INFORMED CONSENT FORM FOR PARTICIPANTS

SAN PEDRO COLLEGE

12 C. Guzman street, Davao City
Tel. Nos. (082) 221-0634 / 224-1481

Research Title:
Acceptability of Vaccination Against Sars-Cov-2 Among Undergraduate Students of
Different Allied Health Courses in a Higher Educational Institution

Student Researchers: Lee Michael J. Mariano Aldorf Lewis D. Nisperos

Aaron Vincent P. Millomeda Andy Mark A. Nuevo
Re-anne Liegh E. Flauta Glydel P. Olodin
Althea Beatrice C. Felizarta Sydney Ella S. Prado
Emmariesa A. Hasan Marlou Gil C. Raymundo
Lea Rose Rosil G. Hermogenes Miraflor O. Sotomayor
Nico Louise Marten S. Lapayag
Maria Trisha Nicole D. Leonor
Ces Marie V. Maravilla

Research Mentor: Cristela Mae C. Candelario, RMT, MSMT

Date Submitted:
Date Received:

SAN PEDRO COLLEGE

This informed consent form is addressed to the 1st to 3rd year students at San Pedro
College AY 2021©-2022 whom we are inviting to participate in our research study
entitled, “ACCEPTABILITY OF VACCINATION AGAINST SARS-COV-2 AMONG
UNDERGRADUATE STUDENTS OF DIFFERENT ALLIED COURSES OF A HIGHER
EDUCATIONAL INSTITUTION”.

This Informed Consent Form has two parts:

• Information Sheet (to share information about the research with you)

• Certificate of Consent (for signatures if you agree to take part)

You will be given a copy of the full Informed Consent Form

PART I: Information Sheet

Introduction
 We are student-researchers from the BSMLS-3F of San Pedro College (SPC).
We are conducting a research study on the “ACCEPTABILITY OF VACCINATION
AGAINST SARS-COV-2 AMONG UNDERGRADUATE STUDENTS OF DIFFERENT
ALLIED COURSES OF A HIGHER EDUCATIONAL INSTITUTION”. This information
sheet is intended to give you information about our study and encourage you to be part
of it. You do not have to decide whether or not to participate right now. You can discuss
the study with whomever you feel comfortable with before making a decision. There may
be words on this consent form that you don't understand. Please do not hesitate to
message any of us if you require additional information.

Purpose

The COVID-19 is an infectious disease that has caused around 2.83M cases in
the Philippines and so far, killed 47,875 people, up until today these numbers are still
overwhelmingly increasing. Professionals are looking for ways in order to stop the
spread of this pandemic leading to the development and discovery of the different
vaccines that are being distributed worldwide. In line with the distribution of the different
brands of vaccines nationwide, we wanted to know what are the factors that influence
the students’ decision to get vaccinated. As most of us know, San Pedro College is one
of the top performing schools in Davao and since face-to-face is about to happen due to
the availability of vaccines, we wanted to know if you are willing to get vaccinated to
attend the face-to-face set-up.

Type of Research Intervention

This research will be in the form of a survey questionnaire consisting of 4 main

themes that will ask your views regarding the factors that affect your decision to get
vaccinated, it will be administered through Google forms and we will give you a day to
answer the entire questionnaire.

Participant Selection

The target population for this study is the 1st year to 3rd year students of San
Pedro College, you are chosen as the participant through the process of stratified
random sampling technique.

Voluntary Participation

Your participation in this study is purely voluntary. If you do not want to

participate, then you may withdraw at any time without sanction or loss of benefit. At the
end of the survey, you will have the opportunity to review all of your responses. If you
want to change your responses after submitting them, you will be given a chance to do
so.

Procedures

Any of the student-researchers will contact you and inform you about your
selection of participation for this study. We will give you first an overview of what the
study is all about, how you became one of our respondents, and also the time and date
for you to answer the survey questionnaire. We will give you the link to the google forms
on the day you will be assigned to take the survey.
 You will be required to complete the questionnaire personally, and if you do not
want to answer any of the survey questions, you may skip them and move on to the next
one. Google forms will be utilized to distribute and collect the questionnaire. In this time
of uncertainty, this platform ensures convenience for both researchers and participants.
Your survey responses will be kept private, and no one other than the leader and group
members will have access to them. The SPC-Research Ethics Committee will also
monitor the progress of the study to ensure that the Ethical Considerations of the study
will not be breached.

Duration

The study will last for a total of four months, starting from January 2021 to April
2021. We will send the consent form in the second week of February and will send you
the questionnaire to be answered in the third week of February. The amount of time you
have to complete it will be dictated by your schedule. Answering the questions could
take anywhere from 20 to 30 minutes.

Risks

In this study, you will be asked for confidential data such as your personal
information but we will not force you, you will always have the authority not to answer
any of those parts if this might make you feel uncomfortable.

Benefits

This study will have no direct benefit to you but this will help the researchers
understand better the different perspectives of the students regarding the acceptability of
vaccines and also their reasons for vaccine hesitancy. By knowing these factors, the
school or even the government may have a better approach on how to encourage
people to get vaccinated which will lead to the end of this pandemic.

Reimbursements

There are no incentives or any tokens that will be given to you for participating in
this study.

Confidentiality

In accordance with Republic Act No. 10173 or the Data Privacy Act of 2012 that
protects the fundamental human right of privacy, of communication while ensuring free
flow of information to promote innovation and growth. We will ensure that all of your
responses will not be disclosed nor shared with other people apart from the researchers’
group. All the data received will be protected and we will erase the data after we have
thoroughly utilized it to safeguard the data against future improper processing.
Sharing the Results

We promise that nothing you submit to us today will be shared with anybody
else. Nothing would be linked to your identity by the research team. the understanding of
Any findings of the study will be shared with you, as well as other persons and
institutions. This study will assist you and you may learn something from it.

Right to Refuse or Withdraw

If you do not want to participate, then you have the full authority to withdraw at
any time without sanction or loss of benefit. At the end of the survey, you will have the
opportunity to review all of your responses. If you want to change your responses after
submitting them, you will be given a chance to do so.

Right of Investigator to Terminate Participation

The researchers’ have the right to terminate a participant's participation during this
study, for instance, the participants would deter the integrity of data (e.g. the participants
would attempt to answer multiple responses) or other justifiable reason for termination.
When a researcher terminates a participant's engagement in study, the researcher must
explain the reasons for the termination to the subject of the participant and would be
notified that they would not have any issues regarding the research.

Who to Contact

For any questions or clarifications, you can ask the research leader, Mr. Lee
Michael J. Mariano, at chael.mariano16@gmail.com/09611297108 or the vice leader Mr.
Aaron Vincent L. Millomeda, at avlmillomeda@gmail.com/09209763264 You can also
contact the researchers’ mentor for this study, Ms. Cristela Mae C. Candelario, RMT,
MSMT at cristelamae_candelario@spcdavao.edu.ph. You can also contact SPC-
Research Ethics Committee at spc_rec@spcdavao.edu.ph.
Part II: Certificate of Consent

This pandemic has alarmed many people the day it increasingly made a drastic number
of people affected by COVID-19. A lot of sectors also had a hard time adjusting to what
COVID-19 has brought upon us in our health, society, and in our daily lives; this includes
how students can shift to a new learning system, with the help of technology, students
can have online classes with the use of different platforms. But, this online class setup is
not permanent. Hence, this study aims to know the acceptability of vaccination among
1st year to 3rd-year students in San Pedro College.

I have read the information stated above and have asked a follow-up question
related to this study and about my contribution to answering this questionnaire. I
am giving my consent to participate in this study.

Name of Participant:
Signature of Participant:
Date:
Date/Month/Year

If illiterate

I have witnessed the reading of this consent form as a possible participant and
the opportunity to ask questions related to this study. I am giving my consent
both to the research and to the individual assigned on my behalf.

Name of Participant: THUMB PRINT OF

PARTICIPANT:
Signature of Participant:
Date:
Date/Month/Year

Statement of the person taking consent

I have accurately presented and read the information that the participant should
be aware of, and made sure that the potential participant understood the
following:

1. They will be given a generous amount of time to answer the survey.

2. The survey form would be done via google forms.
3. The information of each participant would be our priority and shall
remain confidential.
4. The answers of each participant would be analyzed by the researchers of
the study with the help of a statistician.
I verify that the participant was given a moment to ask questions regarding the
study. The questions asked by the said participant were answered with clarity to
address any confusion or misinterpretation about the survey. I confirm that the
participant was not forced to consent to participate in this survey and that the
consent given was voluntarily given.

A copy of this has been given to the participant.

Name of Researcher/person taking the consent Tresha Cosmeno

Signature of Researcher/person taking the consent:

Date: 04/05/22
Day/Month/Year

Submitted By:

Name Signature

Lee Michael J. Mariano

Aaron Vincent L. Millomeda

Althea Beatrice C. Felizarta

Re-Anne Liegh E. Flauta

Emmariesa A. Hasan

Lea Rose Rosil G. Hermogenes

 Nico Louise Marten S. Lapayag

Maria Trisha Nicole D. Leonor

Ces Marie V. Maravilla

Aldorf Lewis D. Nisperos

Andy Mark A. Nuevo

Glydel P. Olodin

Sydney Ella S. Prado

Marlou Gil C. Raymundo

Miraflor O. Sotomayor

Recommended by: CRISTELA MAE C. CANDELARIO

Research Adviser