Republic of the Philippines

San Juan High School Inc.

Pob. West, Moalboal, Cebu

Factors affecting COVID-19 Vaccine Hesitancy among

Senior High Schools Students

Christine Mae Belonguel

 CHAPTER 1
THE PROBLEM AND ITS SCOPE
Introduction
Globally, mass vaccination for Coronavirus Disease 2019 (COVID-19) is
underway. The World Health Organization (WHO) in partnership with different
organizations and COVID-19 response team are on speeding up the vaccination
after they approved and confirmed a vaccine as quality, safe and effective
(McKenna, 2021). The organization emphasized that, vaccines that has been
released are clinically trialed and had undergone general stages.
Meanwhile, vaccine hesitancy is growing worldwide. In fact, WHO
identifies vaccine hesitancy as one of the health threats despite the availability and
consistency of the vaccine. Many countries around the world present vaccine
hesitancy and misinformation as a primary obstacle in obtaining community
immunity. Multiple channels spread misinformation about vaccine and COVID-19
existence together. Thus, governments and health officials must be prepared to
address vaccine literacy.
In this study, the researchers aim to investigate and analyze the factors
affecting COVID-19 vaccine hesitancy among the residents in the municipality of
Badian, Cebu. The residents will be asked certain questions for the purpose of
recording their knowledge and opinions regarding the aforementioned matter.
Moreover, it is very important to determine and understand why there is a
significant number of people who are reluctant about taking COVID-19 Vaccines.
The purpose of this study is to evaluate the different factors influencing vaccine
hesitancy and the final decision of the residents whether to get vaccinated or not
after acquiring clear and accurate information about COVID-19 vaccines. This will
also provide awareness to those residents who are less informed or misinformed
about the vaccines and will give way to addressing COVID-19 vaccine hesitancy.
Conceptual Framework
This conceptual framework serves as the research scheme of this study. It
adopts the system approach known as the input-process-output model. It is
composed of two cycles namely: the cycle 1 (Qualitative Research) and Cycle 2
(Quantitative Research).
The Input of the study in cycle 1 is composed of two parts, Part 1 shows the
demographic profile of the respondents, Part 2 contains the nature or the profile of
the vaccines employed by the government, it includes the name, the benefits and
the side effects.
Accordingly, in the process box, it consists the, enabled steps inthe data gathering
procedure, the processing of the research instrument, the item analysis and the
interpretation of the data after answering the preliminary survey. The output box
includes the themed factors with accordance to the responses of the respondents
from the preliminary survey.
In the second cycle, the input box is also composed of two parts. Part 1
includes the demographic profile of the selected respondents. The part 2 contains
the themed factors or the output of cycle 1.
In the process box, different processes are included such as the enabled steps
in data gathering, the formulation of the final survey questionnaires, the statistical
analysis and tabulation of the gathered data and lastly the formulation of the
conclusion. The Output box includes the expected action or solution which is the
radio broadcasting and the respondent’s final decision with regards to the issue.
For the main purpose of the study, the output box is given to gather data and
assess the respondent's stand against the emerging COVID-19 vaccination.
Statement of the Problem
Specifically, this study aims to determine and evaluate:
1. The different factors that the local residents of Badian have to consider
before getting vaccinated.
2. How these factors would affect their decision of getting vaccinated.
3. The actions to be done to address vaccine hesitancy.
4. If there is a change of attitude observed after providing clear and accurate
information about COVID-19 vaccine.

Hypotheses
No: There is no significant difference between the initial decision and the decision
made after the action is taken.
Na: There is a significant difference between the initial decision and the decision
made after the action is taken.

Scope and Delimitations

The main focus of this study was to determine the factors affecting COVID-
19 Vaccine Hesitancy and had targeted the rural area of Badian, Cebu, with 10% of
its local residents as the respondents, chosen to represent the total population.
This study solely uncovered the factors as to why people would think twice
about getting vaccinated with any COVID-19 vaccines, and other such as gender,
age, and social status are irrelevant and beyond its scope. The researchers
conducted the study, following the time frame, April to June 2021.

Significance of the Study

The result of this study will be beneficial to the following:
Rural Health Unit.The result of this study will give awareness and knowledge to
the RHU as to why there is hesitancy among the residents of Moalboal, Cebu.
People who are not yet to decide whether they want to be vaccinated or not.
The finding of this study will provide more knowledge and awareness as to why
there is a resistance to COVID -19 vaccination.
People who are less informed about the situation. The situation will be addressed
in such a way the people who are less informed will understand what are the
problem which made the reluctance or desire to be vaccinated arose.
Future researchers. The data found will be beneficial to the future researchers as
it will provide knowledge to the subject of research. Furthermore, it will encourage
future researchers to conduct more studies regarding the topic of the study.

Definition of terms
Coronavirus Disease 2019 (COVID-19) – is defined as illness caused by a novel
coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2; formerly called 2019-nCoV).
DENGVAXIA (Dengue Tetravalent Vaccine, Live) – is a vaccine indicated for
the prevention of dengue disease caused by dengue virus serotypes 1, 2, 3 and 4.
Sinovac Biotech Ltd – is a Chinese biopharmaceutical company that focuses on
the research, development, manufacture and commercialization of vaccines.
Vaccination – is a simple, safe and effective way of protecting people against
harmful diseases, before they come into contact with them.
Vaccination hesitancy – refers to delay in acceptance or refusal of vaccines
despite availability of vaccine services.
 CHAPTER 2
REVIEW OF RELATED LITERATURE AND STUDIES
Legal Basis
Republic Act No. 10152 Section 15 Article II of Constitution states: "State
shall protect the right to health of people and instill health consciousness among
them".
The Philippine Government has been doing their best to provide adequate
healthcare especially to those infected and frontline health workers who are prone
to the virus. This statement is supported by, The Bayanihan to Heal as One Act
known as "Bayanihan Act" designated as Republic Act No. 11469. Stated in the
first phase of this law, is to provide medical frontliners with Personal Protective
Equipment (PPE), accommodations, risk allowances and other benefits. This law
also gives every frontliners the support from the government and health
organizations in developing and innovating solutions for COVID-19 virus.
After a year, mass spreading of virus continues but, the government believes
that with mass vaccination it could help lessen the spreading and virus could
dissipate, that is why the Republic Act No. 115251 or known as " COVID-19
Vaccination Program Act of 2021" has been signed by President Rodrigo Roa
Duterte to establish the Corona Virus Disease (COVID-19) Vaccination Program.
This law is declared to address the adverse impact of COVID-19 through the
procurement and administration of safe and effective COVID-19 vaccines through
National Government.
Today, mass vaccination in the country is underway but according to the
latest Pulse Asia survey released last March, 6 out of 10 Filipinos refuse to be
inoculated with the COVID-19 vaccine. The Department of Health (DOH) says,
vaccination is not mandatory but they highly encourage the public to get
vaccinated and be protected. Anyone who will refuse and not to vaccination is not
protected by any law, and it is not also a responsibility but a choice and the right
to every person.
Related Literature
According to Eckersberger E., et. al. (2015) wrote an article entitled
“Strategies for addressing vaccine hesitancy – A systematic view” stating that the
strategies in responding to the issue of vaccine hesitancy and its implementation
has its own potential effectiveness. This review has a purpose in identifying and
describing this potential. This research team performed methods in a strategy
capturing several corners of public trust concerning vaccines. The results of their
efforts showed that vaccine hesitancy is caused by different reasons making the
reluctance a complex topic.Strategies should be identified to fight against this
issue.
In the article of Dudley M. Z., et. al. (2015)entitled “Vaccine hesitancy:
causes, consequences, and a call to action”, the author stated that vaccine hesitancy
is a decision which is affected by factors including the vaccine's nature, health
outcomes, unfamiliarity to the vaccine, and the lack of trust towards groups and
public health agencies. Vaccine hesitancy is a decision that resulted from the
outbreaks of diseases that made children suffer and waste the limited resources
from public health agencies. Due to the nature of vaccine hesitancy, it became an
important issue and should be addressed. This requires a broader approach using
standardized measurement tools to better understand the issue of trust. Vaccines
has the potential of preventing diseases and save lives but depends directly on
parental acceptance of vaccines.
In the article of Bramadat P., et. al. (2013), entitled "Vaccine hesitancy: an
overview", vaccination is considered by individuals as unsafe and is not of need.
This hesitancy became a threat to the vaccination programs. The scope of the
vaccination decreased due to the people's hesitancy. Risks of spreading or
outbreaks of diseases increased due to this matter.
Macdonald N. E. (2015) wrote an article entitled "Vaccine hesitancy:
Definition, scope and determinants" left a statement that the reluctance of being
vaccinated is the cause of the delay of the vaccination programs as stated by the
SAGE Working Group on Vaccine Hesitancy. Despite the availability of the
vaccines, people still choose to be unvaccinated. The Working Group determined
that vaccination hesitancy of an individual is influenced by factors under these
three categories: contextual, individual and group, and vaccination-specific
influences. The reluctance of being vaccinated is a complex topic.
In the article of Jacobson R. M., et. al. (2015) entitled "Vaccine Hesitancy",
vaccination hesitancy dates back to the 1800's. This reluctance caused the delay of
vaccination and received a lot of attention from the stress. A lot of factors in a
variety emerged against the vaccination. This is including the thought of
individuals in balancing the benefits and risks in getting vaccinated. Vaccine
hesitancy will result of being unable to tee receive immunity against diseases.
Clinics are encouraged to be equipped in tools and practices to help fighting the
hesitancy.
In the article entitled "Measuring vaccine hesitancy: the development of a
survey tool" written by Chaudhuri M., et. al. (2015), stated that the SAGE Working
Group on Vaccine Hesitancy worked on creating tools against vaccine reluctance
during in the year 2012. As a guide, this hesitancy induced the development of
equipment’s to assess the nature if the issue. Assessing the nature of vaccine
hesitancy has a goal to inform health professionals to make or perform strategies to
cope against a person ‘a reluctance and sustain his or her confidence in getting
vaccinated.

Related Studies
Several researchers have pointed out the flaws in the approach of COVID-
19 vaccination hesitancy and acceptance toward vaccines. It was said that parents
should better acknowledge the information from healthcare providers compared
with parents getting information from internet or their relatives, as it was stated
also from PubMed researchers Charron et. al. (2020), that information sources
influence on vaccine hesitancy and practices. As comparable from the study
conducted by Du et al. (2021) asserts that obtaining and access to vaccination
information could influence and affect public attitudes toward COVID-19
vaccination. At some point Loomba, et. al. (2021) quantify how exposure to online
misinformation around COVID-19 vaccines affects intent to vaccinate to protect
oneself or others. The researchers also find that some sociodemographic groups are
differentially impacted by exposure to misinformation and the researchers show
that scientific-sounding misinformation is more strongly associated with declines
in vaccination intent.
It is essential to promote universal access to professional vaccination-related
information sources, and use the media to disseminate evidence-based information
and clarify misinformation. In relation to the factors affecting attitudes towards
COVID-19 vaccination, a study from Arg et. al. (2021) confirmed that these who
knew people that were severely affected by the illness are likewise more inclined
to be vaccinated with COVID-19 vaccines. If people have more trust with official
sources of information’s, such as COVID-19 experts and public health institutions.
Alike from Ullah et. al. (2021) that anti-vaccine controversies concerning vaccine
safety are vigorously circulating by social media via different platforms, upsurge
the vaccine hesitancy among community members. The anti-vaccine behaviors
among community due to misinformation might potentially hamper the COVID-19
vaccine program and to have domino effects on other vaccination program.
Although trust in alternative sources and mistrust of government makes for a
lower chance that a person will agree to COVID-19 vaccination. Whereas Purliese-
Garcia et. al. (2018) found that one of the factors of mistrusting vaccine is limited
understanding of vaccines’, including an overlap of medical concepts in local areas
are likely to contributors to incorrect beliefs on vaccines effectiveness and duration
that could lead to future distrust of vaccines and provider. Bettinger et. al. (2016)
states that according to participants, misinformation or lack of knowledge about
vaccines are other important causes of vaccine hesitancy. Recent educational
interventions to correct ‘misinformation’ about vaccines, however, were largely
ineffective to reduce vaccine The World Health Organization (WHO) defined
vaccine hesitance as a delay in the acceptance or refusal to vaccinate, despite the
availability of vaccination services, has been reported in more than 90% of
countries in the world. It was said that it may vary from different perspective of
medical experts, journalists, parents, and self-defined vaccination victims on
vaccination and vaccination hesitance. Though medical experts generally consider
vaccines, despite some flaws, as safe, and they consider most vaccine safety
incidents to be related to coupling symptoms, not to vaccinations. And yet some
parents agree with medical experts, but most do not trust vaccine safety and do not
want to put their children at risk. hesitancy and, even worst, contribute to augment
negative attitudes in the most vaccine-hesitant participants. The “knowledge-
deficit” assumption can lead to labelling parents with vaccination doubts as
innumerate, irrational, emotional, or easily manipulated by anti-vaccination
groups.
While other factors affecting COVID-19 vaccine distrust is that some people
acknowledge common vaccines, yet may wonder whether or not to take the
COVID-19 immunization since it is new and was made rapidly. This appears to be
hurried to a few and may add to worries about vaccine security (Elterman, 2021)
states that while trust in media or media exposure may be driving COVID-19 threat
perceptions and vaccine attitudes which might have amplified its salience early on
and influenced attitudes and behavior. The same as Corpuz (2021) assert that as
COVID-19 cases ascend in one of Southeast Asia’s exceedingly abominable that
hit nations, low public trust in vaccines will be a colossal enclosure in the
government’s vaccination program in the Philippines. In a recent survey in January
2021 which was conducted by Pulse Asia, almost half of Filipinos asserted that
they would not get vaccinated against COVID-19 because of security concerns.
From another point of view on COVID-19 vaccination towards the potential
acceptance of COVID-19 vaccines reported that in a global survey, participants
would be very or somewhat likely to take a COVID-19 vaccine and assert that
respondents reporting higher levels of trust in information from government
sources were more likely to accept a vaccine and take their employer’s advice to
do so (Lazarus, et. al., 2020). Furthermore, the vital role in decision making
regarding vaccine acceptance and refusal are social, cultural, and political contexts
that probably denotes an associated set of responsibilities, knowledge, skills, and
attitudes to COVID-19 vaccination acceptance. Therefore, efforts to diminish the
myths and conspiracy theories on COVID-19 and vaccines that involving multi-
sectorial elements are needed to increase the acceptance of COVID-19 vaccine
when it is available in the near future (Ullah, et. al., 2021).
According to Dubey and Shen, concluded that parental vaccine hesitancy is
an important issue and decision making around vaccination is complex. As the
most trusted source of information on vaccination, physicians are uniquely
positioned to sway parents from vaccine hesitancy to acceptance.
During the COVID-19 pandemic, people utilized various information
resources to acquire perception and health information about the illness, including
television, radio, newspapers, social media, friends, co-workers, healthcare
providers, scientists, governments, and so on. AlSamen et Al. (2020) mentioned
that gaining a perception of the resources of information must be accurate about
vaccines' safety and efficacy to acquire the trust of the nation specifically to those
hesitant and that people trust vastly to obtain knowledge about COVID-19
vaccines as for the critical attainment. Vaccine hesitancy refers to delay in
acceptance or refusal of vaccines despite availability of vaccination services and it
is an individual behavior influenced by a range of factors, such as knowledge or
past experiences, as the overview on parents' opinions about vaccination and
possible reasons of vaccine refusal and this refusal is due especially to an
unjustified fear about potential side effects of vaccines.
Understanding COVID-19 vaccine demand and hesitancy in the study
conducted by Lin et. al. (2020) perceived benefits and barriers to vaccination
(namely vaccine efficacy and adverse event concerns) of the health belief model
constructs were significant predictors of COVID-19 vaccination intent. A
substantial proportion was concerned about fake or faulty COVID-19 vaccines;
however, this was not a significant predictor of vaccination intention. A substantial
proportion was concerned about fake or faulty COVID-19 vaccines; however, this
was not a significant predictor of vaccination intention.
 CHAPTER 3
RESEARCH METHODOLOGY
This chapter contains the following parts essential for collecting and
analyzing data of this study. This includes: method of research, population, sample
size and sampling technique, description of the respondents, research instrument,
data gathering procedure and statistical treatment.
Method of Research
This study is comprised of two cycles: the first cycle is qualitative research
and the second cycle is done by using quantitative research. In the first cycle,
descriptive research method is used to gather data and thematic analysis is used to
evaluate the data gathered. On the second cycle, survey research ad paired two-
tailed t-test is used in order to analyze the data gathered in the survey.
The first cycle aims to determine and understand why there is a significant
number of people who are reluctant in taking COVID-19 vaccine while the second
cycle aims to identify whether there is a difference in the decisions of the
respondents about taking COVID-19 vaccine before and after the action taken by
the researcher.

Population, Sample Size and Sampling Technique

The target population in this study are the residents in the Municipality of
Badian, Cebu with a population of 37, 912 by 2015 survey. The researchers used
both Convenience and Simple Random technique for obtaining the data.
n=N/1+Ne2
Where:
n= Sample size
N= Target population
e= Margin of error
The researchers used 0.05 for the margin of error, thus:
n= 1378/1+ [1378(0.052)] = 310.01
So, the sample size of 310 respondents is required to meet the confidence level that
the researchers need.

Description of the Respondents

The respondents were the residents in the Municipality of Badian, Cebu with a
population of 37, 912 and over 8,000 households according to the 2015 survey.
There are 29 barangays in the Municipality that includes: Alawijao, Balhaan,
Banhigan, Basak, Basiao, Bato, Bugas, Calangcang, Candiis, Dagatan, Dobdob,
Ginablan, Lambug, Malabago, Malhiao, Manduyong, Matutinao, Patong,
Poblacion, Sanlagan, SanticonSohoton, Sulsogan, Talayong, Taytay, Tigbao,
Tiguib, Tubod and Zaragosa. The respondents’ ages range from 20-35, 36-50, 51-
65, 66-85 and above. The researchers chose them as a respondent due to the fact
that they are better suited for the criteria of being legally responsible and capable
of deciding on their own.
Research Instrument
The study uses the unstructured interview approach throughsurvey
questionnaires and face-to-face interviews. The researchers designed an interview
as one of the data collection instrument for this study. The questions were aimed at
eliciting relevant information concerning the students initial stand towards the
COVID-19 vaccines as well as the factors affecting the hesitancy towards COVID-
19 vaccination in the municipality of Badian, Cebu. The residents of Badian, Cebu
are interviewed and were instructed to give their insights to fully comprehend the
possible variables that were affecting one’s hesitancy towards COVID-19
vaccines. From the results of the interviews, data were gathered and analyzed.
The interview will be divided into the Preliminary and Final interviews. The
preliminary will include the demographic profiles of the randomly selected
respondents, their decisions towardsCOVID-19 vaccination, and their reasons o
their hesitancy. The final interview, on the other hand, is consist of the data that is
collected after the action done by the researchers.
Data Gathering Procedure
The researchers used questionnaires and face-to-face interview as the main
research instruments to gather data from the respondents. Consent from the
principal of the school and every barangay captain in the town have been acquired
to conduct the research study. This study included two cycles.

Cycle One
This cycle was done for the qualitative research design of this research
study. Questionnaires were prepared for the preliminary survey. The purpose of
this preliminary survey is to know which of the respondents have agreed and
disagreed to be vaccinated. The interview was done and the researchers determined
which of the respondents agreed and disagreed based on the results acquired. The
researchers will now focus only on the respondents who disagreed to be
vaccinated. Another survey was done on these respondents to know the different
factors that affected their decisions. Their responses undergone the systematic
analysis done by the researchers. While analyzing the data acquired, the
respondents were grouped using their age range.

Cycle Two
This cycle was done for the quantitative research design of this research
study. In this stage, the researchers did a radio broadcasting program for all the
citizens of Badian to be aware of the benefits of being vaccinated. The
broadcasting program lasted for six days. After the program, the researchers did
another survey. The purpose of this survey is to determine whether if there was a
change between the responses of the respondents. The researchers acquired the
responses and transposed the data into numeral data. During the transposing of the
responses, the researchers grouped the respondents using their age range.
Statistical Tool
This study uses paired two-tailed test to ensure accuracy and reliability in
the data analysis.
The study uses paired t-test because the data comes from the same
population and two-tailed type for it only determines if there is a significant
difference between sets of data.
The formula for T-test is:

The study uses a margin of error of 0.05

Christine Mae Belonguel 12/11/2021
Grade 12- St. Claire EAPP
POSITION PAPER

Teenage Relationship

Adolescence is a period of physical and mental maturation that occurs

between childhood and adulthood. This transition involves social, and
psychological changes, with the biological or physiological changes being
the easiest to objectively measure. Work colleagues, tutors, friends, family,
sexual relationships, living together, and marriage are all examples of
relationships. Good connections may be quite beneficial and enrich our life.
Most partnerships, however, go through difficult times and need a
willingness to compromise. Relationship difficulties can produce or stir up
feelings that may be from the past – hurt, anger, hopelessness,
worthlessness, etc. This can be quite frightening and may make you irritable
or withdrawn. Teenage relationships are common in today’s world.
Adolescence is the most important stage for youngsters to make their future
colorful and to become responsible citizens in society. It is also an age
where most teens are attracted to various relationships. Sometimes this
relationships makes their life happier sometimes this relationships destroys
them.

During adolescence many teens become distant from their families,

especially their parents. Parents are the most important role model in a teen's
life. Teens should try to build healthy, trusting relationships with those close
to them. These will help them to grow and to become a better, well-rounded
person. Parents should be interested in the friends of their teen and get to
know them.Parents should never accuse their teen of relating dating to sex.
Sex is an emotional subject, and what is said or not said may affect a teens
own experiences and attitudes. Most of the time girls need a best friend more
than boys. The Teenage Love Relationship deals with the relationship of
love that exists between the teenage groups. Factors that affect teenage
relationship:Friendship, Love, Dating, Premarital Sex, Marriage, Family,
these are some of the issues that young people may face when they grow up.
Teenagers' relationships will have an impact on their life in the future. These
partnerships cause joy, despair, and even depression. Teens should make an
effort to form healthy, trustworthy connections with people who are close to
them. These will assist them in maturing and becoming a more well-rounded
individual. Healthy future relationships are dependent on a teen's ties with
family, friends, and the opposite sex.
Many teenagers grow estranged from their families, particularly their
parents, during adolescence. It becomes increasingly common for them to
spend time with their friends, and it is uncommon if this does not occur.

Parents must be available to their teen(s) at all times. To preserve a

healthy, intimate relationship, parents must create an environment in which
their teen feels safe coming to them and talking about everything, good or
bad. This kind of encouragement and support is critical for a teen's
psychological development.

Teens spend more time with their peers. They claim that their friends
have made them feel more understood and accepted. Parents and other
family members are spending less and less time with their children. Teens
with similar interests, socioeconomic classes, and cultural origins tend to
form close connections.

To summarize, adolescent relationships may provide us with both

terrible and positive experiences. As we develop in this generation, many of
us may encounter puppy love or a teenager error, but this is not a bad thing;
it is part of the lesson that we want to learn or experience in our teen years.
Teenage relationships are not a sin in the eyes of our parents since they
provide us with inspiration and motivation.