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Gabay, Margosatubig Zamboanga Del Sur

Toribio Minor National Highschool
Senior Highschool
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EXPERIENCES OF COMMUNITY HEALTH NURSES IN

PREVENTING NON-COMMUNICABLE DISEASES IN
MARGOSATUBIG

In Partial Fulfillment of the Requirements for the Subject

Practical Research 1
(Qualitative Research)

Presented By:
Annie Grace C. Culanag
Raiyanah A. Macabada
Rojelouh F. Niez
Allyza Novem R. Namantucan

Presented to:
Ms. Brenda R. Cantil
 ABSTRACT

Culanag, Annie Grace C., Macabada, Raiyanah A., Niez, Rojelouh F., Namantucan
Allyza Novem R. (2024). Experiences of Community Health Nurses in
Preventing Non-Communicable Diseases in Margosatubig. Toribio Minor
National High School, Margosatubig, Zamboanga del Sur.

This study examined the experiences of Community Health Nurses (CHNs) in the
prevention of Non-Communicable Diseases (NCDs) in Margosatubig, Zamboanga
del Sur. Adopting a phenomenological research design, purposive sampling was
employed to select all 11 CHNs in the research area. Data were collected through
individual interviews, which were manually transcribed and analyzed using
Thematic Analysis. The findings indicated that CHNs are integral to health
monitoring and promotion, performing monthly assessments and delivering health
education within the community. Nonetheless, they encountered significant
challenges, including patient non-compliance, economic constraints, and resource
shortages. Strategies such as providing free health services and collaborating with
community sectors were utilized to address these issues. The study accentuates the
importance of supporting CHNs through additional training and resource allocation
to enhance NCD prevention efforts. These insights contribute to understanding the
vital role of CHNs in rural healthcare settings and inform future policy development
to improve health outcomes.

Keywords: Community Health Nurses, Non-Communicable Diseases, NCD

Prevention, Health Monitoring, Health Promotion, Phenomenological Research,
Thematic Analysis, Margosatubig, Zamboanga del Sur, Public Health.
TABLE OF CONTENTS
 CHAPTER 1

THE PROBLEM

Introduction

Noncommunicable diseases, also known as chronic non-transmissible diseases,

were responsible for 41 million deaths annually, accounting for 74% of all global deaths.

These diseases posed a significant threat to global health, with far-reaching social,

economic, and health system implications (WHO, 2018).

Non-communicable diseases presented critical international health issues, notably

in the World Health Organization South-East Asia Region, responsible for nearly two-

thirds of all deaths, particularly among individuals aged 30-69 years (Silva et al., 2023).

With cardiovascular diseases, cancers, chronic respiratory disorders, and diabetes

accounting for the majority of NCD fatalities, substantial political and WHO-led initiatives

were implemented to combat this issue (Silva et al., 2023). Despite tangible progress in

reducing tobacco usage, challenges remained in decreasing alcohol consumption and

unhealthy diets, exacerbated by commercial influences that hampered governmental policy

enforcement (Silva et al., 2023). The urgency to address these health challenges was further

intensified by the region's collective ambition to achieve the SDG 3.4 target of reducing

premature NCD mortality by 2030, with most countries still at risk of falling short without

significant improvements in policy and healthcare system interventions (Silva et al., 2023).

There had been a significant increase in NCD cases in America, presenting a major

challenge for public health systems and policymakers. The rise in chronic diseases such as

cardiovascular conditions, cancers, and diabetes was largely attributed to an aging

population and lifestyle factors. This surge required a strategic health response to manage

long-term care and prevention, which included addressing social determinants of health

and inequality in healthcare access. The impact on the economic and social fabric of the

Americas called for integrated international efforts to reduce the prevalence and

consequences of NCDs. Additionally, the Caribbean region, consisting of more than 25

countries and territories, also faced significant challenges in tackling NCDs, which were

the leading cause of death in the region. International issues such as inadequate surveillance

systems, economic impacts, and the need for improved quality of care were highlighted

(Razzaghi et al., 2019).

Non-communicable diseases (NCDs) had emerged as the primary contributor to the

disease burden in the Philippines. The impact of NCDs was strikingly evident. Between

1990 and 2019, the contribution of NCDs to total deaths rose from 39% to 64%. Ischemic

heart disease, stroke, chronic kidney disease, diabetes, and low back pain stood as the top

causes of NCD burden, with cases projected to increase considerably. Without

groundbreaking interventions, cases of major NCDs like hypertension were expected to

double by 2040 (Ulep et al., 2020). In 2019, NCDs were responsible for 70% of the total

600,000 deaths and 65% of the 33 million disability-adjusted life years (DALYs). These

conditions, which included cancers, chronic respiratory diseases, cardiovascular diseases,

and diabetes, were characterized by their long-lasting nature and slow progression (Ulep

et al., 2021, p. 4).

In the Zamboanga Peninsula of the Philippines, a region characterized by diversity

but also by the challenges of low- to middle-income settings, the prevalence of type 2

diabetes had become a serious public health concern. Reflecting global health trends,
studies signaled an alarming rate of undiagnosed non-communicable diseases in such

contexts, of which the Zamboanga Peninsula was emblematic. According to the study

protocol titled "The Community Health Assessment Program in the Philippines diabetes

health promotion program for low- to middle-income countries: study protocol for a cluster

randomized controlled trial" by Gina Agarwal, Ricardo Angeles, Lisa Dolovich, et al., the

Philippines, an LMIC, exhibited a significant gap in the detection and management of

diabetes.

This challenge necessitated innovative health promotion programs tailored to local

capacities and cultural contexts. The CHAP-P was one such ongoing assessment initiative

in the region, designed to be a low-cost, community-driven program involving community

healthcare workers, particularly nurses. These professionals were integral to facilitating

these health assessments, playing a critical role in the early detection, education, and

prevention strategies that sought to address the burgeoning issue of NCDs effectively

within their communities. The experiences of these community health nurses in the

Zamboanga Peninsula, particularly in Margosatubig, could, therefore, provide invaluable

insights into the efficacy of health interventions in preventing NCDs in similar LMIC

settings (Agarwal et al., 2019).

The economic conditions in Margosatubig, Zamboanga del Sur, characterized by

high levels of poverty and limited access to resources, hindered the community's ability to

engage in effective health practices. According to recent data, the region experienced

substantial poverty, which restricted access to essential health services and resources

necessary for NCD prevention and management (Philippine Statistics Authority, 2021).
In response to the pervasive cases of non-communicable diseases (NCDs) in the

Philippines, the Philippine Department of Health (DOH) prioritized addressing NCDs by

implementing the Philippine Package of Essential Noncommunicable Disease

Interventions (PhilPEN) (Yamaguchi et al., 2023, p.2), reinforced under Administrative

Order no. 2012-0029, also known as Implementing Guidelines on the Institutionalization

of the Philippine Package of Essential Non-Communicable Disease Intervention on the

Integrated Management of Hypertension and Diabetes for Primary Health Care Facilities.

PhilPEN was a comprehensive program based on World Health Organization

(WHO) guidelines, aimed at identifying and managing cardiovascular risk factors at the

primary health care level. The program included community-level screening for key risk

factors such as smoking, hypertension, and diabetes, which were prevalent in the

Philippines. PhilPEN's goal was to improve the prevention, early detection, and

management of NCDs to reduce their impact on the population's health. The program

aimed to strengthen the healthcare system's capacity to address NCDs and improve the

overall health and well-being of Filipinos.

Nurses played a crucial role in addressing the global crisis of non-communicable

diseases (NCDs). Nurses, as health educators, were well-positioned to support health

promotion and prevention efforts related to NCDs (DeCola et al., 2012). In a recently

conducted Task Analysis of Doctors and Nurses in Philippine Rural Areas of Tamayo et

al. (2024), the results showed that a majority (81%) of health workers involved in the study

were nurses, indicating the prevalent role of nursing staff in the primary care workforce in

rural areas. According to the study, nurses frequently performed essential preventive care

tasks such as taking vital signs, recording patient history, and advising patients on the
importance of regular follow-ups. These were foundational activities in monitoring and

managing NCDs like hypertension and diabetes, which were chronic conditions requiring

ongoing care and patient education, accentuating the potential for nurses to address gaps

in care, especially with additional training (Tamayo et al., 2024). Conformingly, nurses

were integral to the prevention and management of NCDs due to their significant presence

in the healthcare workforce and their involvement in direct patient care practices that were

key to NCD monitoring and management.

In the context of the Philippine Primary Healthcare System, Community Health

Nurses (CHNs) led house-to-house visitations among identified NCD patients to check and

monitor their condition and provided health education and promotion, and disease

prevention services among NCD patients in their assigned barangays. However, there was

limited understanding of how Community Health Nurses in Philippine rural settings like

Margosatubig engaged in NCD prevention activities as part of the NCD prevention

program. The present study aimed to fill this gap by exploring how CHNs described their

experiences, which encompassed their roles, perceptions of the program, perspectives,

struggles/challenges encountered, and strategies to improve NCD prevention.

The researcher's interest in conducting this study stemmed from a commitment to

improving community health and well-being, particularly in rural areas like Margosatubig.

With a desire to contribute to the field, the researcher saw an opportunity to understand the

vital but often overlooked role of Community Health Nurses (CHNs) in Non-

Communicable Disease (NCD) prevention. By understanding the experiences and

challenges faced by CHNs, the researcher hoped to provide insights that could inform
policies and improve the NCD program, ultimately leading to more effective NCD

prevention strategies and improved health outcomes in the community.

Theoretical Framework

This study was anchored by two principal theories: Role Theory, as elaborated by

authors such as Brookes, Davidson, and Daly in "Role theory: A framework to investigate

the community nurse role in contemporary health care systems," and the Community

Health Worker (CHW) Model, which evolved over time. Role Theory, rooted in the

foundational work within sociology and psychology, was articulated and expanded upon

by various scholars, with notable contributions in the context of nursing roles discussed in

recent literature. At its core, Role Theory stated that individuals' behaviors and perceptions

were shaped by societal expectations and the roles they occupied within social structures.

It provided a conceptual framework defining how individuals behaved in social situations

and how these behaviors were perceived by external observers.

Role Theory allowed for a systematic examination of the roles community health

nurses (CHNs) undertook, particularly how these roles were perceived and enacted in

preventing non-communicable diseases (NCDs) within the target community. By using

Role Theory, the study aimed to describe the professional experiences of CHNs, their role

perception, interactions with societal and policy contexts affecting their work, and the

challenges and adaptations they encountered in their professional practice.

The Community Health Worker Model, while not attributable to a single author,

was developed and refined through practical application and empirical research in public

health. Supported by organizations such as the World Health Organization, this model

gained global recognition and utilization. The CHW Model emphasized the role of health
workers within the community, focusing on their contributions to preventative healthcare,

primary care, and health education. CHWs were essential in bridging the gap between

communities and complex healthcare systems, especially in underserved areas where

access to healthcare was limited.

The CHW Model was suitable for this study as it reflected the practical strategies

employed by Community Health Nurses in Margosatubig, the nature of community

engagement in preventative healthcare, and the support network necessary for effective

public health interventions. It provided the foundational basis for understanding the nature

of CHNs' work, reflecting on how their roles took shape in the context of localized health

needs and the prevention of non-communicable diseases.

Role Theory's focus on understanding how societal expectations shaped individual

behaviors and perceptions was highly relevant for examining the roles of Community

Health Nurses in NCD prevention. This theory provided a comprehensive framework for

analyzing the professional experiences of CHNs, their role perceptions, and the challenges

they faced within the societal and policy contexts of Margosatubig. By concentrating on

roles and societal expectations, Role Theory facilitated a deeper understanding of how

CHNs fulfilled their professional responsibilities and adapted to the demands of NCD

prevention.

The CHW Model's emphasis on practical strategies and community engagement

aspects of healthcare made it particularly appropriate for this study. CHNs in Margosatubig

employed community-driven approaches to NCD prevention, making the CHW Model a

fitting framework to analyze their strategies and interactions with the community. The

model's focus on bridging gaps between communities and healthcare systems coincided
with the study's objective of understanding the CHNs' roles in providing accessible and

effective NCD prevention services.

Both frameworks were integral to this study as they provided complementary

perspectives on the roles and strategies of CHNs in NCD prevention. Role Theory offered

insights into the societal and professional contexts that influenced CHNs' behaviors and

perceptions, while the CHW Model emphasized the practical and community-oriented

aspects of their work. Together, these theories provided a constructive understanding of

the CHNs' experiences regarding their role, challenges, and strategies in NCD prevention

in Margosatubig.

In conclusion, the combination of Role Theory and the CHW Model was highly

suitable for this study. They facilitated a comprehensive understanding of the professional

and community engagement aspects of CHNs' roles in NCD prevention, thereby

contributing to a detailed understanding of the challenges and strategies involved in

addressing NCDs in a rural Philippine setting.

Conceptual Framework

OUTPUT
INPUT
Understanding:
Demographic CHN Roles in NCD
Profiles: Age, Prevention
Gender, Length of
Work Experience PROCESS Account: CHNs
Interviews: Challenges
NCD Programs: Semi-structured
Activities conducted Interview with Implications: Based
for NCD prevention CHNs on findings

Community Data Analysis: Recommendations:

Context: socio- Thematic Based on CHN
economic, Health Analysis Insights/perceived
Facilities effective strategy

Policies &
Resources: NCD
Prevention

Figure 1. Research Paradigm

This study employed the Input-Process-Output (IPO) Model as its conceptual

framework, providing a systematic approach to conceptualize the flow of the research. The

IPO model clarified how various inputs were transformed through specific processes to

yield outputs. The inputs for this study included the profiles of Community Health Nurses

(CHNs), such as their educational background, years of experience, and the demographic

context in which they worked. Additionally, inputs encompassed detailed elements like the

specifics of Non-Communicable Disease (NCD) Prevention Programs currently in

operation, the socioeconomic and cultural landscape of the community, and the available

health infrastructure and policies pertinent to NCD prevention.

 The process involved qualitative research methods, including semi-structured

interviews with the CHNs. These methods were designed to collect raw data, delving

deeply into the experiences, perceptions, and practices of the nurses. Transcription and

thematic analysis were subsequently conducted to interpret the information and identify

emerging patterns and themes.

The outputs of the study consisted of an in-depth understanding of the CHNs' roles,

experiences, and strategies within the context of NCD prevention in Margosatubig. These

outputs revealed the real-world implications of current practices and informed

recommendations for future policy development. The study's findings extended the body

of knowledge in this field, with the potential to impact both local health strategies and

broader public health discourse related to NCD prevention in rural areas.

By employing the IPO model, this study provided structure and clarity,

demonstrating the relationship between the knowledge and experience of community

health nurses (inputs), the methodological approach of the study (process), and the insights

gained regarding NCD prevention (outputs). This approach ensured a comprehensive and

systematic analysis, facilitating a deeper understanding of the complexities involved in

NCD prevention in rural settings.

Statement of the Problem

The purpose of this study was to determine the experiences of Community Health

Nurses (CHNs) in providing Non-Communicable Disease (NCD) Prevention in

Margosatubig. The respondents of the study included all Community Health Nurses

assigned in Margosatubig, Zamboanga del Sur. Specifically, the study sought to answer

the following questions:

1. What are the roles of Community Health Nurses in NCD Prevention in

Margosatubig?

2. What are the perceived challenges faced by Community Health Nurses in NCD

prevention?

3. What are the strategies/coping mechanisms employed by Community Health

Nurses in NCD prevention?

Significance of the Study

The results of this study will be beneficial to the following groups of individuals:

Community Health Nurses (CHNs). The results may enable them to assess and

evaluate themselves and gain a deeper understanding of their roles in NCD prevention,

identify effective strategies for addressing challenges, and advocate for policies that

support NCD prevention in their community. This can improve job satisfaction,

performance, and overall effectiveness in delivering NCD prevention services to the

community.

Community. The result of this study can lead to improved NCD prevention and

management strategies, resulting in better health outcomes for patients. By understanding

the experiences of CHNs, healthcare providers can tailor interventions to meet the specific

needs of NCD patients, ultimately improving their quality of life and reducing the burden

of NCDs in the community.

Policy Makers. The outcome of the study will provide valuable insights for

policymakers on how to improve the Primary Healthcare system's support for NCD

prevention efforts. This can lead to the development and improvement of policies and

programs that better support CHNs and address the underlying causes of NCDs in the

community, ultimately leading to improved health outcomes for the population.

Future Researchers. The ideas presented in this study may be used as a basis for future

research on NCD prevention and the role of CHNs in community health. By building upon

the findings of this study, future researchers can further explore the complexities of NCD

prevention and develop innovative strategies to address the growing burden of NCDs

globally.
Scope and Limitation

The purpose of this study was to determine the experiences of Community Health

Nurses (CHNs) in implementing the Non-Communicable Disease Prevention Program.

The respondents included all Community Health Nurses in the Municipality of

Margosatubig.

To track the experiences, each respondent (Community Health Nurses) underwent

a semi-structured interview. Data regarding the Non-Communicable Disease Prevention

Program were gathered by collecting documents and conducting short-scale interviews

with the assigned personnel in the Rural Health Unit of Margosatubig.

This study generalized or summed up all programs related to Non-Communicable

Diseases, lacking focus on specific NCDs, and only looking at all the NCD programs as a

whole. The study only included Community Health Nurses, excluding other Community

Health workers such as the Barangay Health Workers (BHWs) and Barangay Nutrition

Scholars (BNS).
Definition of Terms

The purpose of defining the terms is to arrive at a common understanding of the present

study, the following terms were defined operationally:

Barangays - The smallest administrative divisions in the Philippines, like villages or

neighborhoods. Barangays are often the primary unit for delivering basic services and

implementing community programs, including healthcare initiatives.

Chronic Diseases - Health conditions that are persistent and long-lasting in their effects or

diseases that develop over time. Typically, they are characterized by slow progression and

long duration, often requiring long-term medical attention and management rather than

immediate or acute care.

Community Health Assessment Program (CHAP-P) - A health promotion program in

the Philippines designed for low- to middle-income countries, involving community

healthcare workers, particularly nurses, to facilitate health assessments and early detection

of diseases.

Community Health Nurses (CHNs) - Registered nurses who work within communities,

providing healthcare services, health education, and disease prevention initiatives. They

often work in collaboration with other Community Health Workers and members to

promote health and well-being.

Economic Burden - The financial strain experienced by individuals or communities due

to the costs associated with healthcare, including the inability to afford medication,

laboratory tests, or transportation to health centers.

Experiences - The perceptions, perspectives, and insights of CHNs regarding their roles,

challenges, and strategies in preventing non-communicable diseases within the community.

Health Assessment - A comprehensive evaluation of an individual's overall health status,

including a detailed examination of medical history, physical examination, and diagnostic

tests to gather information about their current health condition.

Health Promotion - Activities aimed at improving health and preventing disease through

education, awareness, and health-enhancing interventions, often conducted by healthcare

professionals like nurses.

Health Screening - Preventive health checks conducted on individuals who appear healthy

to identify hidden issues before any signs or symptoms of disease manifest. These tests aim

to detect potential health problems early, preventing the development of severe diseases

and complications.

Margosatubig - Refers to the municipality in the province of Zamboanga del Sur,

Philippines, where the research is focused. Margosatubig is composed of 17 barangays,

and the study specifically targets all barangays within this municipality.

Non-Communicable Disease Prevention Program - Established and planned actions

encompassing several programs for different Non-Communicable Diseases by the

Department of Health, implemented by Municipal Health Stations, including the Rural

Health Unit and Barangay Health Stations/Center for mitigating NCDs.

Non-Communicable Diseases (NCDs) - Chronic diseases characterized by long-lasting

effects and slow progression. Examples include cardiovascular diseases, diabetes, cancer,

and chronic respiratory diseases.

Non-Compliance - The failure to adhere to prescribed treatments, including inconsistent

medication intake, ignoring health conditions until they worsen, and a preference for

alternative medicines over prescribed treatments.

Nurse - A registered healthcare professional who has completed the necessary educational

qualifications and licensure requirements to provide nursing care. Nurses are involved in a

wide range of health care services, including patient care, health education, and

participation in health research.

Philippine Package of Essential Noncommunicable Disease Interventions (PhilPEN)

- A program in the Philippines that comprises a set of essential interventions aimed at

addressing noncommunicable diseases (NCDs). PhilPEN focuses on identifying and

managing cardiovascular risk factors such as smoking, hypertension, and diabetes at the

primary healthcare level. The program is based on World Health Organization

recommendations and aims to improve NCD prevention and management strategies,

particularly at the community level.

Socioeconomic Context - The economic and social conditions that influence individuals'

and communities' ability to engage in effective health practices, including factors such as

income levels, education, and access to healthcare resources.

Universal Health Care (UHC) Act - A law in the Philippines that aims to provide

comprehensive health services to all Filipinos, including automatic inclusion in the

National Health Insurance Program..

 CHAPTER 2

Methodology

This chapter presents the methodology employed in this study to explore the

experiences of Community Health Nurses (CHNs) in preventing Non-Communicable

Diseases (NCDs) in Margosatubig. It covers the research design, research environment,

sampling design, research informants, data gathering procedures, data analysis methods,

and ethical considerations. By detailing these elements, this chapter provides a

comprehensive overview of the approach and processes used to conduct the study, ensuring

the validity and reliability of the findings.

Research Design

This research is a qualitative study and employed the Phenomenological research

design. Qualitative research is an approach that emphasizes understanding and

interpreting social phenomena from the perspective of the participants involved. It

focuses on exploring the complexities and nuances of human experiences, behaviors,

attitudes, and perceptions (Aspers & Corte, 2019). The Phenomenological research

design is a qualitative approach that seeks to uncover and describe individuals' lived

experiences and the meanings they attribute to them. This method emphasizes the

interpretation of these experiences from the participants' perspectives, delving into the

complexity of human perception and subjectivity. It engages with participants to access

the essence of their experiences, revealing how their perceptions shape their

understanding and actions (Wilson, 2015).

 Employing the Phenomenological design is particularly appropriate in this study as

it seeks to explore the experiences of Community Health Nurses in the specific context

of NCD prevention in Margosatubig. The suitability of the Phenomenological design

is focused on capturing nuanced and tacit knowledge that informs the daily practices

of health professionals (Wilson, 2015). By utilizing this design, the study provides an

in-depth understanding of the themes that emerge from the research questions, such as

the roles, experiences, challenges, and strategies of Community Health Nurses as well

as their perspectives on NCD prevention policies in Margosatubig, which specifically

align with the objectives of this research. This qualitative depth is essential to

comprehensively understand the phenomenon under study and offers insights that can

inform future interventions and policy developments.

Furthermore, a phenomenological approach is ideal for this study because it

provides the flexibility and depth required to understand the intricacies and subjective

experiences of health professionals within their communities. Phenomenology is

particularly effective at uncovering the 'how' and 'why' behind individuals' actions and

decisions, which are often influenced by their backgrounds, culture, and interpersonal

relationships (Wilson, 2015). By facilitating an empathetic connection and encouraging

the expression of personal narratives, this method enables the researcher to capture the

motivations, feelings, and contextual factors that drive the implementation of NCD

prevention strategies.
 Given the scope of the study, which involves assessing not only the strategies but

also the personal and emotional dimensions of the nurses' experiences, phenomenology

allows for a holistic understanding of the challenges faced by Community Health

Nurses. This comprehensive perspective is essential in informing effective, sustainable

NCD prevention programs that are sensitive to the needs and realities of the community

and the healthcare providers. Phenomenological research thus transcends mere

description of practices, offering insights into the essence of the nursing experience

that can lead to transformative implications for community health care, policy

formation, and the overall well-being of the community in Margosatubig.

Research Environment

Source: Google Map

Figure 1. Map of Research Locale

The research environment in which the study was conducted was in Margosatubig,

one of the 26 municipalities of Zamboanga del Sur, Region IX, Philippines. Margosatubig

was a rural area, with a population of 38,660 people and a population density of 346

individuals per square kilometer (Philippine Atlas Data, 2024). Margosatubig was divided

into 17 barangays, namely Josefina, Poblacion, Digon, Talanusa, San Roque, Igat Island,

Guinimanan, Balintawak, Bularong, Lumbog, Limamawan, Tiguian, Tulapok, Kalian,

Sagua, Magahis, and Limbatong. Each barangay facilitated a Barangay Health Center,

staffed with a Community Health Nurse who visited based on an established schedule. The

municipal healthcare infrastructure also included one Rural Health Unit, tasked with

managing local health services, and one Regional Hospital, both situated in Barangay

Poblacion.
Sampling Design

This study employed purposive sampling as its sampling design. Purposive

sampling is a non-probability sampling technique where researchers deliberately select

participants with specific knowledge or experience to inform their study, as described by

Tongco (2007). Purposive sampling was chosen as it allowed the selection of all

community nurses working in the 17 Barangays of Margosatubig. These individuals had

the direct experience and insights necessary to provide rich, relevant data regarding the

prevention of non-communicable diseases within their communities. Given the small and

specific population of community health nurses (only 11 in total), purposive sampling

ensured that all those who could offer the most pertinent information were included in the

study.
Research Informants
The research informants for this study comprised all the community health

nurses responsible for the 17 barangays within the Municipality of Margosatubig. Despite

there being 17 barangays in the municipality, there were a total of only eleven nurses

assigned. Some community health nurses were designated to multiple barangays, while

others were assigned to only one barangay. They were assigned based on a schedule, which

allowed them to serve various locations. Table 1 shows the demographic profile of nurse

participants in this study:

Table 2. Participant Demographics

PARTICIPANT AGE SEX WORK ASSIGNED

EXPERIENCE BARANGAY
(IN YEARS)
NP1 35 F 3 Poblacion
NP2 33 F 7 Balintawak
NP3 42 F 8 Magahis
Sagua
Kalian
Tulapok
NP4 31 F 4 Tulapok
NP5 38 F 8 Limbatong
NP6 39 F 2 Lumbog
NP7 34 M 8 Poblacion
NP8 29 F 8 Digon
NP9 41 F 9 Kalian
NP10 51 F 20 (Supervisor)
NP11 38 F 7 Tiguian

The demographic characteristics and work experience of the community health

nurses (CHNs) involved in the study are summarized in the table, with each nurse coded

as NP1 to NP11 for anonymization and privacy protection. The ages of the community

health nurses ranged from 29 to 51 years, with the majority being in their 30s and 40s,

suggesting a workforce with significant experience and maturity. This diversity in age
likely benefited the handling of complex tasks related to NCD prevention. Out of the 11

participants, 10 were female, and 1 was male, indicating a predominantly female workforce

among the CHNs in Margosatubig.

The work experience of the nurses varied from 2 to 20 years, with the most

experienced nurse, NP10, having 20 years of experience and serving in a supervisory role.

This variation in work experience highlighted a mix of both relatively new and highly

experienced professionals in the field. Each nurse was responsible for specific barangays,

with some, like NP3 and NP8, being assigned to multiple barangays. NP3 covered four

barangays: Magahis, Sagua, Kalian, and Tulapok, while NP8 was assigned to Digon,

indicating a broader scope of responsibility for these nurses. NP10, as a supervisor, likely

had oversight across multiple barangays or responsibilities beyond direct patient care.

The workload distribution showed that nurses with multiple barangay assignments,

such as NP3 and NP9, faced higher workloads compared to those with single barangay

assignments. This could impact their ability to provide consistent and focused care in NCD

prevention. Understanding these dynamics was crucial for developing targeted support and

resources to enhance the effectiveness of NCD prevention strategies in Margosatubig.

Overall, the demographic and professional profiles of the CHNs in Margosatubig

reflected a dedicated and experienced group, predominantly composed of women. The

distribution of responsibilities across multiple barangays for some nurses highlighted

potential challenges in managing workload and ensuring effective NCD prevention across

the region.
Data Gathering Procedures

The data gathering procedures for this study involved individual interviews.

Interviews were conducted with each community health nurse informant based on an

Interview Guide Questionnaire (IGQ). The IGQ was crafted to align with the research

objectives and was validated and approved by the Research Committee of the affiliated

school or institution to ensure adherence to research standards and ethical considerations.

All sessions were recorded with permission from the informants for accuracy and

transparency. The data collected were transcribed manually and verbatim, ensuring a

detailed and precise capture of the participants' responses. Confidentiality was maintained

throughout the process. Prior to data collection, all informants were provided with

informed consent forms, which detailed the purpose of the study, procedures, their rights

as participants, and measures taken for confidentiality and data protection.

In Chapter 3, the methodology described the use of semi-structured interviews to

explore the experiences, perceptions, and practices of the community health nurses (CHNs)

in Margosatubig. This method allowed for in-depth discussions and provided rich

qualitative data. Each interview was conducted in a private setting to ensure comfort and

encourage openness among the participants. The verbatim transcriptions were analyzed

using thematic analysis to identify patterns and themes relevant to the research questions.

By employing these rigorous data gathering procedures, the study ensured that the

insights and experiences of the CHNs were accurately captured and analyzed, contributing

to a comprehensive understanding of their roles, challenges, and strategies in NCD

prevention. This approach also adhered to the highest ethical standards, safeguarding the

participants' confidentiality and ensuring the validity of the research findings.

Ethical Considerations

The protection and fortification of the human subjects that were involved in the

study were made through the application of proper ethical principles and are very essential

in any research study. In this study, ethical considerations must be followed to ensure that

the subjects and information that were yielded were secured and acceptable. The ethical

considerations that were pursued were:

Informed Consent and Voluntary Participation. Consent were given freely or

voluntary, subjects and respondents understood what was being asked of them. Before the

interview was conducted, the study was explained along with its purpose, and had the

power of freedom of choice that allowed them to decide whether to participate or decline

to the study. Considering the ethical aspect of research, enough time was given to the

respondents of the study during the interviews that were made. This led them to answer the

research questions honestly and truthfully based on what they felt and thought about the

system.

Anonymity and Confidentiality. Consent was taken from the respondents for the

usage of their given data. In ensuring the privacy of their data, anonymity and

confidentiality of the responses were upheld strictly. It was preserved by not revealing their

names and identity in the data collection, analysis and reporting of the study findings.

Moreover, the respondents had the right to withdraw from the study at any stage if they

wish to do so.
 Integrity. The integrity and reliability of the data and findings were done. Beyond

the fact that they can withdraw from the study, the usage of secondary data from any source

were acknowledged with appropriate references while misleading information, as well as

representation of primary data findings in a biased way were avoided. All deceptions or

exaggeration about the aims and objectives of the study were prevented.

Respect for People's Rights, Dignity, and Diversity. In this study, the rights,

dignity, and worth of people were valued and respected. Elimination of bias and any forms

of discrimination based on age; gender; race; ethnicity; national origin; religion; sexual

orientation; disability; health conditions; or marital, domestic, or parental status were not

tolerated.

Any type of communication in the relation of the study was done with honesty and

transparency. The use of offensive languages was prevented in the formulation of the

research questions. Hence, the ethical aspect of research was followed very strictly in this

research (AIMS Education, 2013; Bryman and Bell, 2007).

 Chapter 3

Presentation, Analysis, and Interpretation of Data

This chapter presents the analysis and interpretation of data on the experiences of

Community Health Nurses (CHNs) in preventing Non-Communicable Diseases (NCDs) in

Margosatubig. This includes the responses of the participants of the study generated from

the transcribed semi-structured interviews, the data was analyzed using thematic analysis.

Themes and sub-themes were identified. These involve their roles, challenges encountered,

and strategies in Non-Communicable Disease (NCD) Prevention. The participants have

been anonymized as Nurse Participant 1 (NP1) through Nurse Participant 11 (NP11).

After an in-dept interview and the responses of the participants were transcribed,

six (6) major themes were identified (Table 1).

Table 1. Themes relating to the roles of the CHNs, challenges, and strategies in NCD
prevention.
Theme Sub-Theme
Health Monitoring - Health Screening
- Health Assessment
Health Promotion - Giving health awareness during programs,
advocacy and NCD prevention activities
Health Promotion
Non-Compliance - Inconsistent medication intake
- Ignoring Health Condition until it gets worse
- Alternative Medicines
Economic Burden - Insufficient money to buy medicine/for
medication
- Limited access to nutritious food due to poverty
Lack of Resources for NCD - Insufficient supply of medicines from the
government
- Lack of Management support
Community Coordination - Seeking help from other community sectors
- Incentivized Engagement
Free Offer Strategy - Offering free Health Services
 - Giving free incentives to entice patients

Health Monitoring. The CHNs conduct monthly monitoring of Blood Pressure

(BP), blood sugar testing as part of their mandated role under the Philippine Package for

Non-Communicable Disease Prevention or PhilPen. Additionally, CHNs are also involved

in health assessments for NCDs as part of the on-going Community Health Assessment

Program in the Philippines, which is a community-based health intervention aimed at

improving cardiovascular health, which has been adapted into CHAP-P for the Philippines

context to address non-communicable diseases with a legal basis in public health

promotion and disease prevention efforts (Agarwal et al., 2019). This theme is supported

by the responses of the nurse participants below.

“…mag check lang gyud sa ilang mga BP monthly ana dayon ilang sugar
then monitor lang gyud …labi na katong mga naay maintenance…” [“…
we check their BP monthly and then their sugar then we just
monitor…especially those who have maintenance.”] NP5.
“…mag BP monitoring, kung sa diabetic, mag blood sugar testing pud
mi…” [“…we monitor their BP, for diabetics we have blood sugar
testing…”] NP2
“…we are provided with the PhilPen form in which every client that comes
in the facility for consultation, once included na ang ilahang target age sa
NCD ginahimoan na namo daan siya ug tracking tool so katong PhilPen
form...” ["… we are provided with the PhilPen form in which every client
that comes in in the facility for consultation once their target age for NCD
is included we are making them a tracking tool so PhilPen form."] NP10
“Naa mi CHAP, …so naa diha ang follow up check-up like laboratory so
kinhanglan nila ang CBC ug uban pang FDS testing blood sugar para
mahibaw an ang ilang kondisyon so naa tay monitoring good for 6 months
depende sa ilahang BP.” [“We have a CHAP, …there is the follow up
check-up like a laboratory so they need the CBC and other FDS testing
blood sugar to know their condition so we have monitoring good for 6
months depending on their bp."] NP6
 According to the narratives shared by the nurse participants, their roles in NCD

prevention include health screening and assessments to patients. This has also showed their

adherence to the Philippine Package for Non-Communicable disease which has been part

of the Philippine Public Healthcare System Policy since 2013.

Screening tests are preventive health checks conducted on individuals who appear

healthy to identify hidden issues before any signs or symptoms of disease manifest. These

tests aim to detect potential health problems early, thereby preventing the development of

severe diseases and complications (Ministry of Health and Wellness Jamaica, 2021) this

test was mention by NP2 and NP10 on the provided transcripts.

Health assessments, on the other hand, are comprehensive evaluations of an

individual's overall health status. These assessments involve a detailed examination of a

person's medical history, physical examination, and may include diagnostic tests to gather

information about their current health condition (Ministry of Health and Wellness Jamaica,

2021) which was detailed by NPA5 and NP6, where one participant shared about their

typical role in the recently on-going Community Health Assessment program.

Similar to a study conducted by the Primary Health Care Corporation in Qatar,

which assessed the impact of annual health screenings in identifying non-communicable

disease (NCD) risk factors, it has also shown that health screenings are vital to help mitigate

NCDs. This study demonstrated the effectiveness of regular health checkups in detecting

risk factors for conditions such as diabetes and hypertension, highlighting the importance

of preventive health measures in managing NCDs (Al-Abdulla et al., 2024) (Frontiers).

 Another relevant example is from Rwanda, where a free screening exercise

conducted with an objective of mitigating NCDs was rolled out. This initiative focused on

early detection and management of conditions like hypertension, demonstrating the crucial

role of health screenings in reducing the burden of NCDs on the healthcare system

(Ministry of Health Rwanda, 2023) (Ministry of Health Rwanda).

Health Promotion. The CHNs reminded patients to take medicine, they give health

awareness, health lectures to the community during implementations of health programs

and emphasize to their patients the health risks of non-compliance to health procedures and

regular intake of maintenance especially to patients with NCDs. This theme is supported

by the following transcripts from the participants:

"…every first Friday of the month … diha mi mo sulod para sa awareness

so kinsa tong mga highblooron diabeticon para ma aware sila nga ang
ilaha diay highblood hypertension highblood cases diabetic cases dili lang
diay diha so nagpahigayon mi ug health teaching." [“Example every first
Friday of the month …that's when we come in for awareness so those who
are hypertensive, diabetics they will be included, so we conduct health
teaching.”] NP6
“… Every purok naga adto mi, naga advocacy about kanang mga smoking,
dili lang ang hypertension and diabetic, tanan mga kuan didto.. mga obese,
tanan na sila.” [“We conduct advocacy about smoking, hypertension,
diabetes, and obesity in every purok”] NP8
"Number one para nako is amoang information dissemination campaign
kay gina conduct man jud namo siya kanunay more or less in the community
is the basic thing that we can do to properly disseminate proper
information, health advocacies, health awareness mao ragyud na atong
mahatag nila." [“Number one for me is our information dissemination
campaign because we always conduct it more or less in the community is
the basic thing that we can do to properly disseminate proper information,
health advocacies, health awareness that's what we can give them.”] NP10
 Nurses play a crucial role in health promotion and disease prevention by serving as

educators, providing guidance on immunizations, nutrition, diet, medications, and safety

(Colorado Technical University, 2016). The narratives shown above corroborated the

expected role of Community Health Nurses in Public Health and in the concept of

prevention, which is to disseminate health awareness or give health education to the

community that they serve. In a study conducted by Gillet et al. (2021), it was found that

nurses are essential in promoting public health through education and advocacy. The study

found that nurses' involvement in community-based health education significantly

improved knowledge and behaviors related to disease prevention and health maintenance

among community members. The findings support the idea that nurses' educational efforts

are vital for effective health promotion and disease prevention strategies (Gillet et al.,

2021).
 Non-Compliance. This theme refers to patient’s attitude that acts as a barrier to

NCD prevention which has been a challenge for CHNs. The CHNs were worried about the

citizen’s non-compliant behavior toward NCD prevention which includes the inconsistent

intake of maintenance medication for NCD, ignoring conditions until it gets worse, and

preference to alternative medicines rather than the prescribed medication.

".. kanang pag inom ug maintenance karon mo inom, inig wa nay bation, di
napud mo inom, unya inig balik worse na, na stroke na dayun…" ["...patients
stop taking their maintenance medication once they feel better, only to
resume it when symptoms reappear, by which time their condition has
worsened, sometimes resulting in a stroke..."] NP3
"Ang uban man gud mga patient pag feeling nila ayo na sila, dili na sila
mopadayon sa maintenance…" ["Some of the patients who feel that they are
fine already will not continue taking their maintenance..."] NP7
"... Bisan bitawg ilang BP is grabe na ka taas, dili gihapon sila mu patuo
nga need sila ug kanang check-up ... Then sa kanang mga diabetic patient
nako bisan taas na kayo dili gihapon na sila mu patuo ...” ["... even though
their BP is extremely high, they still don't believe that they need that check-
up ... the diabetic patients also don’t adhere... "] NP8
“Mao nang problema karon kay murag ga salig kaayo sila murag ambot unsa
ba, makulangan pami sa ilahang participation, murag kailangan pa namo sila
hungitan, kami guol na kaayo mi unya sila murag wala lang ana.” [“That's
the problem now because it seems like they're relying too much, like I don't
know what, we lack their participation, it feels like we still need to spoon-
feed them, we're very worried but they don't seem to care at all.”] NP11
“Ang sa amin kasi more on maintenance kami, kung ano ang e reseta ni doc,
yun dapat ang e maintain, pero naa man mga alternative medication…
parang hindi natin ma avoid na mas gusto nila yun kaysa sa mga
maintenance na binibigay ng doctor” [“We are more on maintenance, what
the doctor prescribes is what they should take, but others just prefer
alternative medication than the maintenance the we give them”] NP1
 The World Health Organization defines compliance as engaging in behaviors such

as taking prescribed medication, maintaining a healthy lifestyle, and adhering to

recommendations provided by healthcare professionals; otherwise, non-compliance is

considered to exist (WHO, 2003). According to Naghavi et al. (2019) non-compliance has

substantial impacts on clinical and therapeutic outcomes, leading to disease progression,

increased outpatient visits, re-admissions, and hospitalizations. Non-compliance of

treatment is the neglect or discontinuation of the treatment process and the patient's failure

to follow prescribed treatments. (Atinga RA et al., 2018; Jin J et al., 2003). In the present

study, Community Health Nurses (CHNs) has observed patient non-compliance, which

manifested in inconsistent intake of maintenance medication for non-communicable

diseases (NCDs), neglect of conditions until they worsened, and a preference for alternative

medicines over prescribed treatments. This non-compliance presented a significant barrier

to the CHNs' ability to deliver effective NCD prevention and management among these

patients.

This finding is supported by a study in Finland, where general practitioners (GPs)

identified similar barriers to medication adherence. They noted that patients often paused

or stopped their medication independently, lacked competence in self-management, and

sometimes relied on alternative sources of medication information, such as media and

neighbors, rather than professional advice (BMJ Open, 2019) (BMJ Open).

Additionally, a study in Iran demonstrated several factors contributing to non-

compliance with therapeutic orders. These included patient-related factors like negative

attitudes toward treatment, socioeconomic challenges, and a preference for self-

administered drugs over prescribed medications. Such non-compliance significantly

impacted the effectiveness of chronic disease management and prevention (BMC Health

Services Research, 2020) (BioMed Central).

Financial Burden. Many citizens living in poverty are vulnerable to non-

communicable diseases (NCDs) due to unhealthy behaviors and disparities in access to

healthcare facilities. They lack the financial resources to purchase medication, undergo

laboratory tests, or afford transportation to health centers. The Community Health Nurses

(CHNs) dealt with patients struggling with these financial burden:

"Then isa pud na sa diabetes, isa sab sa challenges is kanang di sila ka

afford sa tambal…" ["one of the problem is that they can't afford the
medicine, some diabetic patients..."]NP3
"...Siguro kwarta pud kung wala silay pamalit sa ilang maintenance
..."["Maybe it's also about money if they don't have anything to buy their
maintenance meds…"] NP11
“…gina instruckan naman na sila nga mu anhi diri, unya di man sila ka
anhi kay pamasahe pa lang burden naman sa ilaha,, so challenge gyud pod
siya para sa amoah …” [“…we always instruct them, but they usually can’t
come, because the fare is already a burden to them, so it's really a challenge
for us …”] NP1

Additionally, this financial burden also limits the patient’s access to nutritious foods
according to NP2:

“…Depende man gud pud sa resources nga available sa ilaha. Example,

ginabawalan namo sila, like gina health educate namo sila nga bawal mu
kaon ug canned goods kay taas siyag sodium content, maka taas ug BP, but
then mao raman ang available gud sa ilaha, so dili pud nato sila ma blame,
mag depende gyud pud sa status pud…” [“It also really depends on the
resources available to them. Example, we forbid them, like when we health
educate them, and advise them not to eat canned goods because it has high
sodium content, it can raise BP, but then that's the only thing available to
them, so we can't blame them either, it depends it's really the status too.”]
NP2
 Based on the narratives above, financial burden also exists as a barrier to NCD

prevention among patients, inhibiting their access to healthcare. As NP3 shared:

“…Pamasahe pa lang burden na man sa ilaha..” [‘..the fare alone is already a burden to

them..”], this often leads patients to sacrifice addressing their health condition primarily

due to economic constraints.

A study by Yamaguchi et al. (2023) on the experiences of Barangay Health

Workers in NCD prevention supports these findings. The results of their qualitative study

showed that 'economic burden' is a significant challenge that Community Health Workers

encounter, acting as a barrier to effective NCD prevention (Yamaguchi et al., 2023).

In an article by Palileo-Villanueva et al. (2023), it was found that Barangay

Health Workers in urban areas of the Philippines face similar economic challenges. The

study found that financial constraints limit patients' ability to seek medical care, purchase

medications, and adhere to treatment regimens, further complicating NCD prevention

efforts (Palileo-Villanueva et al., 2023).

Moreover, a study conducted in Ethiopia focused on the barriers to health

literacy and NCD care among patients. It found that economic burden, together with low

health literacy, significantly hindered effective disease management and prevention (BMC

Public Health, 2023).

 Lack of Resources for NCDs. The CHNs encountered limited resources for

managing non-communicable diseases (NCDs) within the community. They reported that

shortages of medicines and other supplies posed significant challenges in addressing NCDs

effectively. This theme is supported by transcripts below.

"Ang stock pa gyud sa mga pang assess nila ba kulangan jud siya…then
daghan kaayog patient dili lang biya sila ang ano daghan biya tibuok
margos…" ["The stock for their assessment tools is really lacking...then
there are so many patients, it's not just them, there are many from all over
Margos."] NP4
“… sa supplies limited gyud siya, dayon dili man pud ambot ang
government dili sila ka hatag pud tanan sa supply.” [“ … the supplies are
really limited, and the government doesn't care, they don't give you all the
supplies.”] NP4
“…I hope nga ang mga medications for non-communicable diseases kay
dali ra bitaw siya ma hatag sa mga barangays, so that ang mga tawo kay
maka kuha gyud sila kay especially karun murag kulang ang mga supplies.
So dili ma apud, like ang uban, need pa nila mu palit para ma continue
ilang medication …” [“…I also hope that the medications for non-
communicable diseases can easily be given to the barangays, so that the
people can get them because especially now it seems that the supplies are
lacking. Others still need to buy it to continue their medication...”] NP2

Additionally, one Nurse Participant shared that she experienced the lack of

support from the management which hinders her from delivering NCD prevention

services, according to the participant:

"Nag lisod jud ko sa tinuod lang, ga lisod jud ko sa situation nako… kay
dili man ko supportahan nila sa barangay…gwapo kaayo akong center oy,
pero zero man ang unod, pero wala kaayoy tambal, ug naa dire mo dala
man mi pero wala kaayo koy medication..." ["To be honest, I'm really
struggling, I'm really having a hard time with my situation... because they
don't support me, my health center is nice, but there’s nothing inside, I have
no medication supplies, but if we had we’ll bring"] NP5

The lack of support led her assigned Barangay Health Center (BHC) to shortage of

supply which is necessary to provide services to the people with NCD.

Based on the narrative above, the lack of medication supply acted as a barrier to NCD

prevention as majority of patients rely on free medication supply as mentioned by NP4

[“the supplies are very limited and there are so many people in Margos..”]

Furthermore, aside from the scarcity of material resources, there is also an

identified scarcity of ‘human resource’. The population of Margosatubig is approximately

38,660 people and there is only 1 Barangay/Community doctor in the said Municipality.

This is supported by the transcript below;

“…ang doctor man gud nato diri sa health center isa lang, unya almost
40,000 man gud ang atong population. Ang doctor man gud 1 is to 20,000
lang man gud unta, so dapat naa tay duha ka doctor, kay arun nay pwede
sa bukid (kay daghan man gud pud na sila’g mga seminar, mga paper
works, so di na nila ma adto tanan ang barangay) katong isa namo ka
doctor, naga adto man gud siya pero once a year lang, tas dili pod na
tanang tawo sa Digon is magpa check-up, dili tanang tawo maka adto…”
[“"…We only have one doctor here at the health center, and our population
is almost 40,000. Ideally, there should be one doctor for every 20,000
people, so we need two doctors. This is because one should be available for
the rural areas (as they often have many seminars and paperwork, making
it impossible for them to visit all the barangays). Our one doctor visits once
a year, and not everyone in Digon gets a check-up or can go..."”] NP8

According to the provided narrative, there is a scarcity of human resources,

particularly Community Health Doctors. Although there is a Regional Hospital in Barangay

Poblacion of Margosatubig, the ratio of one doctor to 38,000 people in a barangay is still

significantly inadequate. In fact, the World Health Organization (WHO, 2020) “Global

Strategy on Human Resources for Health: Workforce 2030” recommends a minimum of 1

doctor per 1,000 people to ensure adequate healthcare coverage. This reveals the severe

shortage of healthcare professionals in the Philippines and accentuates the challenges faced
by the Philippine healthcare system in providing accessible and quality healthcare to its

population.

Free-Offer Strategy. Providing free incentives for patients is a strategy employed

by CHNs to encourage participation among patients who may be reluctant or unable to

afford healthcare. This includes giving free medicine, vitamins, and health services, and

during health programs, they sometimes offer pamphlets and other tangible takeaways to

entice the people to participate in their health programs/services including on NCDs. This

theme is supported by the following narratives from nurse participants:

“Para sa amoa, kay mag hatag mig mga free meds, vitamins (usahay) para
ma kuan sila (ma convince) pero mananghid pa pud mi ana kung unsa may
mga available, mga ingun ani, (foldable fans and other freebies) mga
pamphlets, para at least dili kay sila ma bored, ma excite sila mu attend sa
mga (programs/activities)” [“"For us, we give out free medications and
sometimes vitamins to convince them, but we also check what's available,
such as foldable fans and other freebies, pamphlets, to keep them from
getting bored and to excite them about attending the programs and
activities…”]NP1
“..motivation pud siguro kung mang hatag kog lollypop HAHAH, free BP,
free sugar testing ana dayon ayha Zumba na dayon health education, gina
usa nalang para package na dayon multi vitamins.” [“"Maybe it would be
motivating if I gave out lollipops, HAHAH. We offer free blood pressure
and sugar testing, followed by Zumba and health education, all packaged
together with multi-vitamins.”]NP4
“Para sa amoa ang pinaka effective is kanang nag hatag mig free nga
services kay di sila moatras perog naay bayronon na di nagyud na
moasdang kana ang free services of monitoring their sugar level and their
blood chem. So mao nang ang ubang clients namo diri ma’am naga
dumdum na diari.” [“For us, the most effective strategy is providing free
services because they won’t hesitate to participate if there’s no charge. This
includes free services for monitoring their sugar level and blood chemistry.
That's why some of our clients here keep coming back.”] NP10
 The transcripts above reveal that giving free offers to people can encourage a

collective participation among citizens. While the Universal Health Care Act (RA 11223)

grants Filipinos the right to access healthcare, practical implementation challenges and

resource limitations often impede the availability of services, including free medications.

Therefore, the "free offer strategy" employed by Community Health Nurses (CHNs) can

still be considered a relevant and practical approach to encourage participation in health

programs.

Despite the legal right to healthcare, resource limitations (e.g., funding, supply

chain issues) mean that not all services or medications are always available for free. This

discrepancy between policy and practice necessitates additional strategies to ensure

community participation and access. World Health Organization. (2020). “Global Strategy

on Human Resources for Health: Workforce 2030”.

While access to free healthcare is a right under the Universal Health Care Act, the

practical implementation of this right faces numerous challenges. Therefore "free offer",

according to the transcripts and existing challenges in resources is justifiable as ‘strategy’

of CHNs.
 Community Coordination. CHNs seek the help of other community sectors to

either convince people to participate or to fund them on supplies that they lack. This theme

is supported by the following narratives of the nurse participants below:

“..Nagapatabang nalang ko ni kap, kay siya raman gud madaganan namo

usahay ug wala nagyud. Lisud pod kayo ikaw mag dala sa problema..” [“
I asked help to te Kapitan because sometimes he's the only one we can turn
to when there's no one else. It's also very difficult to handle the problem on
your own..."] NP8
“..Nangayo kog tabang ni Kap, so karon nakaplit na ug BP monitor per
purok kay sauna looy kaayo mu adto pa sa sentro mag pa BP..” [“...I asked
Kap for help, and now we've been able to buy a BP monitor for each purok
because before, it was very difficult for them to go to the center just to get
their blood pressure checked...”] NP11

Additionally, CHNs also use an ‘incentivized strategy’ to encourage people to

participate in health programs, advocacies, and recommendations. This involves

coordinating with the Pantawid Pamilyang Pilipino Program (4Ps) and the Municipal Link

(ML). This strategy is employed by CHNs to alleviate the existing problem of ‘poor health-

seeking behavior’ among patients and concerned citizens. The CHNs work closely with

authorities from these organizations, who are responsible for distributing incentives to 4Ps

members. They encourage these authorities to mandate regular health check-ups and

adherence to non-communicable disease (NCD) health regulations among 4Ps members,

emphasizing that non-compliance may result in being removed from the 4Ps beneficiary

list (DSWD, 2021; Municipality of Bay, 2021). The following transcripts below supports

this strategy:
“So kasagaran man gud sa mga client namo dali sila matapok kung mo tap mi sa
ML kay labaw na nang mga 4ps mahadlok mana sila ug di ma releasan kung di sila
mo tungha during mga FDS kay at the moment useful and FDS kay naga hatag
permi ug health awareness for 4ps.” [“"So, most of our clients gather quickly when
we…
 coordinate with the ML, especially those in the 4Ps program. They are afraid that
if they don't attend the FDS, they won't receive their benefits. At the moment, the
FDS is very useful because it consistently provides health awareness for 4Ps
members."”] NP10

“…Gina tap namo ang ML kanang diha sa DSWD 4p’s so sila mana ang
usually tuohan kay ingnon man dayon na nila nga I stop namo ni ang
inyohang kwarta, diba so sila ang tuohan so I tap namo na sila, I tap pud
namo ang BHW kay sila gyud na kabalo sa ilahang mga purok… dayon I
tap pud na namo si Kapitan, tanang program nga amoang I conduct ana
nga barangay mo tap gyud mi sa Kapitan mao na siya ang proper gyud.”
[“..We coordinate with the ML from DSWD 4P's because they are usually
trusted since they can say, 'we will stop your financial assistance,' right? So
they are the ones trusted, and we coordinate with them. We also coordinate
with the BHW because they are familiar with their respective areas. Then
we also coordinate with the Barangay Captain. For every program we
conduct in that barangay, we make sure to coordinate with the Barangay
Captain, as that is the proper way to do it.”]NP3

According to the Philippine Institute for Development Studies (PIDS) 2024 report,

"Healthcare, education gaps threaten 4Ps impact; gov’t urged to boost supply-side

investments," it featured two studies co-authored and presented by PIDS Senior Research

Fellow Michael R.M. Abrigo. The studies confirmed that supply-side conditions

significantly affect education and health-seeking behaviors among households. This

implies that the ‘incentivized strategy’ has increased participation in health awareness

programs and adherence to health regulations among 4Ps members. The study also found

that this approach improved health-seeking behaviors among the program's beneficiaries,

contributing to better health outcomes (Abrigo et al., 2021).

Implications of the Study

Community Health Nurses (CHNs). The findings suggest that CHNs are

essential in NCD prevention through health monitoring and health promotion. Continuous

professional development and adequate resource allocation are crucial to improve their

effectiveness. Addressing challenges such as patient non-compliance and resource

limitations can enhance their performance and job satisfaction, leading to better healthcare

delivery and patient outcomes.

Community. The study implies that tailored NCD prevention and management

strategies, based on CHNs’ experiences, can significantly improve community health

outcomes. Addressing financial barriers and ensuring equitable access to healthcare

services are essential to enhance the quality of life for NCD patients and reduce the overall

burden of NCDs within the community.

Policy Makers. The findings highlight specific challenges faced by CHNs, such

as resource limitations and patient non-compliance. These suggest the need for policies that

provide adequate support and resources for CHNs. Improving supply chains for medicines

and providing financial support for healthcare initiatives can enhance NCD management.

The Philippine healthcare system, governed by the Department of Health (DOH), operates

under a mixed public-private framework. The Universal Health Care (UHC) Act, signed

into law in 2019, aims to provide comprehensive health services to all Filipinos, including

automatic inclusion in the National Health Insurance Program. Despite this, practical

implementation challenges persist, especially in resource allocation between urban and

rural areas (WHO, 2019; PIDS, 2024).

The study’s findings indicate that the incentivized engagement strategy, involving

coordination with the 4Ps program and Municipal Links, has effectively increased

participation in health programs. This suggests that integrating such strategies within

broader healthcare policies could improve participation rates and health outcomes,

particularly among 4Ps members. Policymakers should consider structured collaborations

between healthcare providers and community programs to ensure comprehensive and

sustainable health interventions (PIDS, 2024).

Future Researchers. The study provides a foundation for future research on

NCD prevention and the role of CHNs. Future studies can explore more detailed aspects

of NCD prevention, develop innovative strategies, and deepen the understanding of

effective public health practices. The focus on challenges and strategies can guide future

research in formulating comprehensive approaches to managing NCDs globally.

Implications for the 4Ps Program and Healthcare System. The incentivized

engagement strategy, involving coordination with the 4Ps program and Municipal Links,

has proven effective in increasing participation in health programs. This suggests that such

strategies could be formally integrated into the 4Ps program to enhance health-seeking

behaviors and compliance with NCD prevention measures. For the healthcare system, this

implies the need for structured collaborations between healthcare providers and community

programs to ensure comprehensive and sustainable health interventions (PIDS, 2024).

 Chapter 4

Summary of findings, Conclusion and Recommendations

This chapter presents a summary of the findings on the experiences of

Community Health Nurses in preventing Non-Communicable Diseases in Margosatubig.

Conclusions were drawn based on the findings, and recommendations were made

according to the outcomes of the research.

Summary of Findings

Based on the collected data, the following conclusions are presented:

1. What are the roles of Community Health Nurses in Non-Communicable

Disease Prevention in Margosatubig?

Based on transcripts from nurse participants, two (2) themes were identified: Health

monitoring and Health promotion.

Health Monitoring. CHNs play a significant role in health monitoring, including

health assessments and screenings as part of the Community Health Assessment

Program (CHAP) and the Philippine Package of Essential Non-Communicable

Disease Interventions (PhilPEN). This involves monitoring blood pressure, blood

sugar, and other health indicators in the target age group for NCDs.

Health Promotion. CHNs are also responsible for health education, conducting

health awareness campaigns, and providing health lectures to the community. This

role is crucial in educating the public on the risks of non-compliance with health

procedures and the importance of regular maintenance, especially for patients with

NCDs.
2. What are the Challenges faced by Community Health Nurses in preventing

Non-Communicable Diseases in Margosatubig?

Based on transcripts from nurse participants, three (3) themes were identified: Non-

Compliance, Economic Burden, and Lack of Resources for NCD prevention.

Non-Compliance. CHNs identified patient non-compliance as a major barrier to

effective NCD prevention. This includes inconsistent medication intake, ignoring

health conditions until they worsen, and a preference for alternative medicines over

prescribed treatments.

Economic Burden. Many patients struggle with the financial burden of accessing

healthcare, including the cost of medications, laboratory tests, and transportation to

health centers.

Lack of Resources. CHNs reported shortages in essential supplies, such as

medications and health professionals, which hinder effective NCD management.

Additionally, the limited number of healthcare professionals, particularly doctors,

exacerbates this issue.

3. What are the strategies/coping mechanisms employed by Community Health

Nurses to address challenges faced in NCD Prevention?

Based on transcripts from nurse participants, two (2) themes emerged: Free Offer

Strategy, and Community Coordination.

Free Offer Strategy. CHNs use free health services and incentives to motivate

patients to participate in health programs. Despite the Universal Health Care Act

guaranteeing free health services, resource limitations make this strategy necessary.
 Community Coordination. CHNs collaborate with other community sectors, such

as the Pantawid Pamilyang Pilipino Program (4Ps) and the Municipal Link (ML),

to mandate health check-ups and adherence to NCD health regulations among 4Ps

members, thereby improving health-seeking behaviors and participation in health

programs.

Conclusion

Non-Communicable Diseases (NCDs) are a significant public health concern that

requires comprehensive prevention strategies. Based on the findings of this research, it was

found that Community Health Nurses (CHNs) are essential in both health monitoring and

health promotion for NCD prevention. Their work in assessing and educating the

community is vital for early detection and management of NCDs. However, they face

significant challenges, including patient non-compliance, financial burdens, and resource

shortages, which impede their ability to provide effective care. Despite these challenges,

CHNs employ strategies such as offering free health services and coordinating with

community sectors to encourage participation in health programs. By addressing these

challenges which acts as barriers to NCD prevention, the healthcare system in the

Philippines can better support CHNs in their vital role in NCD prevention, ultimately

leading to improved health outcomes for the population.

Recommendations

Based on the conclusions, the following recommendations are suggested:

1. Enhancing Training Programs. Expand and improve training programs for CHNs

to equip them with advanced skills in NCD management and patient education.

This could involve leveraging online platforms for continuous professional

development.

2. Improving Resource Allocation. Ensure a consistent supply of essential

medications and medical supplies to support CHNs in their efforts to manage NCDs

effectively. Additionally, increasing the number of healthcare professionals in

underserved areas is critical.

3. Addressing Economic Barriers. Develop policies that provide financial assistance

for transportation and medication costs to reduce the economic burden on patients.

This could involve partnerships with local government units and non-governmental

organizations.

4. Strengthening Community Engagement. Continue to collaborate with community

sectors like the 4Ps and ML to enhance patient participation in health programs.

Implementing more robust advocacy and communication strategies can further

improve health-seeking behaviors among the community.

5. Future research should investigate the underlying reasons for patient non-

compliance with prescribed treatments. Understanding the psychological, social,

and economic factors influencing non-compliance can inform the development of

targeted interventions, thereby enhancing the effectiveness of NCD prevention and

management programs. This could lead to more comprehensive strategies that

address the root causes of non-compliance and improve overall health outcomes.
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DOCUMENTATION

Last April 12, 2024, the student researchers asked permission from the school principal,
Dr. Sharon Rose T. Sencio, to conduct interviews with Community Health Nurses, the
participants of their research on the Experiences of Community Health Nurses in
Preventing Non-Communicable Diseases in Margosatubig.

On April 18, 2024, the researchers asked permission from the Rural Health Unit Chief
Nurse, Supervisor Ma’am Rosalie A. Ang PHN 4 to interview the eleven (11) Barangay
Community Health Nurses.
 Appendix C. Interview Guide Questions

Prefatory Statement:

Welcome and thank you for agreeing to participate in this interview!

Before we begin, I'd like to assure you that your responses will be treated with the utmost
confidentiality and will solely be used for this study on the prevention of non-communicable
diseases in Margosatubig. Your insights as a community health nurse are invaluable, and there are
no right or wrong answers here. If at any point you have reservations about the research or feel that
your privacy is being compromised, you are free to discontinue your involvement in this study.

This interview should take approximately 20-30 minutes. Rest assured that the information you
provide will remain confidential.

Before we begin, are there any questions you would like to ask? Additionally, could you kindly tell
me a bit about yourself?

Shall we start by testing the audio equipment to ensure we have a clear recording of this interview?

May I have your permission to start the audio recording as we engage in our conversation?
 Interview Guide Questions during the Interview
A. Engaging Question
1. How old are you?
2. How long have you been working as a community health nurse in Margosatubig?
3. In what barangay are you currently assigned?
4. Have you been assigned in other barangays in Margosatubig aside from the barangay that
you are currently assigned?
5. Can you please share what led you to community health nursing specifically?
6. As NCD prevention is a mandated part of your role, how has this responsibility shaped
your experience as a community health nurse?
7. Aside from non-communicable diseases, are there other health concerns in your assigned
barangay that you find particularly alarming or challenging to handle?
8. Apart from providing services for non-communicable disease prevention, what other types
of health services do community health nurses typically offer?
SUB-QUESTIONS DESCRIPTIVE PROBING
(Research Questions) QUESTIONS QUESTIONS
R 1. What are the  What is your perspective as  What activities do you
O roles of a nurse on the prevalence of carry out as a community
L Community NCDs within the community health nurse for NCD
E Health Nurses in you serve? prevention?
S preventing Non-
Communicable  Can you enumerate your  Can you describe how
Disease in personal experiences as a you conduct those
Margosatubig Community Health Nurse activities focused on
with NCD prevention? NCD prevention?

 Can you describe each of  What

those personal experiences
that you face in NCD
prevention?
activities/strategies have
you implemented that
have been successful or
effective in educating the
community about non-
communicable diseases?

C 2. What are the  Can you describe each

H challenges
A encountered by
L Community
L Health Nurses in
E Preventing Non-
N Communicable
 Can you enumerate the
specific challenges you face
related to NCD prevention in
your assigned barangay?
of those challenges you
face related to NCD
prevention in your
assigned barangay?
 How would you
describe the community's
G Diseases in
E Margosatubig
S  Among the various
S 3. What are the  Can you enumerate the
T strategies/coping strategies/coping
R mechanisms mechanisms that you employ
A employed by to address the challenges that
T Community you face in NCD prevention?
E Health Nurses in
G addressing the  How do you engage and
I challenges they motivate the community to
E faced in NCD participate in NCD
S Prevention? prevention activities?
 Please provide an example
of a successful community
engagement initiative you've
led or been part of.
awareness and attitude
towards NCDs?
challenges you've faced,
which have you found
more manageable, and
which have presented
greater difficulty?
 How do these
challenges affect your
ability to effectively
prevent NCDs?
 Please describe the
strategies/coping
mechanisms that you
employ to manage and
overcome these
challenges.
 Why would you
consider those strategies
effective?
 Can you give specific
examples where those
strategies have been
effective?
 Could you share a
specific example of how
you applied these coping
mechanisms to a
challenging situation?
 What specific events or
patterns illustrate the
community's
involvement in raising
awareness and
preventing non-
communicable diseases?
 What strategy
resonated with the
community?
 Why do you think that
strategy resonated with
the community, and how
could it be replicated or
scaled?
 A. Exit Question

Is there anything else you would like to share about your experiences with non-
communicable disease prevention in the community?
DATA GATHERING PROCESS DOCUMENTATION
The completion of the data-gathering process (through interviews) took about one (1)
week to complete.
Below are the researchers during the conduct of the interviews with Nurse Participants:

The following images were blocked to protect the anonymity of the participants:
Upon the consent of each nurse participant, an audio recording was turned on during the
conduct of the interview. Below is the screenshot evidence of the saved audio recordings
during the interview:
RUBRICS

CATEGORY 12-15 points 8-11 points 4-7 points 0-3 points

Introduction/Topic Exceptional Proficient Basic introduction Weak or no
introduction that introduction that that states topic introduction of
grabs interest of is interesting and but lacks interest. topic.
reader and states states topic. Thesis/topic is Paper’s purpose
topic. Thesis/topic is somewhat clear is unclear.
Thesis/topic is clear and and arguable. Thesis/topic is
exceptionally clear, arguable weak or missing.
well-developed, and statement of
a definitive position.
statement.
Statement of the Problem
5 4 3 2
Identification The problem is The problem is The problem is The problem is
and clearly and clearly and clearly and identified and
Definition of objectively objectively objectively defined in a
Problem identified with identified with identified and manner that is
concise language concise language defined; some sometimes/
and defined with and defined with detail may be somewhat
consistent precision some precision of imprecise unclear and/or
of detail. detail. (general) or may manifest
unelaborated. some
subjectivity
Level of Who, what, when, Who, what, Who, what, when, Some answers
Detail where, and how are when, where, and where, and how to who, what,
specifically how are are addressed but when, where,
addressed in addressed answers may be and/or how are
substantial detail adequately. unclear missing or are
inadequate.
Limits on The problem The problem The problem The problem
Solutions statement is statement is statement is statement is
worded to allow an worded to allow worded to allow a worded to allow
unlimited number several possible few possible only a couple of
of possible solutions solutions solutions. possible
solutions.
Methodology Identifies Identifies Identifies The
appropriate appropriate appropriate methodologies
• Sample methodologies and methodologies methodologies described are
research techniques and research and research either not suited
• Procedures
(e.g., justifies the techniques but techniques but or poorly suited
• Measures sample, procedures, some details are many details are to test
and measures). missing or vague missing or vague. hypotheses. The
Data analytic The methodology methodology is
is largely under-
incomplete. developed
 and/or is not
feasible

9-10 7-8 5-6 4-3

Maintains The proposal is well The proposal has The proposal is The document
purpose/focus organized and has a an organizational somewhat lacks focus or
tight and cohesive structure and the focused or has contains major
focus that is focus is clear minor drifts in the drifts in focus
integrated throughout. focus.
throughout the
document
Supporting Provides clearly Provides Provides Provides little or
evidence appropriate adequate inappropriate or no evidence to
evidence to support evidence to insufficient support position
position support position evidence to
support position
References and Citations
References and Properly and Properly cited. The manuscript The manuscript
citations explicitly cited. May have a few has several lacks proper
Reference list instances in which instances of citations or
matches citations proper citations improper use of includes no
are missing. citations. Contains citations.
several
statements
without
appropriately
citing.
Grammar, clarity, The manuscript is The manuscript The manuscript The manuscript
and organization well written and effectively communicates is poorly written
ideas are well communicates ideas adequately. and confusing.
developed and ideas. The writing The manuscript Ideas are not
explained. is grammatically contains some communicated
Sentences and correct, but some grammatical effectively.
paragraphs are sections lack errors. Many
grammatically clarity. sections lack
correct. Uses clarity.
subheadings
appropriately