bringing family members who have fever and symptoms of

dengue to the nearest health station (WM = 4.48). Also, they complied to the

policy of recommending sustained hydration to family members suspected of

having dengue fever. (WM = 4.49).

This finding suggests that the respondents have complied to the DOH’s

dengue preventive measures in terms of seeking early consultation when having

fever. This is evident in the computed average mean of 4.50. The findings also

suggest that the respondents comply to this preventive measure because they

are aware that it is important to seek early consultation between 1 - 3 days of

fever to immediately recognize the disease. Early dengue diagnosis has been

reported to have reduced dengue mortality (Yboa & Labrague, 2013). Complying

to the policy of sustained hydration which may require the patient to increase
 52

fluid intake, especially Oral Rehydration Solution is also proven to be life-saving

for dengue patients (Yboa & Labrague, 2013).

The data in Table 3 presents the respondents’ level of compliance to the

DOH’s dengue preventive measures with regards to supporting fogging, spraying

and misting when a dengue outbreak occurs. It can be gleaned from the table

that the respondents highly complied to the policy of supporting the information

campaign of the DOH regarding the importance of fogging, spraying and misting

(WM = 4.51) and supporting the local health unit’s method of identifying places

that are in need of fogging, spraying or misting (WM = 4.50). Furthermore, they

complied in the policy of allowing health authority to inspect and fog my house

anytime when an outbreak in the community has been reported (WM = 4.42).

They also complied to the policy of immediately notifying the local health units of

areas that are in need of fogging, spraying or misting (WM = 4.44). In general,

the respondents believe that they have complied to the DOH’s policy of fogging,

misting, or spraying on areas identified with dengue outbreak to avoid further

transmission.

DIFFERENCE IN THE LEVEL OF COMPLIANCE

OF THE STAKEHOLDERS

The researcher utilized a multivariate analysis of variance to determine the

significant difference between the level of compliance of the respondents when

they are grouped according to their profile variables, specifically their stakeholder

affiliation, number of officers and members in the group and source of fund.

The result of the statistical test was presented in Table 5.

 53

Table 4
Difference in the Level of Compliance of the Stakeholders
when Grouped Along their Profile Variables

Profile Variable Wilk’s λ p-value Interpretation

Stakeholder Affiliation 0.774** 0.001 Significant
Number of Officials 0.974 0.381 Not Significant
Number of Members 0.924** 0.008 Significant
Source of Fund 0.948* 0.011 Significant
**significant at 1% level of significance
* significant at 5% level of significance

It can be gleaned from the table that there is a significant difference

between the level of compliance of the respondents when they are group

according to their stakeholder affiliation; Wilk’s λ = 0.774, p < 0.05. Hence, the

null hypothesis stating that there is no significant difference between level of

compliance of the respondents when they are grouped according to their

stakeholder affiliation is rejected. This suggest that level of compliance vary

significantly by stakeholder affiliation. The result of the post hoc test suggests

that the level of compliance of the DSWD 4Ps group and the local business

group is significantly different and lower compared to the other groups.

There is also a significant difference between the level of compliance

when they are grouped according to the number of members in their stakeholder

group; Wilk’s λ = 0.924, p < 0.05. Hence, the null hypothesis stating that there is

no significant difference between level of compliance of the respondents when

they are grouped according to the number of members in their stakeholder group

is rejected. This means that the level of compliance varies significantly by

number of members in the group. The result of the post hoc test suggests that

group with less than 5 members have significantly different and lower level of

compliance compared to the other group.

 54

Further, there is also a significant difference between the level of

compliance of the stakeholders when they are grouped according to their group’s

source of fund; Wilk’s λ = 0.948, p < 0.05. Hence, the null hypothesis stating that

there is no significant difference between level of compliance of the respondents

when they are grouped according to their group’s source of fund is rejected. This

suggests that the level of compliance varies significantly by the group’s source of

funds. The post hoc test further suggests that the level of compliance to the

DOH’s dengue preventive measures of the group whose funding is solicited and

member’s initiative is significantly different and lower than those who have

government funding and private funds.

Consequently, no significant difference existed between the level of

compliance of the respondents when they are grouped according to the number

of officers in their group. Hence, the null hypothesis stating that there is no

significant difference between level of compliance of the respondents when they

are grouped according to the number of officers in their group is failed to be

rejected. This suggests that the stakeholders have significantly the same level of

compliance regardless of the numbers of officers in their group.

The findings presented above shows that those who belong to the DSWD

4Ps group have statistically different level of compliance. This implies that those

who belongs to the marginalized sectors have varying degree of compliance to

the DOH dengue policy. Mulligan et al (2015) posited the association between

economic status and compliance to dengue preventive measures. He found out

that there is a positive association between measures of policy compliance and

 55

poverty. He suggested that to improve compliance, intersectoral coordination

meetings should be conducted to identify possible partners for public education

dengue control campaigns to help finance the program/activities. Reorientation

training of community health workers should be conducted regularly to improve

their technical skills and capability, and their ability to supervise prevention and

control activities.

RELATIONSHIP BETWEEN LEVEL OF AWARENESS

AND LEVEL OF COMPLIANCE

To determine the relationship between respondents’ level of awareness

and their level of compliance to the DOH’s dengue preventive measures, the

researcher utilized the Pearson’s r statistical test. The result of the statistical test

is presented in Table 6.

Table 5
Relationship Between the Stakeholders’ Leve of Awareness and Level of
Compliance to the DOH Dengue Preventive Measures

Level of Awareness
Level of compliance Interpretation
r-value p-value
Search and Seek .215** 0.000 Significant

Self-Protection Measures .090* 0.042 Significant

Seek Early Consultation .345** 0.000 Significant

Support Fogging, Spraying and Misting .249** 0.000 Significant

Overall level of compliance .281** 0.000 Significant

*Correlation is significant at the 0.05 level (2-tailed).

**Correlation is significant at the 0.01 level (2-tailed).

The result of the statistical test shows that there is a significant

relationship between the level of awareness of the respondents and their level of

compliance to the search and seek policy of the DOH’s dengue preventive
 56

measures; r = 0.215, p < 0.000. Hence, the null hypothesis stating that there is

no significant relationship between the respondents’ level of awareness and their

level of compliance to the search and seek policy is rejected. This result further

shows that there is a significantly low linear relationship between their level of

awareness and level of compliance to the search and seek policy of the DOH’s

dengue preventive measures. This suggests that the higher the level of

awareness of the respondents to the DOH’s dengue preventive measures the

higher their level of compliance will be to the search and seek measures of the

said policy.

The finding above shows that when the respondents are becomes more

aware of the importance of checking and eliminating mosquito breeding grounds

in my house and in the community, of the DOH 4’o clock habit and other vector

control method, the also become more compliant to the DOH’s search and seek

measures. Thus, enhancing the respondents’ awareness of these procedures will

have a positive effect on their compliance to the said measure.

There is also a significant relationship between the respondents’ level of

awareness and their level of compliance to the Self-Protection Measures of the

DOH’s dengue preventive policy; r = 0.090, p < 0.05. Hence, the null hypothesis

stating that there is no significant relationship between the respondents’ level of

awareness and their level of compliance to the Self-Protection Measures is

rejected. The finding also suggests that there is a significantly low linear

relationship between the level of awareness and level of compliance. It can also

be concluded, therefore, that the higher the level of awareness of the

 57

respondents to the DOH dengue preventive measures the higher their level of

compliance to the self-protection measures policy will be.

The finding suggests that when the respondents become more aware of

the importance of using self-protection measures such as mosquito and insect

repellants, they become more compliant to the DOH’s self-protection policies

under the dengue preventive program. Hence, enhancing the awareness of the

respondents regarding the use of dengue prevention materials and implements

will have a significant effect on their compliance to the said policy.

Further, a significant relationship was also reported between the level of

awareness of the respondents and their level of compliance to the early

consultation policy of the DOH’s dengue preventive measures; r = 0.345, p <

0.000. Hence, the null hypothesis stating that there is no significant relationship

between the respondents’ level of awareness and their level of compliance to the

early consultation policy is rejected. It can also be noticed that there is a

significantly low linear relationship between the two levels. Hence, a the higher

the level of awareness of the respondents to the DOH’s dengue preventive

measures the higher their compliance to the early consultation policy of the said

measure will be.

This finding further suggests that when the respondents becomes more

aware of the importance of seeking medical attention on the onset of fever with

possible dengue symptoms and sustained hydration when having a fever for

more than 2 days, they become more compliant to the DOH policy of seeking

early medical consultation to above dengue complications as listed in the

 58

department’s dengue preventive measure. Thus, enhancing the respondents’

level of awareness regarding the importance of seeking medical attention on the

onset of fever have a significant effect on their level of compliance to the early

consultation policy under the DOH’s dengue preventive measures.

And lastly, a significant relationship also existed between the level of

awareness and the respondents’ level of compliance to the fogging, misting and

spraying policy of the DOH’s dengue preventive measures; r = 0.249, p < 0.000.

The null hypothesis stating that there is no significant relationship between the

respondents’ level of awareness and their level of compliance to the fogging,

misting and spraying policy of the DOH’s dengue preventive measures is

therefore rejected. Also, the statistical result further shows that there is a

significantly low linear relationship between the two levels. Hence, the higher the

level of awareness the respondents have will also produce a higher level of

compliance to the to the fogging, misting and spraying policy of the DOH’s

dengue preventive measures.

In general, the statistical results showed that there is a significant low

positive relationship between the level of awareness and level of compliance as

shown by the computed r-values with corresponding p-values which are all lower

than the set 0.05 level of significance. This means that the higher the awareness

the higher also is the level of compliance in all the four areas.

PLAN OF ACTION TO ENHANCE THE IMPLEMENTATION

OF THE DOH DENGUE PREVENTIVE MEASURE
 59

Table 6
Plan of Action

Time Person/s Funding

Objectives Strategies Activities
Frame Involved Sources
Conduct an
enhanced
Re-orient the orientation to
Barangay LGU the Barangay
and Health LGU and Officer-in-
workers Health units as Charge of
To enhance the regarding the to the the
implementation implementation implementation Municipal
Every of the DOH of the DOH of the DOH’s Health
Municipal
June Dengue Dengue Enhanced 4S Office,
Health
and Preventive Preventive Program. Barangay
Fund
July Measure in the Program. Officials
Municipal Discuss to the and
Level. Disseminate Barangay LGU Barangay
the Municipal and Health Health
Dengue Units the Workers
Prevention Municipalities
Program Dengue
Prevention
Program
Conduct a
meeting and
orientation with
business
owners in the
Send letters to
municipality
all local
regarding the
business
DOH dengue Officer-in-
owners in the
To involve the preventive Charge of
municipality.
business sector measures. the
in the Municipal Municipal
Every Construct a
implementation Encourage Health Health
March Memorandum
of the DOH’s business Office, Fund
of Agreement
Enhanced 4S owners to local
involving the
program. participate in business
municipality
the owners
and the
municipality’s
business
dengue
owners.
prevention
program
through a
Memorandum
of Agreement
Year – To Monitor the Create a Orient families Barangay Barangay
Round Implementation dengue in the officials, Health fund
 60

community on
how to
implement the
DOH’s dengue
preventive
measures in
their own
monitoring household.
system.
head of
Create a
the
Conduct an dengue
of the DOH’s Barangay
extensive monitoring
Enhanced 4S Health
orientation system which
Program in the Unit,
program will determine
community Residenc
regarding the the degree of
e of the
DOH’s dengue compliance of
Barangay.
preventive every area in
measure. the barangay
giving incentive
to those who
perform
outstandingly in
the
implementation
of the program.
 61

Chapter 5

SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the summary of the research, conclusions, and

recommendations of the researchers regarding the topic ventured. The

researchers summarized the study in order for the readers to answer the

problems regarding the topic of this research while recommendations are for the

development of the present status about the topic presented by the researchers.

Summary of Findings

The following are the salient findings of the study:

1. Majority (73 or 14.26%) of the respondents belongs to the Teachers’ group,

Barangay Health Workers’ group (8.79%) and Municipal Health Workers’

group (8.01%) while the others are distributed mostly evenly on the other

stakeholder groups. Other stakeholder groups were represented by 8.20% of

the respondents and are distributed among the BPO group (1.37%), Pastoral

Fellowship’s group (1.17%), Senior Citizens group (2.73%) and SK

Federation group (2.93%). Majority of the respondents belong to a group with

less than 5 officers (29.88%) while the rest are distributed mostly evenly with

groups having 6 to 10 officers (24.61%), 10 to 15 officers (22.66%) and more

than 15 officers (22.85%). Majority of the respondents belong to a group with

11 to 20 members (20.51%). There are also 95 (18.55%) respondents who

belong to a group with less than 10 members and 93 (18,16%) belong to a

 62

group with more than 50 members. Eighty-four (84) or 16.41% belongs to a

group whose members are 41 to 50 persons while 72 (14.06%) belongs to a

group with 21 to 30 members. Lastly, 63 (12.30%) of the respondents belong

to a group with 31 to 40 members. Majority of the respondents (79.49%)

belong to a group whose funding came from the government. Eighty-one (81)

or 15.82% of the respondents belong to a group who have private funding,

while 14 (2.73%) and 10 (1.95%) of the respondents belong to a group whose

funding is from solicitation and the initiative of the members respectively.

2. The respondents are aware of the DOH’s enhanced 4S program (WM = 4.04,

Aware) as well as the DOH’s 4’o clock habit (WM = 4.03, Aware). They are

also aware of the implementation of the “Search and Seek” program (WM =

3.99, Aware). Findings suggests that the respondents are aware of the

dengue Vector Control program of the government. The respondents are also

aware of the DOH’s self-protection measures (WM = 4.05, Aware). In general,

the respondents are Aware of the DOH’s dengue preventive measure.

3. The respondents comply to the “Search and Seek” program of the DOH (WM

= 4.41, Complied). Findings suggest that the respondents comply with the

DOH’s 4’o clock habit, search for containers and other possible mosquito

breeding sites, change the water in plant pots or jars every week, clean the

drain for blockages every 7 days and convince others to always put all

garbage into closed bins. This means that the respondents have a high level

of compliance to the said policy. Also, the respondents comply to the Self-

Protection Measures of the DOH’s dengue prevention policy (WM = 4.42,

 63

Complied). This means that they wear long pants and long sleeves shirt early

in the morning and late in the afternoon, use mosquito repellant to reduce the

possibility of getting bitten, use mosquito nets when sleeping, clean their

surroundings of my house to eliminate mosquitoes breeding grounds and they

don’t usually go to places that are identified as dengue hotspot. This finding

suggests that the respondents have a high level of compliance to the Self-

Protection Measures of the DOH’s dengue prevention policy. The

respondents comply to the early consultation policy of the DOH’s dengue

preventive measure (WM = 4.50, Complied). This suggests that the

respondents immediately bring family members who have fever and

symptoms of dengue to the nearest health station, recommend sustained

hydration when a family member has a flu, educate their household and

neighbors about the early symptoms of dengue fever and follow the

recommendations of doctors to prevent further complications. This finding

shows that the respondents have a high level of compliance to the early

consultation policy of the DOH’s dengue preventive measure. The

respondents comply to the systematic fogging, misting and spraying during

dengue outbreak (WM = 4.47, Complied). This means that the respondents

support fogging, spraying and misting in designated dengue hotspot areas,

allow health authority to inspect and fog my house anytime, support the

information campaign of the DOH regarding the importance of fogging,

spraying and misting, support the local health unit’s method of identifying

places that are in need of fogging, spraying or misting and report immediately
 64

to the local health unit areas that are in need of fogging, spraying or misting.

This finding suggests that the respondents have a high level of compliance to

the systematic fogging, misting and spraying program of the DOH during

dengue outbreak. In general, the respondents comply (WM = 4.45) to the

DOH dengue preventive measures.

4. There is a significant difference between the level of compliance to the DOH

dengue preventive measures in terms of stakeholder affiliation (0.001),

number of members (0.008) and source of fund (0.011) but not significant in

terms on the number of officers (0.381).

5. There is a significant relationship between the level of awareness and

compliance along the stakeholders to all the DOH preventive measures along

search and seek (0.000), self-protection measures (0.05), seek early

consultation policy (0.000) and support to systematic fogging, misting and

spraying (0.000).

6. There is a proposed plan of action to enhance the implementation of the DOH

dengue preventive program.

Conclusions

Base on the findings listed above, the following conclusion were

formulated:

1. Majority of the respondents are from the teachers’ group with less than 5

officers, and with 11 to 20 members and is funded by the government.

2. The respondents are aware of the Department of Health’s dengue preventive

measures.
 65

3. The respondents complied to all the DOH dengue preventive measures along

the search and seek components, self-protection measures, early

consultation policy and the systematic supporting fogging, spraying and

misting program of the DOH’s dengue preventive measure.

4. The level of compliance varies significantly by stakeholder affiliation, number

of members in the stakeholder group and the group’s source of fund. Post

hoc test suggests the respondents belonging to the DSWD 4Ps group, the

local business group, the group with less than 5 members, and the group

whose funding is based on solicitation and member initiative have significantly

lower level of compliance.

5. The level of awareness affects the level of compliance to the DOH dengue

preventive program.

6. There is a plan of action to standardized the implementation of the DOH

dengue preventive measures.

Recommendations

With thorough analysis of the findings and conclusions of the study, the

following recommendations were carefully formulated and conceptualized:

1. It is recommended that the local government unit should put emphasis on

activity that will improve the stakeholder’s awareness of the dengue

preventive measures. Teachers from the municipality may be tapped by the

local government as an instructional support unit that will help barangay

health officials in the promulgation of the DOH dengue preventive measures.

 66

2. Strict group monitoring should be conducted by the municipal health unit to

determine the extent to which the DOH dengue preventive is being observed

in the barangay level, as well as in business and in private and public

schools.

3. An extensive re-orientation program should also be conducted by the

municipal health unit to address the differences in the level of compliance of

the different stakeholders group giving special attention to those who belong

in the 4Ps group and business group.

4. The municipal health office should also focus in enhancing the level of

awareness of the stakeholders on the DOH dengue preventive measures by

providing seminars in the community-level as well since it was found out the

these will have an impact on the respondent’s level of compliance to the DOH

dengue preventive programs.

5. The recommended plan of action should also be adopted by the municipal

health unit as a way to enhance the implementation of the DOH dengue

preventive measures.

6. Further research should also be conducted by other researchers taking into

consideration the level of readiness of the municipality during dengue

outbreaks.
67
 68

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Appendix A

Research Instrument

PART 1: Respondent’s Demography

Name (Optional): ________________________________________________

What type of Stakeholder group are you incorporated (Check one that applies to
you):

____ School Administrators

____ Teacher
____ School Nurse
____ Medical Practitioners
____ DSWD 4P’s Recipient
____ Barangay LGU
____ Barangay Health Worker Group
____ Municipal LGU
____ Municipal Health Worker
____ Local Business
____ Law Enforcement
____ Social Safety (Fire Protection, Road Safety, Security Agency, etc.)
Others : ____________________

How many officials/officers do your group have?

____ Less than 5

____ 6 to 10
____ 10 to 15
____ More than 15

How many members do your group have?

____ less than 10

____ 11 to 20
____ 21 to 30
____ 32 to 40
____ 41 to 50
____ more than 50
 75

How is your group being funded?

____ Government Fund

____ Private Corporation
____ Member Initiative
____ Solicited fund

PART 2: Level of Awareness of the DOH’s Dengue Control and Prevention

Policy

Each item in this questionnaire will determine your level of awareness regarding
the DOH dengue preventive measures following the Enhanced 4s Strategy. Put a
check (✔) on the box that is true to you using the scale given below:

5 Very Aware
4 Aware
3 Somewhat Aware
2 Unaware
1 Very Unaware

I am aware of. . . 5 4 3 2 1
1. The DOH’s enhanced 4S program
2. The DOH’s 4’o clock habit
3. The implementation of the “Search and Seek”
program.
4. The importance of checking and eliminating
mosquito breeding grounds in my house and in
the community.
5. The DOH’s Policy regarding self-protection
measures.
6. The importance of using organic and non-
chemical mosquito repellent.
7. Dengue prevention through the use of
implements such as mosquito nets, long
sleeves clothing and the like.
8. The importance of seeking medical attention on
the onset of fever with possible dengue
symptoms.
9. The importance of sustained hydration when
having a fever for more than 2 days.
10. The DOH’s policy of fogging, spraying and
misting areas which are identified as dengue
hotspot.
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PART 3: Level of Compliance to the DOH’s Dengue Control and Prevention

Policy

Each item in this questionnaire will determine the level on which you comply on
the DOH’s Policy to control and prevent dengue. Put a check (✔) on the box that
is true to you using the scale given below:

5 Highly Complied
4 Complied
3 Moderately Complied
2 Slightly Complied
1 Did Not Complied

Search and Seek 5 4 3 2 1

1. I comply with the DOH 4’o clock habit.
2. I search for containers and other possible
mosquito breeding sites.
3. I change the water in plant pots or jars every
week.
4. I clean the drain for blockages every 7 days.
5. I always convince others to always put all
garbage into closed bins.
Self-Protection Measures 5 4 3 2 1
1. I wear long pants and long sleeves shirt early in
the morning and late in the afternoon.
2. I use organic, non-chemical mosquito repellant.
3. I Use mosquito nets while sleeping.
4. I clean the surroundings of my house to
eliminate mosquitoes breeding grounds.
5. I don’t usually go to places that are identified as
dengue hotspot.
Seek Early Consultation 5 4 3 2 1
1. I immediately bring family members who have
fever and symptoms of dengue to the nearest
health station.
2. If a family member has a fever, I usually
recommend sustained hydration.
3. I educate my household and neighbors about
the early symptoms of dengue fever.
4. If a household has a fever for two to three days
already, I bring him/her immediately to the
health center or hospital for a rapid test to know
if it is dengue or not.
 77

5. If diagnosed with dengue, I follow the

recommendations of doctors to prevent further
complications.
Support Fogging, Spraying and Misting
1. I support fogging, spraying and misting in
designated dengue hotspot areas.
2. I allow health authority to inspect and fog my
house anytime.
3. I support the information campaign of the DOH
regarding the importance of fogging, spraying
and misting.
4. I support the local health unit’s method of
identifying places that are in need of fogging,
spraying or misting.
5. I report immediately to the local health unit
areas that are in need of fogging, spraying or
misting.

THANK YOU VERY MUCH

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Appendix B
Electronic Form of the Research Questionnaire
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Appendix C

Questionnaire Validation Tool

Republic of the Philippines

PANGASINAN STATE UNIVERSITY
School of Advanced Studies
Urdaneta City, Pangasinan

June 25, 2020

NAME
Designation

Sir/Ma’am

Greetings!

The undersigned is a graduating student of Master’s in Education at the

University of Pangasinan undertaking her research entitled “Stakeholders’
Compliance on the DOH Dengue Preventive Measures”.

With your expertise, I am humbly asking your permission to validate the attached
survey questionnaire for the research using the prescribed rating tool.

I am looking forward that my request would merit your positive response.

Thank you and more power.

Respectfully Your,

ANTONETTE T. MELEGRITO
Researcher

Noted by:

HONELLY MAE S. CASCOLAN, PhD

Adviser
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POOLED-JUDGMENT QUESTIONAIRE VALIDATION

The questionnaire is divided into two parts (1) a set of question to determine the
respondents’ level of awareness regarding the DOH’s dengue preventive
measures following the Enhanced 4s Strategy and (2) will determine the level on
which you comply on the DOH’s Policy to control and prevent dengue. Please
rate the following items in a scale of 1 to 5 (1 being the lowest and 5, the highest)
based on the given criteria. Thank you very much for your time and effort.

PART 1: Level of Awareness of the DOH’s Dengue Control and Prevention

Policy

Items Criteria
I am aware of. . . Objectivity Clarity Readability Comprehensiveness
11. The DOH’s enhanced 4S
program
12. The DOH’s 4’o clock habit
13. The implementation of the
“Search and Seek” program.
14. The importance of checking
and eliminating mosquito
breeding grounds in my
house and in the community.
15. The DOH’s Policy regarding
self-protection measures.
16. The importance of using
organic and non-chemical
mosquito repellent.
17. Dengue prevention through
the use of implements such
as mosquito nets, long
sleeves clothing and the like.
18. The importance of seeking
medical attention on the
onset of fever with possible
dengue symptoms.
19. The importance of sustained
hydration when having a
fever for more than 2 days.
20. The DOH’s policy of fogging,
spraying and misting areas
which are identified as
dengue hotspot.
 91

Part 2: Level of Compliance to the DOH’s Dengue Control and Prevention Policy

Items Criteria
Search and Seek Objectivity Clarity Readability Comprehensiveness
1. I comply with the DOH 4’o
clock habit.
2. I search for containers and
other possible mosquito
breeding sites.
3. I change the water in plant
pots or jars every week.
4. I clean the drain for
blockages every 7 days.
5. I always convince others to
always put all garbage into
closed bins.
Self-Protection Measures Objectivity Clarity Readability Comprehensiveness

1. I wear long pants and long

sleeves shirt early in the
morning and late in the
afternoon.
2. I use organic, non-chemical
mosquito repellant.
3. I Use mosquito nets while
sleeping.
4. I clean the surroundings of
my house to eliminate
mosquitoes breeding
grounds.
5. I don’t usually go to places
that are identified as dengue
hotspot.
Seek Early Consultation Objectivity Clarity Readability Comprehensiveness

1. I immediately bring family

members who have fever and
symptoms of dengue to the
nearest health station.
2. If a family member has a
fever, I usually recommend
sustained hydration.
3. I educate my household and
neighbors about the early
symptoms of dengue fever.
4. If a household has a fever for
two to three days already, I
bring him/her immediately to
 92

the health center or hospital

for a rapid test to know if it is
dengue or not.
5. If diagnosed with dengue, I
follow the recommendations
of doctors to prevent further
complications.
Support Fogging, Spraying Objectivity Clarity Readability Comprehensiveness

and Misting
1. I support fogging, spraying
and misting in designated
dengue hotspot areas.
2. I allow health authority to
inspect and fog my house
anytime.
3. I support the information
campaign of the DOH
regarding the importance of
fogging, spraying and
misting.
4. I support the local health
unit’s method of identifying
places that are in need of
fogging, spraying or misting.
5. I report immediately to the
local health unit areas that
are in need of fogging,
spraying or misting.

COMMENT:
________________________________________________________________
________________________________________________________________
________________________________________________________________

SUGGESTIONS:
________________________________________________________________
________________________________________________________________
________________________________________________________________

Adapted from:

Bolarinwa, OA (2015). Principles and methods of validity and reliability testing of questionnaires
used in social and health science researches. Niger Postgrad Med J [serial online] 2015
[cited 2020 Jun 25];22:195-201. Available from: http://www.npmj.org/text.asp?
2015/22/4/195/173959
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Appendix D
Letters to the Validators

Curriculum Vitae
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CURRICULUM VITAE