Understanding the Communication

Dynamics of Healthcare Professionals and

Low-income Patients in the Philippines
Mikkah Joy B. Britt*, Kristine Paola V. Caña, Romelyn M. Espiritu,
Leabel T. Fabella, Aimie Winter Idul & Duchess Maylee Robin I. Tang-O
Polytechnic University of the Philippines, Manila
*mikkahbritt@gmail.com

Abstract. Healthcare is a fundamental human right. However, the socioeconomic conditions

of people, especially those from the poverty line, affect their ability to access it. Through Critical
Health Communication Theory and the Narrative Paradigm, this study attempts to understand
the socioeconomic status and power structures that affect the communication process that seeks
to understand the communication dynamics between healthcare professionals (HCPs) and low-
income patients (LIPs) during the consultation process. This study collected data through
virtual interviews with six participants using a semi-structured interview guide. Thematic anal-
ysis for the data revealed twelve themes: healthcare standards, the impact of COVID-19 on the
Philippine healthcare System, HCPs’ preconceived judgments, LIPs’ condition, and preconceived
judgment before seeking healthcare, communication barriers, HCPs’ communication strategies,
communication strategies, Results of the Consultation, LIPs’ concerns with the consultation and
treatment, solutions provided by HCPs and LIPs to resolve problems, LIPs’ Responsibility, and
LIPs’ Narratives. Communication between healthcare professionals and low-income patients is
a process. The study found out that doctors use various communication strategies, especially
using layman’s terms and thorough explanations in transmitting health information about the
patient’s condition, knowing that underlying factors such as socioeconomic status, level of edu-
cation affect patients’ reception of health information, identification of communication barriers
such as fear of judgment, set of beliefs, limited technological means, and difficulty understanding
of patients limits reception and retention. Hence, engaging both parties to devise resolutions to
address and resolve the communication barriers will result in effective health communication.

Keywords. Communication dynamics, critical health theory, healthcare professionals, low-

income patients, health communication

1 Introduction
Healthcare accessibility is a fundamental right of individuals. However, the COVID-19 pan-
demic strained the healthcare systems globally, significantly affecting human beings’ primary
care providers (Cohut, 2020). It challenges the capacity of medical institutions to accept pa-
tients and protect their healthcare providers in times of crisis. According to the United Nations

1
Britt, M.J.B. et al. Understanding the Communication Dynamics

report, Southeast Asian countries generally have good healthcare capacity, but the Philippines
is particularly concerned about their evaluation. This report used four indicators, such as the
number of physicians, nurses, midwives, and hospital beds per 10,000 people and their health
expenditure in 2016, to assess the health care systems within the region (Cabico, 2020).
Considering that the pandemic has significantly impacted the country’s healthcare system,
the poor and marginalized people are more vulnerable to the crisis and suffer the effects of
the disease (Tadem, 2020). According to Philippine Institute for Development Studies (2018),
cited by Domingo (2020), low-income people classified as poor have P10,957 and below as their
monthly income. Additionally, Kenworthy (2017, as cited from WHO, n.d.) identified that the
healthcare system in the country is fragmented since there is a history of unequal treatment in
providing health-related services. The government also spends more on health programs that
cause high-out-of-pocket services creating more significant gaps between the social classes.
This is not only the root of the social dilemma. Health communication is also crucial, espe-
cially in this pandemic where everyone is seeking protection and the correct information. Every
individual treats health as a valuable resource and effective health communication. Furthermore,
the Centers for Disease Control and Prevention (n.d) defines health communication as the study
and use of communication strategies to inform and influence decisions and actions to improve
health.
This means doctors play a vital role in the communication process since patients are more
reliant on the decision made by the doctor rather than understanding the totality of the disease,
portraying paternalistic doctor-driven decision-making (Uy et al., 2021). Compared to the upper
classes, patients tend to communicate more actively and show more effective expressiveness,
eliciting more information from their doctor. Thus, it has also been emphasized that the medical
professional’s communicative style is affected by how patients communicate.
Additionally, a study by Pacific University (2021) emphasized that patients with low health
literacy suffer discrimination due to their inability to read and comprehend health information.
Thus, the research also shows that low-income individuals, people who did not graduate high
school, and the unemployed are part of the demographic groups that suffer from low health
literacy.
Although there are various studies related to the topic, there is no adequate data during the
COVID-19 pandemic, and little is known about the subject of the study in the Philippine context.
Furthermore, most of the available literature focuses on the perspective of medical practitioners
as healthcare field experts. This gap calls for a deeper understanding of the communication
dynamics between the low-income patients and healthcare providers during the COVID-19 pan-
demic in the Philippines, particularly the patient’s perspective of the message transmitted by
healthcare professionals. Thus, the primary goal of this study is to understand the communica-
tion dynamics of healthcare professionals and low-income patients in the Philippines. Researchers
utilized phenomenology as the study’s research design. Phenomenology focuses on understanding
an individual’s lived experiences (Neubauer et al., 2019). The theoretical framework of this study
is the Critical Health Communication Theory and Fisher’s Narrative Paradigm (1985), in which
health communication focuses on the experiences hidden in health discourses, personal, cultural,
and social structures. Moreover, critical health communication focuses on the experiences hid-
den in health discourses; personal, cultural, and social power structure. And so, the narrative
paradigm will help the researchers understand different experiences of low-income patients and
the healthcare professionals’ experiences during consultations through interviews. The process
involves the low-income patient informing the healthcare professional about their health con-
cerns and the doctor providing feedback or health-related advice. With this information being
passed to the patient by their physician, there can be two possible outcomes: (1) the patient
understands what is being said by the healthcare professional, or (2) the patient is having a hard

2 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

time understanding what has been said. However, due to personal, cultural, and even social
barriers, it may be difficult for patients to fully grasp or understand what is being said and
interpret their concerns. These barriers can affect their decision-making in terms of their health
concerns, thus, resulting in poor decisions regarding their health. Other factors affecting their
understanding and action are the patient’s educational background and the power structures
between the doctor and patient. With that, Critical Health Communication Theory addresses
these barriers and sheds light on serving as a voice for low-income patients to understand their
struggle in accessing healthcare services.

2 Related Studies
2.1 Understanding Health Literacy and Its Importance In Public Health
Center for Disease Control and Study (2021) cited Healthy People 2030 (2020) defined health
literacy as the individual’s ability to find, understand and inform themselves and others of
their health-related decisions and actions. According to Santiago (2019), healthcare literacy
means empowering people with medical knowledge. A study by Pleasant (2014) shows that low
education and health literacy levels influence health outcomes and healthcare utilization. With
that, health literacy must be a primary public health goal; through banking, practical health
information programs allow the public to think about their decisions regarding their health care.
In the Philippines, several studies show that Filipinos have a low level of literacy, partic-
ularly those who belong to the low socioeconomic class, which resulted in many Filipinos be-
ing unhealthy and sick; hence, morbidity and death rates are pervasive. It has been observed
that the lack of health literacy has been linked to an increased risk of communicable and non-
communicable diseases. Adjacent to that, in a 2018 study conducted on Filipinos aged 50-70
who belong to low-income families, 94% of the study participants had a low or non-existent level
of health literacy. These participants only have a high school education, and being unable to
see a doctor in the previous 12 months was statistically linked with inadequate health literacy
(Santiago, 2019; Javier, 2019; Agosto et al., 2018). That is why ensuring that healthcare is
accessible to all people, as it is the basic principle of universal healthcare, should be seen and
practiced in society. It is a way for people to take control of their health. However, the problems
in healthcare, education, and poverty are standardized, meaning they are inextricably linked
to one another. This results in a domino effect on every individual’s access to the entirety of
healthcare.

2.2 Healthcare in the Philippines

According to the Department of Health (2019), the country’s health care system has rapidly
evolved due to the challenges experienced through time. Before the pandemic, health service
delivery devolved to the Local Government Code of 1991 to prevail in fragmentation concerns
regarding healthcare accessibility. Unfortunately, this action does not resolve the existing gap
within the social class regarding quality healthcare.
The casualties brought by the COVID-19 pandemic revealed the flaws of the healthcare sys-
tem of the Philippines, emphasizing its demand for further analysis and evaluation to meet the
challenges of the outbreak. Key issues include how the Philippine healthcare system lacked
facilities and human resources due to decades of neglect and the systematic reorientation to-
wards privatized healthcare at the expense of public health (Council for Health and Development
Philippines, 2021). Another instance would be the battle to put community health programs as
priorities to aid communities that may find themselves battling outbreaks of illnesses that put

3 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

vulnerable populations like the elderly at higher risk (Brooks, 2019). Although implementing one
within the community is a great start, the process does not stop there. Evaluating the impact of
the healthcare system is critical to the decision-making process that will be done in the future.
It enables us to compare the observed outcomes and the envisioned result in the planning and
brainstorming stage (Clarke, 2019).
In addition to these, a report published by the UN (2020, as cited by Cabico 2020), wherein
four indicators were examined to evaluate the healthcare systems in the Southeast Asia region:
the number of physicians, nurses and midwives, and hospital beds per 10,000 people. Their
health expenditure in 2016 revealed that there are only two healthcare care professionals per
10,000 people, which is the lowest ratio among the evaluated countries. In addition, there are
only ten hospital beds for every 10,000 patients. On top of this, Filipino nurses and other
healthcare professionals have been leaving the country due to inadequate compensation.
As for public health programs in the Philippines, the Universal Health Care (UHC) Act is a
crucial law to understand that is very much utilized, especially during the COVID-19 pandemic.
According to the UHC Act, every Filipino citizen shall now benefit from health coverage to
lower patients’ out-of-pocket health expenses (Tomacruz, 2019). Before this law’s passage, only
Filipinos registered with the Philippine Health Insurance Company (Philhealth) were entitled to
avail of benefits.
Aside from the UHC Act, the National Integrated Cancer Control (NICC) Act of 2019 insti-
tutionalized that early and sufficient access to cancer treatment should be intensified to “ensure
the highest possible chance of survival” (Montemayor, 2019). Meanwhile, the Responsible Par-
enthood and Reproductive Health (RPRH) Act of 2012 mandates universal and free access to
modern contraception and reproductive health education, among others, serve as legislative proof
that all citizens, including impoverished communities, are entitled to less financially burdening
health care.
The Local Government Code of 1991 first introduced the backbone of Filipino healthcare at
the local level. According to this code, local government units (LGUs), specifically barangays or
townships, are empowered to establish a barangay health center in each locality to offer first aid,
maternal, and child health care. In addition, the Policy on Primary Health Care for Community
Health Development of 1996 advocated for direction to LGUs in supporting a community-based
approach to primary health care. However, a report funded by the USAID, JSI Research &
Training Institute, and the FHI 360 (Advancing Partners & Communities, 2016) discovered that
despite having these policies, there is no single policy that uniformly guides community health
in the Philippines.
Besides those aforementioned general guidelines for local public health programs, barangays
are free to employ various programs applicable to their localities.

2.3 Applying Communication in Healthcare

The healthcare industry, whether a public or a private business, must communicate between the
administrators, staff, physicians, and especially with the patient. It is then proven beneficial to
have communication practices to protect the patient and save on costs and inefficient day-to-day
operations, decreasing medical errors. The critical point of better healthcare communication
is to prioritize the patient’s safety and reduce negative impact, specifically death. According
to OnPage Corporation (2020), healthcare professionals must be clear, timely, and discrete,
especially when the patient’s diagnosis is being elaborated. Proper and effective communication
reduces the risks and negative impact on the patient’s safety. It improves the doctor-patient
relationship by gaining the patient’s and their doctor’s trust and vice versa in addressing a
health issue.

4 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

On the other hand, communication dynamics in terms of doctor-patient relationship flow in

collaborative communication can also have a positive or negative impact. First, doctors are the
decision-makers and the key transmitter of the message, which includes symptoms resolution,
diagnosis, pain control, physiologic measures, and emotional being of the patient. Second, pa-
tients are the receivers of quality healthcare which involves the patient’s satisfaction and loyalty
to keep a mutual understanding of the dynamics (Benchmark Institute, n.d.).
Questions of how the doctor understands the patient and how the patient agrees to the terms
needed for self-care and the ability of the patient to cope as prescribed by the doctor is essential
to gaining the patient’s trust. The results show that better agreement between doctor-patient
was associated with the improved confidence and more likely affects the reception of the patient
to gain better healthcare if the doctor transmitted the message with complete understanding
considering the patient’s condition.
Socioeconomic status, educational background, culture, and power dynamics are some of the
factors that affect doctor-patient communication. Studies show that effective communication
between medical doctors and patients is crucial to successful medical care (Bientzle et al., 2017).
Identifying the communication styles between the doctor and patient will help researchers, espe-
cially in the medical field, understand more about the underlying concerns and issues faced by
doctors and their patients. Although doctors must consider several factors when communicating
with their patients in patient-centered communication, it will benefit them in terms of improving
communication between them and the patient and providing better healthcare, which can posi-
tively impact non-patients’ health literacy. Understanding a patient’s educational background,
socioeconomic status, and culture will be extremely helpful in resolving a health condition since
it will allow clinicians to determine how to communicate with the patient properly. Identifying
and implementing an effective communication strategy in the medical profession helps promote
awareness that doctors are concerned about their patients’ current circumstances and are eager
to assist them in understanding their health issues and what they can do to address them.

2.4 Health behind Power Relations

Access to healthcare varies from person to person due to wealth distribution and poverty rates
among countries and socioeconomic groups (Jison, 2020). As communication has implications
depending on individuals’ cultural, socioeconomic, and health literacy, these contribute to and
affect the communication process between a healthcare professional and their patients. Looking
through the lens of individuals who belong to low socioeconomic groups, this is beyond their
financial incapability and educational level; instead, it is the society and the systems behind it.
There is still lacking studies on the communication between doctors and low-income patients
in the context of the Philippines. Still, a recent study by Philippine General Hospital on Diabetes
Exploration (2021) during outpatient consultation shows that patients with a lower educational
background are more or less familiar with terms used during the consultation. It shows that
patients relied on its implication and treatment adjustment of their attending physician rather
than understanding the totality of their diabetes management. There are circumstances where
healthcare professionals and patients, especially low-income earners, struggle to communicate
and express their thoughts and feelings. Once there is inefficient communication between a
patient’s physician can result in a sub-par quality of care and poor outcomes for the patient
(Uy et al., 2021; Yunk, 2019). As shown in the studies mentioned earlier, the proliferation of
miscommunication inside the workforce must end. Hence, strategic communication between the
HCP’s and LIP’s should be present to achieve effective communication.
According to HIPAA Journal (n.d.), miscommunication results in misdiagnoses and other
medical mistakes that can easily lead to unavoidable health complications and the death of

5 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

patients. In line with that, Almutairi, (2020) says that language barriers also exist in healthcare
and can result in miscommunication. Yunk’s (2019) also claims that the complexity and volume
of the service call can be a barrier since some healthcare providers handle hundreds of calls daily.
Without prioritizing and monitoring them, critical service requests can fall through a downfall,
and there might be a failure to address the patients’ concerns. That is why according to Regis
College (n.d), the need for concise and effective communication should always be present in
the health field. It appears that numerous communication barriers can hinder and affect the
communication process. Hence, both individuals involved should be aware of those barriers.
Apart from that, poverty is also a complex and insidious determinant of health caused by
systemic factors that can persist for generations in a family (AAFP, n.d.). Low-income patients
are often the most difficult to reach, given access issues, language barriers, and lack of resources
(Bylander, 2013). Poverty and low-income status are also associated with various adverse health
outcomes, including shorter life expectancy, higher infant mortality rates, and higher death rates
(AAFP, n.d.). Many low-income patients said that they do not trust the system, mainly because
it had failed or even harmed them in the past. Several patients experienced discrimination
by providers and said they feared healthcare institutions because of it. (Abrams et al., 2019).
Low-income patients from rural areas usually suffer from getting specialty care (Abrams et al.,
2019). This could lead to patients receiving the wrong treatment or procedure, being given
incorrect medication, or could result in delays to essential tests and treatments (HIPAA, n.d.).
As the healthcare system undergoes massive changes under reform, now is the time to reshape
that system into one that is patient-centered, efficient, and highly effective (Bylander, 2013).
This conveys that being in a low socioeconomic status comes with various problems such as
discrimination, preconceived judgment on health-related issues, and an endless cycle of struggle
against the system. Thus, the role of the health institutions is crucial as they are the one who
has a significant contribution to the decision for the public interest, more particular to the poor
and marginalized individuals. marginalized individuals.

3 Methodology
The researchers utilized the qualitative research design to understand the healthcare professional
and patients’ narratives concerning health communication and the phenomenological research
tradition, which considers several individuals’ lived experiences (Cresswell, 2006). This gives a
deeper context to the existing beliefs, experiences, behavior, and interactions of the subjects that
cannot be measured, which can also bring significant contributions to health research (Pathak
et al., 2013). In line with this, Polkinghorn (1989, as cited in Creswell, 2006) suggests that
in-depth interviews must be conducted with individuals experiencing the phenomenon. While
determining the target participants, the researchers utilized purposive sampling for its intentional
selection based on the participants’ ability to elucidate a specific theme, concept, or phenomenon
(Robinson, 2014).
As the study extends its reach beyond physical boundaries, online semi-structured interviews
were conducted as the primary method for the data collection. In this method, the data is
mostly acquired through the internet between the interviewer and the participant (Hewson,
2008). Therefore, the participants for this study consist of three (3) healthcare professionals
or HCP, and three (3) low-income patients or LIP. Healthcare professionals are defined as the
people who promote health, prevent diseases, and deliver health care services (WHO, n.d.). At
the same time, the low-income patients are the working individuals who have less than PHP
18,200 as an indicative range of monthly family income (Albert et al., 2018). With this, the
researchers sought two female OB/GYN physicians, one male internist, and three male patients

6 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

from poor socio-economic backgrounds who went to a public or private hospital in the Philippines
during the pandemic.
Furthermore, thematic analysis was used to analyze the qualitative data sets, specifically the
interview guide’s transcripts (Nicolas, 2021). The first stage of the approach is to learn about
healthcare providers’ and low-income patients’ experiences during the COVID-19 pandemic,
understand their communication dynamics, and describe the many communication obstacles
they confront during the health crisis. Moreover, the second stage is the production of the initial
codes based on the participants’ responses. Each researcher independently coded the recorded
interviews to assess the significance of the raw data, and themes and sub-themes were reviewed
thoroughly to see whether they were realistic. When the codes, themes, and final analysis
were interpreted, discussions throughout the process were held until the researchers achieved
consensus.
Following the uplifting research ethics, the researchers commit that all interviews that served
as this study’s data gathering procedure were done humanely and in observance of protecting
the rights of all subjects. The purpose is to fully inform all participants of their participation in
this study and how the information they provide will be treated and managed.
Moreover, as the researchers are also committed to protecting the privacy of the participants’
identities and the limits of their consent upon conducting this study, the names and identify-
ing factors that may point directly to the research subjects were removed. Thus, all of the
participants’ names are not publicly disclosed.

4 Results and Discussion

According to the analysis of the interviews with HCPs and LIPs, the study identified twelve
themes. The participants shared sentiments regarding: (1) Healthcare standards, (2) Impact of
COVID-19 on the Philippine healthcare system, (3) HCPs’ preconceived judgments, (4) LIPs’
condition and preconceived judgment before seeking healthcare, (5) Communication barriers, (6)
HCPs’ communication strategies, (7) Communication strategies, (8) Results of the Consultation,
(9) LIPs’ concerns with the consultation and treatment, (10) Solutions provided by HCPs and
LIPs to resolve concerns, (11) LIPs’ Responsibility, and (12) LIPs’ Narratives.

4.1 Transmission
4.1.1 On communication strategies used by Healthcare Professionals to successfully
relay health information
Due to the two factors: transmission and reception, communication between healthcare pro-
fessionals and low-income patients are ineffective. According to Ha (2010), facilitating an
understandable exchange of information from both parties is one of the goals of the effective
doctor-patient relationship. As Physician #3 explained, HCPs adjust according to the patient’s
knowledge to get a complete conclusion about their diagnosis.

“Kasi kung para sa ikabubuti ng pasyente, tutulong kami at gagamutin namin sila
pero in the way na para maintindihan nila, kailangan kami ‘yung mag-adjust kapag
low socio-economic.” - Physician #3

Healthcare professionals must communicate diagnoses to patients in a straightforward, timely,

and discrete manner despite issues with limited mobility, hospital capacity, strict health-protective
behavior, and consultation via telemedicine. The healthcare professionals then carefully and com-
prehensively explain to low-income patients depending on their health literacy and how a lack

7 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

of resources affects their health decisions. In another lens, those who fall into the middle and
upper economic classes have no difficulty comprehending medical terms and financial concepts
(Jison, 2020). The doctor’s treatment plan is highly reliable on the patient’s status, where every
individual’s beliefs are influenced by their environment, culture, and media. Self-respect is nec-
essary. For Physician #2, regardless of their socioeconomic background, whether low or middle
income, what counts most is that they develop an understanding.

“So, ang importante sa akin ay maintindihan niya ako. So, regardless of whether is it
low or middle aged, I mean middle income na ano, ang importante kasi sa akin they
have to kung kailangan nila maintindihan.” - Physician #2

Individuals who lack appropriate financial and social resources are more likely to lack adequate
health literacy, and it highlights the budgetary limits experienced by low-income patients. This is
why healthcare providers must communicate effectively. Once there is inefficient communication
between a patient’s physician can result in a sub-par quality of care and poor outcomes for
the patient (Uy et al., 2021; Yunk, 2019). Hence, efficient communication is essential as it
saves lives and money and aids in preventing medical errors. As Physician #3 indicated, higher
socioeconomic patients are believed to have a more precise knowledge, as a result of which they
will follow the directions without needing to repeat them.

“Higher socioeconomic patients, mabilis makausap, right away, kahit sabihan mo

siya. Siguro dahil na rin high educational attainment, kahit ano sabihin mo kahit
hindi ka na bumaba doon sa level, at hindi ka na magpa-ulit ulit, gets kaagad nila.
Mas mabilis magdisclose ang pasyente, naiintindihan kaagad nila kung ano ang mga
instructions, kung ano ‘yung mga gagawin.” - Physician #3

4.1.2 On communication used by low-income patients in expressing their health

concerns
Despite their low-income background, LIPs can effectively communicate health concerns by ex-
plaining that they understand it is their responsibility as the patient. Aside from health concerns
related to COVID-19, pre-and post-pandemic consultations for health issues are identical.

“Sinabi ko po na masakit yung tiyan ko at yung dumi ko parang ano na yung kamatis
yung ano na ng kamatis e matubig na talaga parang ano po ng kamatis at tsaka yun
po tapos laging may hangin po yung tiyan ko at sabi ko bakit ganon na pag umiinom
ako ng diatabs e umaano naman humihinto naman hindi tuloy tuloy ako mag CR
pero pag ano na ng 4 hours balik naman po ako sa CR” - Patient #1
“Wala naman akong ibang itinatagong nararamdaman ko na hindi ko puwedeng bang-
gitin sa doktor dahil kapag hindi mo ito binanggit, malamang hindi ka niya mabibi-
gyan ng tamang gamot doon sa nararamdaman mo.” - Patient #3

However, patients sometimes face the problem of healthcare facilities appearing to be closed
because of the pandemic. On top of this, HCPs have mentioned that some participants have
preconceived notions about their health, which became their reasons for not prioritizing their
health. As a result of the delay in getting medical care, some patients’ conditions deteriorate
even more.

“During pandemic of course, mahirap kasi a lot of patients are afraid coming to the
hospital to seek their ano health issues, sometimes pupunta lang sila kung kailan
malala na.” - Physician #3

8 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

4.2 Reception
4.2.1 Promoting doctor-patient confidentiality, maintaining healthcare standards,
and showing empathy and understanding towards patients
When it came to accepting and aiding low-income patients, the healthcare professionals all
said they used ”patient-centered” and ”patient-centered with a need orientation” strategies.
According to Beintzle et al. (2017), patient-centered communication entails detecting patients’
needs and empathically responding to them. Two scenarios emerged from their participants’
responses. Certain patients expressed apprehension about disclosing their entire medical history,
particularly those exposed to COVID-19, engaged in risky sexual practices, or abused alcohol and
illegal drugs. Fear motivates some patients to outright lie or deny. In these instances, health care
professionals assert that it is critical to instill a sense of protection in their patients and treat them
fairly regardless of their background. Another scenario discusses receiving emotionally distraught
pregnant patients due to life-threatening medical issues. While the patient is unconscious, it is
vital to inform their kin or chaperone about the surgery. According to Physician #1, despite
these circumstances, health care professionals agree that patients should receive equitable access
to high-quality care regardless of their socioeconomic status, stating that ”they value therapy
for its efficacy, not its cost.”

“Nakikita ko po sila na may interest po sila na magamot po at gusto po nila na

gumaling po ang pasyente.” - Patient #1

Finally, the health care professionals were questioned on how they ensure mutual under-
standing and avoid the need for extra clarifications or misunderstandings. The emerging themes
indicated that healthcare providers required patients to recite prescriptions, lab work, and simi-
lar instructions. They assume that if their patients can verbatim repeat all of their instructions,
they have internalized them.

4.2.2 Receiving Healthcare and Health Information can be a struggle for Low-
income Patients
Critical Health Communication Theory emphasizes physician-patient communication, which may
result in message comprehension or misinterpretation. According to Wyman (2017), low-income
patients are highly susceptible due to challenges with healthcare access, financial transparency,
and, perhaps most significantly, linguistic assistance.

“Siguro sa ano minsan kasi kaming mga halimbawa high school graduate lang, may
mga ini-explain sya na.... Kasi minsan nag eenglish din yung docktor eh kaya minsan
di rin namin maintindihan syempre yung iba kasi parang ano eh parang aral na sila
sa pagkadoktor. “ - Patient #2

Repeating the healthcare professional’s statement ensures accuracy for low-income patients.
This is critical for their health and the efficacy of their medications. The doctors appeared to
have concentrated on explaining the tests they needed to perform, the medicines they needed
to take, and how much they needed to take. When the medication failed to work, the doctor
instructed the patient to return in three days. Despite these restrictions, the study discovered
that doctors communicate with patients in Filipino, demonstrating a doctor’s familiarity with
the patient’s native tongue (identified subtheme). Additionally, a technicality in the diagnostic
laboratory test was highlighted as a barrier.

9 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

“Pakikinig ng maayos sa doktor kung anong sasabihin ng doktor dapat sinusunod

ng isang pasyenteng kagaya ko. Naintindihan niya naman ako, naintindihan niya rin
ako kaya kaming dalawa bilang pasyente at isang doktor, naging maayos yung aming
pag-uusap tungkol doon sa nararamdaman kong inilahad sa kanya.” - Patient #3

4.3 Communication Barriers

4.3.1 Doctors cite lack of education, financial struggle, and COVID-19 as funda-
mental barriers to LIPs’ health based on experience before and during the
COVID-19 pandemic
As the Critical Health Communication Theory posits that one’s living condition reflects larger, it
has been emphasized by the healthcare professionals that communication barriers are primarily
rooted in their clienteles’ lack of education, which affects their health literacy.
However, due to the lack of education for low-income patients in the Philippines (Santiago,
2019), the doctors attest that some patients come to them with informal and mostly incor-
rect health beliefs and practices rooted in culture, such as dependence on herbal or alternative
medicine. Adjacent to that is a study from Rondilla et al. (2019) stating that Filipinos perceived
folk and alternative treatments are effective in alleviating health concerns firm belief and practice
of superstition. Thus, on rare occasions, some patients cannot accept medical treatment because
of conflict with their religious beliefs.
When further asked about commonly encountered communication barriers, Physician #3,
finds themselves in conflict with a language barrier because of their patient’s native language.
Their patient’s inability to communicate verbally due to a communication disability and minimal
education at all resulted in patients being unable to read or write.

Sa akin, sa pinaka nahihirapan ako, sa dialect kasi sabi ko nga sa inyo, maraming LSI
ngayong pandemya dito. Tagalog kasi ako, di ako marunong mag-ilonggo, mag-bisaya,
ewan ko ah, ang dami nila minsang words na hindi ko maintindihan. -Physician #3

Another theme in the study is the patient’s inability to fully disclose their health condition
because of the fear of social stigma or legal consequences. Health care professionals’ responses
discussed that some patients deny or refuse to disclose that they have contact with persons under
monitoring or investigation concerning COVID-19. On other occasions, some patients deny they
have specific symptoms or refuse to discuss their health history thoroughly, leaving out sexual
relation history or substance use.

They wouldn’t tell you na they did shabu for years pero when you probe—ask ques-
tions, they will tell you and that’s one big cause of their problem diba? Parang do
you imagine it na parang if you don’t ask na if they use drugs, they will not tell you
they use drugs, eh yung drug use nila is very vital in getting the diagnosis. -Physician
#1

On matters relating to patients’ financial struggle, insights from the internal medicine Physi-
cian #2, suggest that his patients’ financial worries can become emotionally overwhelming.
Agreeing to this sentiment, another health care professional discussed that in their experience,
patients who are from the middle to high socioeconomic class, as compared to low-income pa-
tients, are more welcoming and agreeable with the medical opinion and often agree to have the
treatment plan started right away with far less hesitation and inquiries. According to both ac-
counts, patients from low-income households are typically more concerned about the cost of the

10 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

treatment, often asking repetitive questions about the purposes of each step in the treatment
plan and usually seeking financial assistance.
As mentioned above, barriers such as language, communication disabilities, or lack of educa-
tion, identified by healthcare professionals, reflect the results of Filipinos from low socioeconomic
backgrounds being fundamentally restrained by their societal conditions, thus affecting the pa-
tients’ health literacy and efficiency as communicators. Changes in the Philippine healthcare
system brought about by the COVID-19 pandemic also led to more technological communica-
tion barriers.
Furthermore, the threat of coronavirus disease made it necessary for hospitals to use telemedicine
instead, which, according to the doctors, made their jobs less easy to fully diagnose their pa-
tients. Thus, it has been identified as a problem for individuals who are not equipped with
a home telephone or cellphone and those who do not have the financial means to buy prepaid
loads. In testimony from HCP informant #3, she even discussed that due to the need for triaging
for out-patient department concerns, patients who had to wait for a long queue on the phone
decide to either delay or discontinue seeking healthcare attention altogether. Additionally, the
healthcare professional participants disclosed that the threat of the COVID-19 pandemic also
added to the patients’ fear of going to the hospitals because of the increased risk of infections.
This communication barrier even becomes a threat to the patients’ health condition as the
delay in getting healthcare attention puts them in a worsened condition compared to when they
initially sought health care.

This communication barrier even evolves to become a threat to the patients’ health
condition as the delay in getting healthcare attention puts them in a worsened con-
dition compared to the time when they originally sought health care. So, kapag alam
nila na matatagalan sila sa outpatient, tulad noon magpapapila sila, teleconsult muna
tapos ano, di na sila nagpapatingin. -Physician #3

4.3.2 Low-income patients face various barriers even before being able to seek
healthcare
It has also been found in the study that limited hospital capacity and consultation time were
also an issue, especially with the ongoing pandemic. Remarks include the patient noticing that
their doctor rushed the consultation due to a long queue of patients and that consultations are
only possible on certain days.

“Hindi sya sapat kasi ano sya ah ah ano kami naka schedule kami sa sa sa clinic na yun
na na pagkonsulta bali meron kasi schedule sya halimbawa ganito Monday ngayon
and doktor Tuesday pa ngayon magpapa-schedule kami sa nurse na magpacheck up
kami bukas yon. Siguro ang mga magpapaschedule umaabot ng mga sampu mahigit
kaya pila pila yan kailangan paunahan sya. Kaya ang mangyayari pag ang doktor eh
nag-check up yan, ang doktor may limit din yung oras. Siguro mga 5 mins yata, oo
5 mins kasi nga may kasunod pa.” - Patient #2

Responses also showed that low-income patients had a hard time understanding specific
medical terms and terms expressed in English, which can contribute to the sub-par quality of
care and poor outcomes for the patient Yunk (2019).
However, despite the lack of understanding, limited consultation time, and other barriers
present, low-income patients could still recall and describe and listen attentively to the healthcare
professional assigned to them. This shows that given enough financial capacity and knowledge
of their health concerns, the patients are more than willing to participate in addressing their

11 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

health concerns. In general, the low-income patients were still satisfied with their consultations
and treatment results, despite the identified barriers.

“Oo nakikinig naman sya kasi ano kailangan nya din initindihin dahil ano kami eh
pasyente kung di nya iintindihin yun kawawa naman kami.” - Patient #2

4.4 Resolutions
4.4.1 The Healthcare Professionals’ Strategies and Solutions to Resolve Commu-
nication Barriers
As healthcare professionals seek the best technique for effective communication to establish
communication dynamics with well-defined transmission and reception (Benchmark Institute,
n.d.), Physician #1, as one of the participants, emphasized the importance of a systematic process
in interviewing a patient to determine their symptoms firsthand. She discussed that in medical
school, it is preferable to ask an open-ended question, especially when gathering a patient’s
medical history. Thus, healthcare professionals’ consultation procedures have not changed due
to the pandemic; how they previously treated patients is still their strategy at this time, such
as asking the right questions and being cautious of sensitive ones. Likewise, healthcare experts
give instructions after every appointment printed on their prescriptions, and they explicitly say
that the patient must reiterate what was recommended to attain mutual understanding.
Regardless of language barriers, healthcare providers are still required to deliver high-quality
healthcare that adheres to human rights and equity principles to all their patients (Almutairi
et al., 2020). As healthcare professionals meet several people from different backgrounds, being
sensitive is very important even in interactions with a common language– from understanding
conventions regarding eye contact to physicians appreciating how lifestyle and culture can influ-
ence their treatment plans (Butler & Sheriff, 2021). Thus, Physician #3 stated that it is best
to know their patient’s preferred language when speaking so as not to cause any confusion. In
instances where they cannot understand the language completely, the best way is to talk with
a relative who can ensure that the patient comprehends the situation; the presence of a trans-
lator is always a good solution. Not only that, but the usage of visual analogs can also help
explain the patient’s situation and answer their concerns and challenges while undergoing the
diagnosis or treatment process. Using a visual analog allows the patient to see more clearly what
the healthcare expert is describing, particularly the symptoms arising in the patient’s body and
the treatment plan that will be used to resolve them. Regardless, treatment can take the form
of verbal and nonverbal communication to guarantee that the patient’s diagnosis is made on a
case-by-case basis by the healthcare professional (Johnson, T., 2019).
Healthcare professionals recommend patients to hospitals that provide free treatment, such as
medicines and diagnostic procedures, to ensure the patient’s responsibility to follow the treatment
process. According to Physician #2, one method is to generate dread in the patients about the
implications of not completing the treatment. He also remarked that using a layman’s term is
vital to consider in effective communication. As a result, if the patient fully comprehends the
following treatment plans, they will be more comfortable repeating the procedures offered by
healthcare experts and healthcare professionals to clarify and assure the patient before releasing
them.

“... like in this day and age, that’s one of the big reasons why you have to probe, to
ask the right questions kasi if not, the patients can just tell you what they want to
tell you, there are things na they would want to keep to themselves.” -Physician #1

12 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

4.4.2 The Patient’s Strategies and Solutions to Resolve the Communication Bar-
riers
Despite the challenges encountered by the low-income patients, it has been observed by the
healthcare professionals that they have the willingness to engage more with their providers and
avail themselves of new healthcare delivery models and technologies (Bylander, 2013). Some
low-income patients also initiate and come up with their strategies and solutions despite the
communication barriers, such as paying attention and actively engaging during consultations,
freely communicating their symptoms and conditions, and following the doctor’s advice.

“Sabi ko doc ano po bang pwede kong gawin sa sakit ko na to. Kung ano po yung
kailangan kong gamot na pwede i-take para gumaling ako sabi ko. Ano pa ba yung
kailangan kong iwasan na mga pagkain. Ayun sinagot nya naman ako nung anong
pinagbabawal.” - Patient #2
“Ang responsibilidad ko na mismo doon ay yung pagbibigay niya ng tamang oras ng
pag-inom ng gamot, dahil kung hindi rin natin susundin ‘yon malamang hindi rin
tayo gagaling.” - Patient #3

Now, as we focus on the low-income patients’ strategies and solutions, one emerging theme is
the LIP’s responsibility during consultations and treatments. During the data-gathering process,
all three (3) LIP participants mentioned that it is important to communicate one’s conditions
honestly to the doctor to be given the proper medication and treatment. LIP #2 also emphasized
that it is best to be open and not be hesitant when conversing because, according to literature,
once there is inefficient communication between a patient’s physician, it can result in a sub-par
quality of care and poor outcomes for the patient (Yunk, 2019).
In addition, all three (3) LIP participants also answered that it is essential to follow the
doctor’s instructions, especially when undergoing treatment, for faster recovery. LIP #3 also
reiterated the importance of remembering the time and number of medicines intakes and the
dates for the follow-up check-ups. It was also evident in their responses that the LIPs practice
health-seeking behavior, in which they are not hesitant to get any medication.
Another theme that arose is the communication strategies made by the low-income patients.
Here, LIP #1 also shared that the first step during the consultation is to communicate, the
second is to listen, and then the third is to act (which pertains to buying the prescribed medicines
and doing the treatment plan). During a conversation with the healthcare providers, LIP #2
mentioned speaking in the Filipino language because it is what works best for both of them.
While on the other hand, LIP #3 initiates by repeating the prescribed medical instructions to
make it clear to the HCPs that he could follow everything they have mentioned.

“Kadalasan talaga ang pinakikinggan ko sa doktor ay kapag nagbibigay siya sa akin

ng reseta. Inuulit ko talaga kapag hindi ko naintindihan, kunwari sabihin sa akin
“three times a day, ito, inumin lang sa umaga, three time a day”. - Patient #1

In conclusion, effective communication between medical doctors and patients is crucial to

successful medical care (Bientzle et al., 2017). Patients should also have their purpose and goals
whenever going to their healthcare providers. It is also essential for them to be reminded of open
communication, active listening, and giving feedback or responses during consultations. Accord-
ing to Bylander (2013), this is to continuously combat the challenges in communication between
patients and providers, increase patient satisfaction, trust in their doctors, and confidence in
being engaged in healthcare decisions.

13 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

5 Conclusion
In analyzing the communication dynamics from narratives gathered from the healthcare profes-
sionals and low-income patients in the Philippines, it is evident that regardless of the distinct
socioeconomic factor that the study wanted to look into, all elements of the communication
dynamics are still present. A communication flow that involves transmission, reception, commu-
nication barriers, and resolution is still applicable between HCPs and LIPs.
While healthcare professionals are bound by their ethics as professionals and healthcare stan-
dards to provide or at least try to maintain the same quality of healthcare to all patients regardless
of socioeconomic backgrounds, the results of this study suggest that socioeconomic factors do
affect doctor-patient communication dynamics to some extent.

1. As the communication process requires the patient’s intention and initiative to seek health-
care, LIPs’ financial limitations, and preconceived judgments, which are made worse by the
hindrances of getting medical attention in the middle of a health crisis, result in a feeble
start to the establishment of communication dynamics between healthcare professionals
and the patients.
2. In terms of message transmission, socioeconomic backgrounds affect HCPs’ choice of lan-
guage and rhetoric with the need to ‘adjust’ to the level of comprehension that is accessible
to the patients; strategies include avoiding the use of technical jargon, expressing their
sensitivity to the patients’ cultural backgrounds, and utilizing communication tools that
provide practical examples of situations for the patient.
3. Successful reception is achieved when patients can grasp that their doctors can establish
empathy in patiently assessing and concluding the proper diagnosis. In other words, doctors
mostly use patient-centered with needs orientation communication styles to communicate
with LIPs.
4. Common communication barriers between HCPs and LIPs are (a) language barriers which
occur when doctors and patients struggle to find a common language to converse with, and
(b) knowledge gaps that suggest the LIPs’ lack of health education hence their tendencies to
hold on to cultural beliefs about health or being misinformed by their ‘independent research
and what is fed to them through media and, (c) patients’ socioeconomic limitations that
become a source of emotional distress which compromises their ability to comprehend.
In addition to these barriers that limit the patients’ ability to comprehend their doctor’s
opinion, the limitations of the COVID-19 pandemic also pose a concern as it causes the
LIPs’ health conditions to worsen before they get medical attention.
5. Finally, resolutions for the barriers mentioned earlier are worked on as early as starting
the transmission of diagnoses, treatments, and provision of assistance. HCPs in this study
are lenient to adjust depending on the case of their LIP, assisting them in ways such as
(a) use of communication strategies to instill a health-seeking behavior in the patients, (b)
directing them to government institutions or social services to help with the finances, and
(3) build a good relationship with the patient, so they will be trusted in terms of following
their professional medical advice.

6 Recommendations
To further contribute and develop the acquired knowledge about this research, the researchers
propose the following as ideas for the next course of actions that may be pursued:

14 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

1. Further research may include perspectives from low-income patients in distant or rural
areas, as this study was only able to involve HCPs and LIPs from urban cities in the
Philippines.
2. Acknowledging that the COVID-19 pandemic makes LIPs delay getting medical atten-
tion, there should be more efforts to innovate how healthcare services could be efficiently
extended outside a hospital facility. Some possible ways include mobilizing programs to
offer affordable yet quality out-patient care in local health units so that patients may have
the opportunity to get medical attention while avoiding the risk of getting infected inside
hospital facilities.
3. Aside from campaigns that promote utilizing existing social services and more accessible
healthcare, HCPs can also look into how a culture of health-seeking behavior can be com-
municated and cultivated among Filipinos to not only address the concerns of the sick but
also boost the health of all Filipinos as a preventative measure to counter-cultural beliefs
and preconceived health belief systems that result to misinformation.

References
[1] AAFP (n.d.). Poverty and Health - The Family Medicine Perspective.
https://bit.ly/3m6sCZn
[2] Abrams, M. K., Lewis, C., Seervai, S., Zephyrin, L. (2019, May 15). Listening to Low-
Income Patients and Their Physicians: Solutions for Improving Access and Quality in
Primary Care.The Commonwealth Fund: https://bit.ly/3EZNZ64
[3] Agosto, H. G. C., Briones, M. V. A., & Palatino, M. C. (2018, April 31). Correlates of
Health Literacy among Filipinos aged 50-70 years old Belonging to Low-Income Families in
a Selected Community. Acta Medica Philippina. https://doi.org/10.47895/amp.v52i3.397

[4] Albert, J. R. G., Santos, A. G. F., Vizmanos, J. F. V. (2018). Defining and profiling the
middle class. https://bit.ly/3DRDiB6
[5] Almutairi, A. G., Kalbani, T. A., Mashrafi S. A., Shamsi H. A., (2020, April
30). Implications of Language Barriers for Healthcare: A Systematic Review. NCBI:
https://bit.ly/3F16S8z

[6] Benchmark Institute (n.d.). The Dynamics of Communication. https://bit.ly/3q1WeYO

[7] Bientzle, M., Fissler, T., Cress, U., & Kimmerle, J. (2017). The impact of physicians’ com-
munication styles on evaluation of physicians and information processing: A randomized
study with simulated video consultations on contraception with an intrauterine device.
Health expectations : an international journal of public participation in health care and
health policy, 20(5), 845–851. https://doi.org/10.1111/hex.12521
[8] Brooks, A. (2019, March 4). What Is Community Health and Why Is It Important? Ras-
mussen University. https://bit.ly/3yqNZtn
[9] Bylander, J. (2013, November 1). Communication about Health Care with Low-
Income Californians: Results from a New Survey: Health Affairs Blog. HealthAffairs.
https://bit.ly/3yuAd8Z

15 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

[10] Cabico, G. K. (2020, July 30). UN report: ’Weak’ Philippine healthcare system lacks
nurses, hospital beds. Philstar. https://bit.ly/3yAsaYj
[11] Centers for Disease Control and Prevention (2021, May 19). What Is Health Literacy?
Centers for Disease Control and Prevention. https://bit.ly/3s8Eqhq
[12] Clarke G M, Conti S, Wolters A T, Steventon A. (2019). Evaluating the impact of health-
care interventions using routine data BMJ 2019; 365 :l2239 doi:10.1136/bmj.l2239
[13] Cohut, M. (2020, May 15). The effect of the COVID-19 pandemic on primary healthcare
worldwide. Medical NewsToday. https://bit.ly/3dTuxMw
[14] Council for Health and Development Philippines. (2021, December 6). Failing COVID-
19 Response: A failure of a weak and privatized healthcare system. phmovement.org.
https://tinyurl.com/hr2e7djy
[15] Creswell, J.W. (2006, November 28). Chapter 4: Five Qualitative Approaches to Inquiry.
https://bit.ly/3IS8m7G
[16] Domingo, K. (2020, September 17). Who are identified rich, poor? Gov’t shows income
class brackets in PH ABS. https://bit.ly/3oWxtOz
[17] Fisher, W. R. (1985). The Narrative Paradigm: In the Beginning. Journal of Communica-
tion, 35(4), 74–89. https://doi.org/10.1111/j.1460-2466.1985.tb02974.x
[18] Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. The Ochsner
journal, 10(1), 38–43.
[19] Hewson, C. (2008). Internet-mediated research and its potential role in facilitating mixed
methods research. https://bit.ly/3scAnRg
[20] HIPAA Journal (n.d.). Effects of Poor Communication in Healthcare.
https://bit.ly/3ITVD4k
[21] Javier, R., Tiongco, M., & Jabar, M. (2019). How Health Literate are the iGener-
ation Filipinos?Health Literacy Among Filipino Early Adolescents in Middle Schools.
https://bit.ly/3GGa3my
[22] Jison, John Raymond. (2020). The need to recognize health as politi-
cal.https://www.researchgate.net/publication/350898666 The need to recognize health as political
[23] Johnson, T. (2019, March 11). The Importance of Physician-Patient Relationships Com-
munication and Trust in Health Care. https://bit.ly/3DRFpVC
[24] Kenworthy, K. (2020, April 18). 10 Facts About Healthcare in the Philippines. The Borgen
Project. https://bit.ly/3oVyiHh
[25] Montemayor, M. T. (2019, July 21). Health for all FILIPINOS: Universal healthcare law.
Philippine News Agency. https://bit.ly/3yuUuLJ
[26] Neubauer, B. E., Witkop, C. T., & Varpio, L. (2019, April 5). How phenomenology
can help us learn from the experiences of others. Perspectives on Medical Education.
https://bit.ly/3H1RQQP
[27] Nicolas, A. A. (2021, February 18). Thematic analysis. Research Prospect.
https://bit.ly/3scTw5B

16 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022
Britt, M.J.B. et al. Understanding the Communication Dynamics

[28] Onpage Corporation (2020, August 14). Effective Communication Between Healthcare Pro-
fessionals – Best Practices. https://bit.ly/31ZMNkS
[29] Pathak, V., Jena, B., Kalra, S. (2013, July). Qualitative research. Perspectives in clinical
research. https://bit.ly/3oXtul1

[30] Pleasant A. (2014). Advancing health literacy measurement: a pathway to better health
and health system performance. Journal of health communication, 19(12), 1481–1496.
https://doi.org/10.1080/10810730.2014.954083
[31] Regis College (n.d.) What Is the Importance of Communication in Health Care?
https://bit.ly/324Zk64

[32] Robinson, R. (2014). Purposive Sampling. SpringerLink. https://bit.ly/3GON7lo

[33] Rondilla, N. A., Rocha, I. C., Roque, S. J., Lu, R. M., Apolinar, N. L., Solaiman-
Balt, A., Abion, T. J., Banatin, P. B., & Javier, C. V. (2021, April 19). View of Folk
Medicine in the Philippines: A Phenomenological Study of Health-Seeking Individuals
— International Journal of Medical Students. International Journal of Medical Students.
https://ijms.info/IJMS/article/view/849/1163
[34] Santiago, J. P. (2019). Health Literacy For All Filipinos. https://bit.ly/3ETsp33
[35] Tadem, E. C. (2020, December 16). [ANALYSIS] Philippine marginalized communities and
the state in pandemic times. Rappler. https://bit.ly/3ytIo5w

[36] Tomacruz, S. (2019, April 1). EXPLAINER: What FILIPINOS can expect from the uni-
versal health care law. Rappler. https://bit.ly/33kZwif
[37] Uy, A. B., Chiu, H. H., Larrazabal Jr., R., & jimeno, C. (2021). An Exploration of
Knowledge and Themes on Diabetes during Outpatient Consultation in a Tertiary Re-
ferral Hospital.Journal of the ASEAN Federation of Endocrine Societies, 36(1), 31-36.
https://doi.org/10.15605/jafes.036.01.05
[38] Wyman, O. (2017, January 18). Low-income patients cite financial, cultural barriers to
care. Patient Engagement HIT. https://bit.ly/3ythDOq
[39] Yunk, K. (2019, March 16). Effects of Poor Communication in Healthcare.8x8:
https://bit.ly/3m6Bcax

17 Talastásan: A Philippine Journal of Communication and Media Studies

Volume 1, Number 1, June 2022