DAVAO MEDICAL SCHOOL FOUNDATION INC.

College of Medicine
Medical School Dr., Poblacion District,
Davao City, Davao del Sur, 8000
______________________________________________________________________________
INFORMATION AND INFORMED CONSENT FORM

Research Title: Level of Anxiety during the COVID-19 Pandemic among

First-Year Medical Students of Davao Medical School Foundation

Investigator/s

Del Val, Jonathan Richard D. Cabanilla, Maria Therese C.

Codilla, Rae Krystylynne O. Campued, Jade RochelleV.
Castillo, Dianne Marinella Cunanan, Luis Antonio R.
Castillo, Ma. Mikaela D. Costan, Kristofer Rey J.
Chieng, Shannon Lee P. Chispa, Keren Mnhz B.
Cenita, Jose Robert A. Dionsay, Jean Kareen
Busran, Bai Faiza M. Casio, Meriella A.
Duay, Dawna T. Diel, Mariell G.

Purpose and Conduct of the Study

The state of mental health among first-year medical students is an increasing global concern

as this specific population has been reported to be susceptible to variable levels of anxiety. As they

are gradually introduced into a highly stressful and challenging medical education during the

COVID-19 Pandemic, First Year Medical students may increasingly experience maladaptive

Behavior, including variable anxiety levels.

Thus, this study aims to identify vulnerable students, to prevent long term-risks of

developing significant mental illness, this study will provide an awareness and understanding of

their anxiety levels. By this means, we could identify medical students who are at risk of anxiety

levels who will need referral for further evaluation and management.
Role of the Participants

You were chosen because you are one of the medical students officially enrolled in Davao

Medical School Foundation, Inc. studying the course of Medicine during this COVID-19

Pandemic that is said to be an added factor to the anxiety to first-year medical students. We believe

that our study can help identify students who needs immediate help and support.

As a respondent, you will be requested to fill out the Informed Consent Form. Moreover,

you will also be asked to participate by answering the questions about the General Anxiety

Disorder–7 (GAD 7) Study Questionnaires through the Google Forms that will be provided.

Procedure

If you agree to participate in this research study, the following will occur: We will seek

first the permission from you as one of our participants. Then you will be provided with an

informed consent form to sign before conducting the research. You will be sent with a link through

the Google Form. The questionnaires are easy to answer because there is no need for you to answer

in sentences. You only must select from the given choices. You will be asked to tick the option if

you will agree to participate in the study. Once consent is approved, you will click the link,

redirecting the Google Forms containing the Study Questionnaire that consists of Socio-

demographic profiling to determine your inclusion for the research study, and the Generalized

Anxiety Disorder – 7 (GAD-7) questionnaires. Your participation is voluntary, however if you feel

like the procedure has become unfavorable to you or has been a burden on your part you may

withdraw during the process. All information gathered will be downloaded and stored in a flash

drive and laptop for storage.

Duration of the study

When you agree to join our study, you will take about 5-10 minutes to finish answering the

study questionnaire. After all the entries are filled out and your done answering the study

questionnaire, you will be asked to click the "submit" button that indicates the end of the

questionnaire.

Risks and Inconvenience

You may feel discomfort during the course of the survey so you may opt not to answer the

questions which make you feel any psychological or emotional distress, or you can withdraw as a

participant of the study. The researchers value your participation and will place your welfare as

the highest priority during the study. During the screening while answering the questions given

you may feel that the questions are too sensitive, do not worry for the questions that are in the

questionnaire are all valid and can be used for screening your level of anxiety.

Possible benefits for the participants

This study can generate relevant information which can be useful to public and private

administrators and different individuals

In joining our research, you may be sensible if there is a presence of anxiety and if there is

you will be able to know your current anxiety level and to prevent long term-risks and also to

provide awareness and understanding for further evaluation and management.

Remuneration and Reimbursements

Your participation will help determine the level of anxiety among the first-year medical

students. You will not be given a remuneration for participating in the study; however, a simple

token of gratitude will be given for the time you spent as a respondent in the study. You will also
be recompensed of whatever expenses you may have incurred in the conduct of the study such as

mobile load for the internet data that you will be spending while answering the questionnaire.

Provision for injury or related illness

If it is proven that the illness is acquired during the study, we will compensate for the

damages and shoulder the responsibility.

Voluntariness of participation

Your participation is voluntary, free of coercion in participating, with your consent in

participating in our study, you may also have the right to withdraw anytime or you may not proceed

to the next section of the questionnaires in the Google Forms without a need to give an explanation

on the said decision, the data and information gathered from you will also be taken out from the

study, unless you allow the researchers to retain the gathered information with your consent. Your

refusal to participate will involve no penalty or loss of benefits to which you are otherwise entitled.

You may withdraw your consent at any time and discontinue participation without penalty. You

are not waiving any illegal claims, rights, or remedies because of your participation in this research

study.

Confidentiality

We will keep your records for this study confidential as far as permitted by law. Any

identifiable information obtained in connection with this study will remain confidential, except if

necessary, to protect your rights or welfare. This certificate means that the researcher can resist

the release of information about your participation to people who are not connected with the study.

Rest assured that the data or information that you provide during the conduct of the research study

will be treated with complete anonymity and utmost confidentiality by means of discrete coding.

No individual identities will be used in any reports, presentations or publications resulting from
the research study. All research data or information will be kept in locked files at all times (for

material copies) or password protected folder (for electronic copies).

When the results of the research are published or discussed in conferences, no identifiable

information will be used. We assure you that all personal information will be kept strictly

confidential and responses on the Google Forms will be collected and tabulated in a remote

computer unit.

Access to Data

If you decide to join our research study, you have the right to access your personal data,

and information. Furthermore, the findings of the study can also be shared with you upon your

request. Your request should be written with date and signed. Cases of non-disclosure of results

by us to you and your fellow participants would be reviewed and decided by the Ethics Review

Committee.

Researchers’ Responsibility During Adverse Situations

This study is bound to study the level of anxiety during the COVID 19 Pandemic among

first year medical students. Specifically, the data that will be gathered will use a survey

questionnaire. In the event that you would feel discomfort while answering the questionnaire, you

are entitled with a choice to withdraw as a participant of the study. Moreover, any expenses related

to participating in the study will be fairly reimbursed.

In order to avoid the occurrence of any potential type of harm (i.e., psychological,

emotional or social) during the conduct of this research study, the researchers will provide you in

advance with information on counseling matters or services or appropriate support bodies (if

necessary) dealing with the issue. But in the event that interaction with you may inadvertently

harm you in some unintended way, the researchers will take responsibility to address the issue.
 In the event that you will get a score of 0-4, it indicates that you have no to minimal anxiety.

According to the study of Spitzer et al., 2007, no treatment actions are required at this level. Be

that as it may, you will be advised to identify and avoid possible triggers of anxiety, continue

healthy lifestyle such as having physical activities at least 30 minutes a day for 5 days a week, and

improve quality of sleep.

If you will get a score of 5-9, it indicates that you have mild anxiety. According to the study

of Spitzer et al., 2007, you will be advised to monitor your symptoms. After 2 weeks from the

initial screening, you will be advised to answer the GAD-7 questionnaire again to gauge whether

the symptoms have improved, stayed the same or become more excessive and affect your activities

of daily living. In this case, you will be advised to seek consult with a licensed mental health care

provider for further evaluation and management.

A score of 10 and above indicates that you have moderate to severe anxiety. According to

the study of Spitzer et al., 2007, a score of 10-14 is addressed by counselling and/or

pharmacotherapy. A score of 15- 21 is addressed by active treatment with pharmacotherapy and/or

psychotherapy. At any of these levels, you will be advised to see a licensed mental health care

provider for further evaluation. If you will consent, the researchers, with the guidance of the

mentor who is a licensed physician, will facilitate the process of referral, until such time that you

will be seen, further evaluated and given proper management of your condition. The researchers,

with the guidance of the mentor, will provide psychosocial support throughout the entire time of

this process. The same process will also be followed if the result of the follow-up after 2 weeks

revealed a score of 10 and above, in case the initial screening will turn out to be mild anxiety.
Disseminating Results to the Public

The data collected from this research study will be used solely for the attainment of the

intended purposes. It may be presented at any research for and/or published in journals or used

for any other legitimate purposes, which Davao Medical School Foundation considers proper in

the interest of education, knowledge, or research.

Contact persons:

For any concerns regarding the details and progress of the research paper, you may contact:

NAME CONTACT NUMBER EMAIL ADDRESS

Cenita, Jose Robert 09475769231 jracac14@gmail.com

jracenita@email.dmsf.edu.ph

Helene Joyce O. Emphasis, MD, +63 925 501 3647 hjontal@gmail.com

DFM

Ethics Committee of DMSFI 226-2344 rec@email.dmsf.edu.ph

 DAVAO MEDICAL SCHOOL FOUNDATION INC.
College of Medicine
Medical School Dr., Poblacion District,
Davao City, Davao del Sur, 8000
_____________________________________________________________________________

CONSENT FORM

I have read and understood the provided information, or it has been read to me. I have had

given the opportunity to ask questions about it and any questions I have been asked to have been

answered to my satisfaction. I understand that I will be given a copy of this form, and the

researchers will keep another copy on file. I hereby consent voluntarily to be a respondent in this

study.

Name of Respondent (Optional): ______________________

JAZ

Signature of Respondent: ______________________

Date Signed: ______________________

MAY 20, 2021