CHAPTER I

INTRODUCTION

Background of the study

Immunization is by far the most successful method of

preventing serious diseases in infants. It allows the

child to develop immunity to specific diseases, reducing

the severity of the disease. It provides protection for

the person and the community by preventing the disease

from spreading. Which is why infants or children should

have access to routinely prescribed vaccines as a

decrease in immunization rates will most certainly have a

negative impact on overall public health.

The Expanded Program on Immunization shortly known as EPI

was developed to ensure the access of infants and

children to the recommended vaccines. To ensure that all

children in the Philippines are Fully Immunized Child

(FIC), the Department of Health (DOH) utilized several

strategies such as the Reaching Every Barangay (REB)

strategy adapted from WHO-UNICEF’s Reaching Every

District (RED) strategy, Supplemental Immunization

Activity (SIA) to reduce the rate of missed children or

dropouts from routine immunization, and lastly through

strengthened disease surveillance. In addition, Republic

Act No. 10152 mandated that infants and children under 5

1
years old should receive basic immunization (Department

of Health of the Republic of the Philippines, 2011).

On July 15, 2020, the World Health Organization and

UNICEF (2020), released an urgent alert about a global

decrease in the number of children receiving life-saving

vaccines. This is attributable to the COVID-19 pandemic

disrupting the supply and uptake of immunization services

(UNICEF, 2020).

Moreover, according to the most recent WHO and UNICEF

data on vaccine coverage figures, the preliminary results

for the first four months of 2020 show a significant

decrease in the number of children receiving three doses

of the diphtheria, tetanus, and pertussis vaccine in 106

countries (WHO, 2020). Now this endeavor is at risk of

reversing hard-won progress toward reaching more children

and adolescents with a broader variety of vaccinations,

which has already been delayed by a decade of slowed

coverage.

Furthermore, vaccination rates in the Philippines via

services provided by national health authorities are also

less than satisfactory, possibly because individuals are

unwilling to leave home for fear of being infected with

COVID-19, or because of transportation interruptions,

economic burden, and restricted movements because of

COVID-19-prevention strategies. One major barrier is the

2
lack of healthcare professionals (HCPs) to perform

vaccinations because of the burden of the pandemic, and a

lack of personal protective equipment (PPE) for HCPs has

also been observed (WHO, 2020).

From the data provided by the PHO in Northern Samar. Las

Navas is one of the municipalities with the lowest

vaccination rate for the year 2019 and 2020 with an

average vaccination rate of 40.38% in 2019 and 51.37% in

2020 and having a total mean of 45.875% for 2019-2020

(Northern Samar PHO, 2019).

Another factor that affects the vaccination rates, is the

level of knowledge of parents, specifically on new

mothers is an essential determinant of their practices

towards routine immunizations (Mohd-Nor and Bit-Lian,

2019). Knowledge directly affects attitude, thus, working

on educating new mothers should be a basis for acquiring

better attitudes and practices (Mohd-Nor and Bit-Lian,

2019). Favin et al. (2012) talked about the association

between the lack of immunization and the lack of

knowledge regarding vaccine necessity. Conversely, Matta

et al. (2020) mentioned about how parents who have less

knowledge about immunization was more compliant and was

explained by the fact that parents who acquired knowledge

about vaccines also questioned their safety and

necessity.

3
In addition, another factor related to child immunization

practices is the parental attitude towards vaccines

especially for new mothers. In the study of West and Hart

(2011), parents who had negative attitudes towards

vaccination did not vaccinate their children and did not

attempt to gain knowledge about immunization.

The COVID 19 pandemic has most likely influenced the rate

of child immunization in the municipality of Las Navas,

Norther Samar, as limits on healthcare facilities have

also been imposed. Which is why the researchers is

prompted to conduct a study to assess the knowledge,

attitude, and perception of new mothers towards child

immunization during the COVID-19 pandemic and understand

its relationship.

4
Objectives of the Study:

Generally, this study aims to determine the

Knowledge and Attitude of new Mothers Towards Child

Immunization During COVID-19 Pandemic. Specifically, it

aims to:

1. To determine the socio-demographic profile of the

respondents in terms of:

1.1 Age

1.2 Educational Attainment

1.3 Occupation

1.4 Number of Children

2. Determine the immunization status of the

child/children of the respondents.

3. Identify the relationship between the socio-

demographic profile and the immunization status of the

child/children of the respondents.

4. Determine the relationship between the socio

demographic profile and the knowledge, attitude and

perception of the respondents to routine immunization

during COVID- 19 pandemic.

5
5. Determine the relationship between the knowledge,

attitude, and perception of the respondents to routine

immunization and the immunization status during COVID-19

pandemic.

6. Determine the effectiveness of conducting limited

face-to-face or Webinar on Community Immunization

Promotion Activity that will provide information about

the benefits of vaccines and would debunk myths and

provide research-based data to questions of new mothers

in Las Navas.

Scope and Limitation of the Study

This study will be limited only to the knowledge,

attitude, and perception of new mothers towards child

immunization during covid 19 pandemic. The respondents of

this study will focus only on new mothers with children

aging 1-14 years old within the vicinity of Las Navas

Northern Samar. This will be conducted during the school

year 2021-2022.

This study will seek to prove the relationship

between the socio-demographic profile of the respondents,

its immunization status to the knowledge, attitude and

perception of new mothers towards child immunization

during covid 19 pandemic. Furthermore, the responses of

6
the respondents and the outcome of this study will be

beyond the researcher’s control.

Moreover, the researchers conducted ranking of the

vaccination rates of the Municipalities in Northern Samar

through averaging of the data provided by the PHO.

Silvino Lobos ranked 1st and followed by Las Navas,

though Silvino Lobos is the municipality with the lowest

vaccination rates, the researchers together with their

adviser decided that the study will be conducted in Las

Navas for the safety of the researchers and also to

follow the health protocols amidst pandemic.

Conceptual Framework

The conceptual framework consists of socio-

demographic profile of the respondents namely: age,

educational attainment, occupation, and number of

children, including knowledge, attitude and perception of

new mothers towards child routine immunization during

COVID-19 pandemic as the independent variables which will

be correlated to the immunization status as the dependent

variable. This study assumes that there is a significant

relationship between the socio-demographic profile to the

knowledge, attitude, and perception of new mothers

towards child immunization and that both variables have

7
 significant influence on the immunization status during

COVID-19 pandemic. This study assumes the effectiveness

of conducting limited face-to-face or Webinar on

Community Immunization Promotion Activity that will

provide information about the benefits of vaccines and

would debunk myths and provide research-based data to

questions of new mothers in Las Navas.

Paradigm

Independent
Dependent Variable
Variable

SOCIO-DEMOGRAPHIC
PROFILE:
 Age Webinar/ limited
Knowledge,
 Educational IMMUNIZATION Attitude and
face—to-face
Attainment STATUS Perception of New Community
 Occupation Mothers to Child Immunization
 Number of Immunization Promotion
Children Activity

Figure 1. Shows the schematic diagram showing the

relationship between the independent and dependent

variable

Hypotheses

Based on the problem of the study, the researcher

identified the following hypotheses.

8
 There is no significant relationship between the

socio-demographic profile and the immunization status of

the child/children of the respondents.

There is no significant relationship between the

socio-demographic profile and the knowledge, attitude and

perception of the respondents to routine immunization

during COVID-19 pandemic.

There is no significant relationship between the

knowledge, attitude, and perception of the respondents to

routine immunization and the immunization status during

COVID-19 pandemic.

Theoretical Framework

The core theory that will be supporting this study is the

Health Promotion Model by Nola Pender. The HPM was proposed as

a framework for integrating nursing and behavioral science

perspectives on factors that influence health behaviors. The

model is to be used as a guide to explore the biopsychosocial

processes that motivate individuals to engage in behaviors

directed toward health enhancement (Pender et al., 2011).

Major concepts of the HPM are individual characteristics and

experiences (prior related behavior and personal factors),

behavior-specific cognitions and affect (perceived benefits of

action, perceived barriers to action, perceived self-

efficacy, activity-related affect, interpersonal influences,

9
and situational influences), and behavioral outcomes

(commitment to a plan of action, immediate competing demands

and preferences, and health-promoting behavior) (Wills, E. M

and McEwen M., 2014).

Furthermore, the theory of Dr. Pender will be employed in

this study because the model has been used extensively as a

framework for research aimed at predicting health- promoting

lifestyles as well as specific behaviors. In the application

of this theory the researcher must provide outmost care by

providing emotional and health support the respondents need if

they do not know the importance of immunization to their

children, the researcher must teach the respondents to focus

on the positive effect of having complete immunizations and

not on the negative outcomes. It is vital to understand that

this model of Pender affects the behavior and attitude to

improve wellbeing of an individual including their health and

against the thought of focusing on illness or what could go

wrong.

The theory of planned behavior by Icek Azjen (Kan M.

and Fabrigar L. 2017) provides a further insight into

intentions and actions which underpins this study. Azjen

claims that actions are immediately influenced by

behavioral motives and, under some conditions, assumed

behavioral influence. It is used to explain and predict

behaviors. Attitudes toward the action, subjective norms,

and perceived behavioral regulation are all factors that

influence behavioral intentions. (Fabrigar, 2017)

10
 Moreover, the Theory of Reasoned Action, introduced

by Fishbein and Azjen in 1975, will also be utilized to

support this study. The theory focuses on the creation of

a system of observation of two groups of variables:

attitudes, defined as a positive or negative feeling in

relation to the achievement of an objective, and

subjective norms, which are the exact representations of

an individual's perception in relation to the ability to

meet an objective. And asserts that the contributions of

perceived behavioral regulation are important in

understanding the actions. Fishbein and Azjen also

emphasizes the importance of intention more than the

reality of usage. (Kan and Fabrigar, 2017)

We have chosen the following theories that holds

significance to the current study. The theory of urgency

and importance by Eisenhower can be related to the

behavior and approach of the governing bodies in their

allocation and prioritization of resources towards the

negation of the spread of the Corona virus disease. Which

resulted in the neglect to the prior established programs

on routine childhood vaccination. On the other hand, the

theory of planned behavior by Icek Azjen can be related

to the relationship of the knowledge towards risk and

efficacy of vaccination to the immunization status of the

respondents. And lastly, the theory of reasoned action by

Fishbein and Azjen pertaining to the preconceived

11
understanding regarding vaccination which elaborates the

effect of knowledge and attitude to the intention towards

immunization.

Significance of the Study

The finding of this study will deem significant to

the following:

New Mothers- it will provide key inputs in meeting

patient expectations and initiate changes that will

improve patient clinical outcomes and patient

satisfactory levels in terms of infant/child immunization

practices. It will provide better understanding and

initiate changes in their immunization attitude and

practices.

Local Government Unit (LGU)- it will provide them useful

information for local government units or for them to

make policies on of planning an intervention or a

campaign on targeting mothers who are at risk of

defaulting immunization during COVID-19 pandemic.

Hospital Administration- it will provide basis for the

necessary input which will serve as their guide in

creating policy.

Future Researchers- This study will be of use as reference

for future studies involving immunization practices.

12
Definition of Terms:

The following are conceptually and

operationally defined in this study for further

understanding of research concept.

Knowledge- is conceptually defined as the fact or

condition of knowing something with familiarity gained

through experience or association. As used in this study,

it is defined as the knowledge of new mothers towards

child immunization during COVID-19 pandemic.

Attitude- a feeling or way of thinking that affects a

person’s behavior. As used in this study, it is defined

as the attitude of the respondents towards child

immunization during COVID-19 pandemic.

Perception- an active process of interpreting or

understanding something through the senses in response to

environmental stimuli. As used in this study, it is

defined as the impressions or understanding of the

respondents towards child immunization during COVID-19

pandemic.

13
Child Immunization- is conceptually and operationally

defined as vaccinations administered to infants to

prevent the spread of infectious diseases (William and

Shiel, 2021)

New Mothers- is operationally defined as mothers who

recently gave birth and are under 24 months postpartum,

living in Las Navas, Northern Samar and are the target

respondents of the study.

Coronavirus- are a large family of viruses that cause

illness ranging from the common cold to more severe

diseases such as Middle East Respiratory Syndrome (MERS-

CoV) and Severe Acute Respiratory Syndrome (SARS-CoV)

(WHO).

Pandemic- defined as an epidemic occurring worldwide, or

over a very wide area, crossing international boundaries

and usually affecting a large number of people.

14
 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

The COVID-19 pandemic has greatly affected childhood

immunizations not just the overall administration rate

and compliance, but also potentially increase the

susceptibility of countries to epidemics of vaccine-

preventable diseases (VPDS) including measles and polio

(UNICEF, 2020). Among the biggest contributors to

decision-making of new mothers are their attitude and the

general knowledge they have about child immunizations.

This research aimed to conduct a review of related

literature involving the knowledge, attitude, and

perception of new mothers towards child immunization

during COVID-19 pandemic.

Age

The childbearing age in women technically starts

with the beginning of the first menarche or also known as

the first menstrual cycle (Guldbrandsen et al., 2014),

15
the median age of adolescent girls having the first

menstrual cycle according to the American College of

Obstetrics and Gynecologists (2015), is aged at 12.43

years.

In the Philippines, women who began their first

childbirth are ages 20-24 years old, that comes within

the first year of marriage (PSA, 2017). This age group is

considered as “young adults” which is around 18 to 24

years old (State Adolescent Health Resource Center,

n.d.). Young adulthood is the time of frequent change and

exploration that covers many aspects of life such as

home, family, work, school, resources, and role (SAHRC,

n.d.). During this stage, they develop a personal value

system that is less influenced by peers and can

acknowledge and respect multiple viewpoints, value the

diversity of people and perspectives and appreciate that

there can be many right answers to a problem (SAHRC,

n.d.).

Potential Adverse Impacts of COVID-19 on Vaccination

Programs

Outbreaks of infectious diseases have been

associated with complex emergencies and natural disasters

(Culver et al., 2017; Waring and Brown, 2005; Watson et

al., 2007), such as floods, tropical cyclones (e.g.,

hurricanes and typhoons), tsunamis, earthquakes, and

16
tornadoes (Kouadiol et al., 2012; Ligon, 2006). Underlying

reasons include large-scale population displacement and

crowding, poor sanitation, lack of clean water,

malnutrition, and low healthcare and vaccine coverage,

leading to long-term deprivation of primary health care

(Culver et al. 2017; Paquet and Hanquwt, 1998; Spiegel et

al. 2007).

COVID-19 is not associated with natural disasters,

yet some of its adverse impacts are similar, while others

differ. Almost the entire world is currently observing

social isolation, physical distancing, and quarantine

either by choice or by force. Numerous countries have

imposed lockdowns and curfews, while others have been

more lenient in their responses. Both approaches have

some logic behind them. In any case, it is clear that

vaccination programs to control and eliminate other VPDs

such as polio and measles in the Philippines are being

significantly affected by the national response to COVID-

19.

For this, there are three primary and interrelated

reasons: (1) governments, global stakeholders such as

WHO, and healthcare workers are currently primarily

focused on dealing with the challenges posed by COVID-19;

17
(2) routine vaccination programs in low-resource

countries have been put on hold, as the vaccinators

themselves may contract and/or transmit the virus;

(Remuzzi and Remuzzi, 2020); (3) physical distancing and

quarantine may mean that people will not be able to visit

a healthcare facility to seek routine vaccinations for

themselves or for their children.

In low-resource countries, such as the Philippines,

newborns may not receive vaccines in a timely way,

particularly the oral polio vaccine (OPV-0) and Bacillus

Calmette–Guérin (BCG) at birth and the OPV 1, Penta 1,

and Pneumococcal conjugate vaccine (PCV) 1 at the sixth

week after birth. This delayed uptake of vaccination is

less likely to occur for babies born in hospitals in

high-income countries. However, babies in low-income

countries who are more likely to be born in homes

attended by traditional birth attendants (TBAs), also

known as “Treained Hilot” in the Philippines or in small

rural clinics may remain unvaccinated (Ali, 2020).

In addition, some babies may not get their scheduled

vaccines – OPV II, Penta II, and PCV II, as well as OPV

III, Penta III, and PCV III – during the 10th and 14th

weeks, respectively. The Measles I and Measles II

vaccinations for older children given during the 9th and

15th months are likely to also be affected. The current

18
global pandemic may globally affect the WHO’s recommended

22 vaccines – of which some are area-specific (WHO,

2020).

According to the Philippine Statistics Authority

(PSA) (2018), approximately 4,570 babies are born daily,

this means that millions will be born during this

pandemic who may not be able to appropriately receive the

required OPV 0 and BCG vaccines. Other calculations about

newborns based on a more extended period of COVID-19 show

the potentially severe impacts. If the pandemic lasts

longer than expected, then the aggregate of babies in the

Philippines without required vaccination due to delays

would substantially escalate. Although they may receive

the vaccinations later, in the meantime, these

unvaccinated babies will be more vulnerable to catching

other infections.

Unvaccinated newborns are a severe public health

concern, as are the older children who will receive

delayed (or may miss completely) scheduled vaccinations.

Those children, who are more likely than babies to catch

and spread infections, are at much higher risk,

especially against measles, Diptheria, and polio,

particularly in the Philippines where these viruses

already prevail and vaccination rates are already low

(Pasteur, 2019).

19
 Despite national efforts such as the Measles and

Rubella Initiative (MR&I), the measles virus still caused

outbreaks in the country. In 2019, the Philippines

Department of Health (DOH) (2019) have reported a total

of 47,871 measles cases between January 1 and December

31, 2019. In addition, measles complications were

responsible for 632 deaths (International Federation of

Red Cross and Red Crescent Societies, 2020). More than

eight out of ten people affected by the measles outbreak

were children aged 4 years and younger (International

Federation of Red Cross and Red Crescent Societies,

2020).

It is essential to mention that these measles

outbreaks occurred when routine vaccinations, as well as

supplementary immunization activities (SIAs), were being

regularly conducted. Everything was “normal,” in that

health care systems were not overwhelmed, and the

vaccinators had no fears of infecting or being infected.

During the current extremely challenging circumstances,

measles outbreaks can be foreseen, because on 26th March

2020, WHO’s Strategic Advisory Group of Experts on

Immunization (SAGE) recommended that all countries

suspend mass vaccination drives against all VPDs, arguing

that, “Any mass campaigns would go against the idea of

20
social distancing.” (Roberts, 2020). Suspensions of

vaccination against measles in only 23 countries will

result in 78 million unvaccinated children (Roberts,

2020). As vaccination programs cease in more countries,

the aggregate of unvaccinated children will critically

increase.

The longstanding Global Polio Eradication Initiative

(GPEI) may also be severely affected. The wild poliovirus

is still prevalent in Pakistan and Afghanistan. In

Pakistan in 2019, there were around 150 polio cases, and

as of April 2020, around 30 new cases have been reported

(GPEI, 2020). By 24 March 2020, the GPEI had already

directed countries to postpone their mass vaccination

programs until the second half of this year: these

campaigns reach around 400–450 million annually (Roberts,

2020). WHO’s Michel Zaffran – the head of GPEI – fears

that the poliovirus will likely spread to polio-free

countries (Roberts, 2020). Thus the United Nations is

already expressing concern about the millions of children

who will not receive vaccinations against measles,

Diptheria, and polio, and who will then be at critical

risk of infection (Zaidi, 2020).

To be clear about why the vaccination programs will

be interrupted, the following are the central reasons:

(1) These children, including their parents, are in

21
social isolation, physical distancing or self-quarantine;

many countries have imposed lockdown, curfews and put

armies and police into action to push people to follow

these rules; (2) healthcare systems are overwhelmed due

to dealing with COVID-19; most healthcare personnel are

actively engaged in the ongoing pandemic and even looking

for volunteers; and (3) vaccinators who normally visit

each door, especially during supplementary immunization

activities (SIAs), cannot perform this task due to these

reasons, including the fact that they themselves may be

carriers of COVID-19 or vulnerable to catching it during

vaccination (Ali, 2020). All these factors are complex,

interlinked, and overlapping. Nevertheless, it is

plausible that the pausing or stopping of routine

vaccinations constitutes yet another foreseeable

challenge that the COVID-19 pandemic is posing at a

global level.

Relationship Between Demographic Data and Child Immunization

Completion

In the study of Abdullah et al (2016), the

researchers explored the practice of childhood

immunizations among parents and their associated factors

in Hulu Langat, Selangor, Malaysia. Out of the 830

parents who brought their children to the selected

22
childcare centers in Hulu Langat, 760 parents

participated in this study. Most of the respondents were

female (70%), Malay (87%), employed (92%) and college or

university graduates (99.7%). In this study, 98.2% of

parents had their children immunized. However, 14(1.8%)

parents who took part in this study did not have their

children immunized, with most of them stating that

“vaccinations are dangerous”. This belief was their

reason for vaccination refusal. Also, mothers aged

between 18 to 29 years old and 30 to 39 years old

recorded the higher percentage of not getting their

children immunized, with 3 (2.5%) and 11 (2.0%)

respondents, respectively. Meanwhile, 4 (6.9%)

respondents who graduated from secondary school and 2

(6.1%) from STPM or their equivalent reportedly did not

get their children immunized, and these numbers are

higher compared to other respondents. Results also showed

that mothers who have 3 to 5 family members (13 or 2.3%

of respondents) and employed (14 or 2.0% of respondents)

typically refused or defaulted their child’s vaccination.

Even though the number of parents who did not vaccinate

their children was not huge, parents should still be

given adequate and detailed information on childhood

immunization.

23
 One of the World Health Organization’s (WHO)

strategies for reducing childhood mortality is through

childhood immunizations. However, according to The United

Nations Children's Fund (UNICEF) (2020), childhood

immunization in the Philippines has been declining

sharply in recent years from 87% in 2014 to 68% in 2019

increasing the risk of children with vaccine-preventable

diseases. Various studies described the association

between disadvantaged groups - namely the ethnic

minority, single parent, young or old maternal age, low

household income, and low parental education status -

with incomplete immunization.

In the study results of Ridad (2019) entitled

“Barriers to Adherence to Expanded Program on

Immunization Among Parents In Lanao Del Norte,

Philippines”, respondents were parents residing in the

selected municipalities of Lanao del Norte with low

compliance to Expanded Program on Immunization (EPI). A

total of 352 respondents from all the three (3)

municipalities participated in the study. Majority of the

respondents (75.28%) were females or mothers. The male

population was only 24.72% All of them belonged to the

reproductive age; most (46.31%) belonged to the age

bracket of 21-30 years old while those parents who were

31-40 years old composed 36.93% of the total respondents’

24
population. An average mean of 2.87 identified that most

respondents considered geographical factors as a barrier

along with social factors. In addition to this,

respondents identified that the distance of the health

center from respondents’ house, problems with

transportation, and that health centers being non-

operational or closed most of the times; leaving the

respondents no other choice than to go to the Municipal

Health Center, which is kilometers away from them, if

they wanted to have their children immunized.

Knowledge About Child Immunization

In the study of Matta et al. (2020), showed that

female gender having a primary, complementary, secondary

and university levels of education in comparison with

illiteracy, were significantly associated with better

knowledge regarding routine immunizations. On another

note, having an intermediate monthly income compared to a

low income is associated with reduced knowledge on

routine immunizations. This result strongly supports the

findings of the study of Smith et al. (2004) and Elbur et

al. (2014) where mothers were more aware of the

immunization schedule of their children compared to

fathers.

25
 Also, in the study of Krishna et al. (2019), where

the researchers talked about the association of a higher

level of education with more knowledge about vaccination.

This might be because being more educated allows a better

communication with health care providers and less chances

of acquiring wrong beliefs regarding vaccines. The

results of Matta et al. (2020) also showed that having an

intermediate monthly income was accompanied with less

knowledge when compared to low monthly income. In

contrast, in the studies of Kara et al. (2018) and Ahmad

Hamidi et al. (2018), they concluded that having a higher

income provides more access to health care providers and

physicians, thus, having more information about vaccines.

This might be because families with higher income have

access to good health care and feel secure and assured by

offered vaccination programs without further

investigation about the topic.

Moreover, the study of Ridad (2019) identified that

the respondents lacked knowledge and awareness on the

benefits of immunization, the number of vaccines their

child needs to receive, site and schedule, side-effects,

and contraindications. However, the study resulted with a

mean above 2.34 indicating that respondents were informed

on the appropriate interventions for side-effects of

vaccines, as well as their right to refuse vaccination

26
(Ridad et al., 2019). The respondents in the said study

had a moderate over-all level of adherence to routine

immunizations. Thus, expanded information on childhood

immunization is important in minimizing lack of knowledge

regarding child immunizations. This is to change their

attitude and perception towards vaccination, which will

then improve the national coverage.

According to Bernsen et al 2011, the majority of

mothers were aware of the significance of adhering to

child immunization programs. More than 85% of mothers

were conscious that childhood vaccines protect children

from life-threatening diseases and that most of the

information regarding immunization are from healthcare

personnel. Their study also demonstrated a significant

relation of knowledge on immunization towards the actual

immunization of child/infant (Bernsen et al., 2011).

However, the study of (B Al-lela O et al. 2014),

states that television is the primary source of

knowledge, since television is readily accessible at home

and it is more convenient for parents to watch medical

programs than to use the internet, the findings indicate

that television is the best source for immunization

information because not all parents understand how to use

the internet or read for details (B Al-lela O et al.,

2014).

27
Attitude towards Child Immunization

In the results of the study of Matta et al. (2020),

entitled “Parents’ knowledge, attitude and practice

towards children’s vaccination in Lebanon: role of the

parent-physician communication”, where out of 3500

questionnaires given, 2785 (79.57%) were collected back

where the researchers found out that having a secondary

and university level of education and better knowledge of

parents are significantly associated with a better

attitude. In contrast, having a high monthly income is

associated with a worse attitude (Matta et al., 2020).

This goes in agreement with previous results from the

studies of Elbur et al. (2014) and Findley et al. (2009)

where it demonstrated that parents with higher education

showed positive attitudes towards vaccination mostly

because these parents tended to understand more its

importance. Educated parents seem to understand more the

risks of infectious diseases and the benefits of

vaccination in their prevention. Moreover, Matta et al.

(2020) also proved that parents with a high income showed

more negative attitudes than those with a low income.

Confirming the previous results of Bernbaum et al.

(2013), that having a high income is associated with less

vaccination rates. This might be because parents with a

28
high income have the means to treat their children and

live near health facilities. Some may also think that

they can protect their children through less exposure and

healthier lifestyles. But in the study of Sakai (2018),

results showed that having a low income can be associated

with a negative attitude since some parents with low

income choose to spend money on other necessities. Hence,

the literature to proves that having more knowledge about

the efficacy of vaccines, and having a positive attitude

towards vaccination and its benefits, all will increase

vaccination rates.

Perception towards child immunization

According to the study of Bernsen et al. 2011, the

most common reason given by their subjects for refusing

immunizations was that the mother perceived that vaccines

are unnecessary. On the other hand, the majority of the

mothers (94%) displayed a positive view about regular

immunization as they stated that it was worth it and

because they want their chikdren to avoid acquisition

major deadly diseases according to BN Tagbo et al. 2012

CHAPTER III

METHODOLOGY

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Locale of the Study

This study will be conducted in the province of

Northern Samar, municipality of Allen. Located on the

northwestern tip of the province, bordering the

municipality of Victoria to the south, the municipality

of Lavezares to the east, and the strategic San

Bernardino Strait to both the north and west. It has a

population of 25,469 people.

Research Design

This study will utilize a descriptive-correlational

research design. The design selected is used in research

studies that aim to provide static pictures of situations

as well as establish the relationship between different

variables (McBurney & White, 2009). This study is

descriptive in nature since it will deal with determining

factors that will provide a more specified view on what

influences the attitude and knowledge of new mothers

toward immunization of their child amidst COVID-19

pandemic. Moreover, it will provide a complete picture of

what occurs at a given time through determining answers,

that will be manifested by respondents. The correlational

method is deemed appropriate for this study since it will

assess and measure the significant relationship and

between the dependent and independent variables. This

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will determine whether independent variable has a direct

relationship to the dependent variable or vice versa. It

will also allow the researchers to study if the

independent and dependent variables has no significant

relationship.

Respondents of the Study

The respondent that the researcher will choose will

be the new mother under 24 months postpartum residing in

the municipality of Las Navas, Northern Samar.

The respondent that the researcher will be choosing

are based on the collected data from the Public Health

Office in which all the vaccine that must be received by

those new born up to 24 months old infant are stated or

tallied. And it shows that the Municipality of Las Navas

is one of those Municipalities that has a lower

percentage in terms of vaccination of newborn up unto 24

months old infant. They are one of those Municipalities

that are been always part of the Top 5 Municipalities

that have a lower percentage of vaccination rate.

Municipality of Las Navas is only the second top

municipalities in terms of vaccination rate. Silvino

Lobos is the one that is leading yet since the

Municipality is not convenient to conduct study with

because of the pandemic and seems that the municipality

has no stable signal for them to be reached out by the

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researcher, and their Municipality is quite far from

those nay other Municipalities that’s why the researcher

tend to pick another option to which they can conduct

their research. Since the Municipality of Las Navas was

the second lowest vaccination percentage among any other

Municipalities, the researcher tend to pick Las Navas as

the locale and the new mothers in that Municipality as

the Respondent of the study.

Variables of the Study

The independent variables of this study include the

socio-demographic profile of the respondents in terms of

age, educational attainment, occupation, number of

children and immunization status of the infant/child of

the respondents.

Independent variables

Age as used in this study, is the current age of the

respondents upon gathering the data needed. The

researchers adapted the age grouping by Erik Erikson.

According to his psychosocial stage of development,

adolescent stage is those with the age range from 12-18

years old and young adulthood with an age range from 19-

40 years old. Age is classified into: 12-18 years old;

19-40 years old; 40-65 years old

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 Educational attainment as used in this study, is the

highest education attained by the respondents. The

researchers adapted the categorization of education

attained from scholar pro 2021. It is classified into

elementary level; elementary graduate; high school level;

high school graduate; college level; college graduate;

post-graduate.

Occupation as used in this study, is the type of job

the respondents currently have. it is categorized as

government employee; private employee; self-employed;

etc.

Number of children as used in this study, refers to

the number of children scheduled for immunization. In

this study it is categorized as 1-2 child/children; 3-4

children; 5-6 children; 7 and above.

Immunization status as used in this study, refers to

whether the child/children has complete or incomplete

immunization.

Dependent variables

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 The dependent variable of this study is the

assessment of the knowledge, attitude and perception of

new mothers towards child immunization during the COVID-

19 pandemic. This refers to the knowledge of postpartum

mothers towards immunization, their attitude in the

administration of vaccines to their child/children and

how they perceive routine vaccination during COVID-19

pandemic. Moreover, another dependent variable is the

intervention that will be tested by the researchers based

from the result of the assessment on the knowledge,

attitude and practices of new mothers towards child

immunization during the COVID-19 pandemic.

Research Instruments

The researcher will use a set of questionnaire

gathering the necessary data. The questionnaire was

adapted and modified by the researcher from the study;

Singh H. et al. 2019 entitled: “Assessment of knowledge

and attitude among postnatal mothers towards childhood

vaccination in Malaysia” The questionnaire will focus on

the knowledge and attitude of new mothers towards child

immunization during Covid 19 pandemic. The questionnaire

will be composed of 3 parts:

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 The first part will determine the socio-demographic

profile of the respondents in terms of age, educational

attainment, occupation, and number of children. The

second part will determine the immunization status of the

child/children of the respondents. The third part will

include the assessment of the knowledge, attitude and

perception of new mothers towards child immunization

during covid 19 pandemic using a five point likert scale.

Validation of Instrument

The questionnaire is adapted from the study of Singh

H. et al. 2019 entitled: “Assessment of knowledge and

attitude among postnatal mothers towards childhood

vaccination in Malaysia” The research instrument will

undergo validation from experts in order to examine its

credibility in its attempt to study its variables. After

validation, the research instrument will undergo pilot

testing to ensure its reliability.

Scoring and Interpretation

The data will be scored and interpreted objectively

for the knowledge, attitude and perception of new mothers

towards child immunization during COVID-19: the

sociodemographic profile and immunization status will be

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measured using frequency counts and percentages based on

assigned categories

Likewise, the knowledge, attitude and perception of

new mothers towards child immunization during covid 19

pandemic will be scored using four-point Likert scale as

presented below to determine response and level of

agreement. The data will be interpreted as presented

below.

Scoring for Knowledge on Child Immunization

Scale Adjectival Description

Rating

5 Strongly Agree The respondent has a strong

feeling or opinion.

4 Agree The respondent has similar

feeling or opinion.

3 Neutral The respondent does not have a

stand about the idea being

presented.

2 Disagree The respondent does have a

different opinion.

1 Strongly The respondent does have an

Disagree intense disapproval from the

idea being presented.

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Interpretation for the Knowledge on Child Immunization

Weighted Mean Interpretation Description

for Each

Statements

4.2 to 5.0 Very The respondents are very

Knowledgeable knowledgeable on the issue

about child immunization.

3.4 to 4.1 Knowledgeable The respondents are

knowledgeable on the issue

about child immunization.

2.6 to 3.3 Less The respondents are less

Knowledgeable knowledgeable on the issue

about child immunization.

1.8 to 2.5 Least The respondents are least

Knowledgeable knowledgeable on the issue

about child immunization.

1.0 to 1.7 Not The respondents are not

Knowledgeable knowledgeable on the issue

about child immunization.

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 Scoring for Attitude Towards Child Immunization

Scale Adjectival Description

Rating

5 Strongly Agree The respondent has a strong

feeling or opinion.

4 Agree The respondent has similar

feeling or opinion.

3 Neutral The respondent does not have a

stand about the idea being

presented.

2 Disagree The respondent does have a

different opinion.

1 Strongly The respondent does have an

Disagree intense disapproval from the

idea being presented.

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Interpretation for the Knowledge on Child Immunization

Weighted Mean Interpretation Description

for Each

Statements

4.2 to 5.0 Extremely The respondent has an

positive extremely positive attitude

attitude towards child immunization.

3.4 to 4.1 Positive The respondent has a positive

attitude attitude towards child

immunization.

2.6 to 3.3 Neither The respondent does not have

positive nor a stand about the idea being

negative presented.

1.8 to 2.5 Negative The respondent has a negative

attitude attitude towards child

immunization.

1.0 to 1.7 Extremely The respondent has an

negative extremely negative attitude

attitude towards child immunization.

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Scoring for the Perception Towards Child Immunization

Scale Adjectival Description

Rating

5 Strongly Agree The respondent has a strong

feeling or opinion.

4 Agree The respondent has similar

feeling or opinion.

3 Neutral The respondent does not have a

stand about the idea being

presented.

2 Disagree The respondent does have a

different opinion.

1 Strongly The respondent does have an

Disagree intense disapproval from the

idea being presented.

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Interpretation for the Knowledge on Child Immunization

Weighted Mean Interpretation Description

for Each

Statements

4.2 to 5.0 Extremely The respondent has an

positive extremely positive perception

perception towards child immunization.

3.4 to 4.1 Positive The respondent has a positive

perception perception towards child

immunization.

2.6 to 3.3 Neither The respondent does not have

positive nor a stand about the idea being

negative presented.

1.8 to 2.5 Negative The respondent has a negative

perception perception towards child

immunization.

1.0 to 1.7 Extremely The respondent has an

negative extremely negative perception

perception towards child immunization.

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Population and Sampling

The researchers will employ cluster sampling method

to identify the target population which will be divided

into groups based on their respective barangays to select

80 respondents. The criteria for sampling are: 1) the

respondent must be a bonafede resident of the barangay;

2) the respondent must be twelve months postpartum.

Data Gathering Procedure

To gather the needed data, the researcher will ask

permission to the respondents with the use of an informed

consent. Upon approval, the questionnaire will be given

to the respondents and the researcher will observe as

part of the validation of data gathered. The data

gathered will be tallied, tabulated, analyzed and

interpreted.

Statistical Treatment of Data

For analysis and interpretation of data, the

following statistical tools will be used:

Frequency distribution, Percentage and Weighted

Mean. As for the tabular presentations, researchers used

these statistical treatments to express or describe the

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size or proportion of one figure in comparison with

others. This statistical tool will primarily be used in

analyzing the socio-demographic profile and the

immunization status of the respondents.

Pearson Product Moment Correlation (PPMC). This

statistical tool will be used to measure the strength of

the relationship and association of both independent

variables:(1)socio-demographic profile and

(2)immunization status, and their relationship to the

dependent variable – knowledge, attitude and perception

of new mothers towards child immunization. Pearson r is

essential to calculate the effect of change in one

variable when the other changes (“Pearson r”,n.d.)

Where:

N = the number of pairs of scores

Σxy = the sum of the products of paired scores

Σx = the sum of x scores

Σy = the sum of y scores

Σx2 = the sum of squared x scores

Σy2 = the sum of squared y scores

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 Literature Cited:

UNICEF-WHO Philippines: Polio Outbreak Situation Report

#1 (19 September 2019)

https://reliefweb.int/report/philippines/unicef-who-

philippines-polio-outbreak-situation-report-1-19-

september-2019

UNICEF. Over 13 million children did not receive any

vaccines at all even before COVID-19 disrupted global

immunization. 2020 April 24 [Cited 2021 March 28].

https://www.unicef.org/press-releases/over-13-million-

children-did-not-receive-any-vaccines-all-even-covid-19-

disrupted

Hutchesson, Melinda J. et. Al. 2020 January 23. [cited

2021 March 29]. Supporting women of childbearing age in

the prevention and treatment of overweight and obesity: a

scoping review of randomized control trials of behavioral

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interventions. Retrieved from

https://bmcwomenshealth.biomedcentral.com/articles/10.118

6/s12905-020-0882-3

American College of Obstetrics and Gynecologists (ACOG).

2015, December [cited 2021 March 29]. Menstruation in

Girls and Adolescents: Using the Menstrual Cycle as a

Vital Sign. Retrieved from

https://www.acog.org/clinical/clinical-guidance

/committee-opinion/articles/2015/12/menstruation-in-

girls-and-adolescents-using-the-menstrual-cycle-as-a-

vital-sign

Abdullah, A. C., Nor Afiah, M. Z., & Rosliza, A. M.

(2016). Practice Of Childhood Immunizations Among Parents

And Their Associated Factors In Hulu Langat, Selangor,

Malaysia. International Journal of Public Health and

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World Health Organization. (2013). Immunization.

Retrieved from

https://www.who.int/topics/immunization/en/

Department of Health of the Republic of the Philippines.

(2011). Expanded program on immunization. Retrieved from

https://www.doh.gov.ph/expanded-program-on-immunization

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Ridad,

https://belitungraya.org/BRP/index.php/bnj/article/view/6

95

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