Mindanao State University

Iligan Institute of Technology

COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH

(COPAR)

Age: Materials Used:

40- 46- 51- 56- O concrete
45 50 55 60 O wood
Moth O mixed wood/concrete
er
Fath Tenure of Lot:
er O owned
Educational Attainment: O rented
Mother Father O occupying free with consent
Elem. O occupying free without
Grad. consent
High
School Family Planning:
College 1. Have you used any Methods
Grad. of FP?
Masterals O yes O no
PHD’s 2. If any, what are these
Blood Type: methods?
A.
Mother Father
B.
A
C.
B
D.
AB
E.
O 3. Are you contented with the
Income: methods you are using?
Mother Father O yes O no
5000 4. If not, what are the reasons?
below A.
6000- B.
10000 C.
11000 D.
above E.
Civil Status: 5. What are the reasons why
O Married you have stopped using
O Widow methods of FP?
O Separated A.
B.
Residential Status C.
O Permanent D.
O Temporary 6. What is the participation of
your husband in FP?
Type of House Unit: A.
O Single detach B.
O Apartment/Condo C.
O Multiple dwelling units D.
E.
Ownership of dwelling unit: F.
O owned 7. Are you given knowledge
 O rented about FP and responsible
O occupying free with consent parenthood before
O occupying free without marriage?
consent O yes O no

10.Have you take Vit. A one

8. Where did you get that month after giving birth?
information? O yes O no
A. 11.Have you been given
B. Ferrous Sulfate after giving
C. birth?
D. O yes O no
E. 12.Are you given enough
F. knowledge about methods
9. How many children would of Family Planning?
you want to have? O yes O no
A. 13.Are you given enough
B. information about this?
10.How many years is the O yes O no
spacing do you want to 14.What are the foods you take
have? the previous days?
A. 15.
B. Go food Grow Glow
food food
Maternal and child Health A. A. A.
Care:
1. Have you undergo prenatal B. B. B.
before this pregnancy?
O yes O no C. C. C.
2. How many times have you
visited the health center? D. D. D.
O once
O twice E. E. E.
O many
O none F. F. F.
3. What are the reasons why
you haven’t visited the In the previous years, do you
health care center? know anyone who died
A. during pregnancy, upon
B. giving birth or six weeks
C. after giving birth?
D. O yes O no
E. 16.Have you experienced being
4. Have you been given sick?
tetanus toxoid injection? A.
A. B.
B. C.
C. 17. Do you have a child six
5. Did you take Vit. A this months and below? What is
pregnancy or the previous the milk used?
one? A.
O yes O no B.
6. In other week, have you C.
used iodized salt? 18.The previous six months,
O yes O no has the baby been weighed
7. This or the previous (5 years and below)?
pregnancies have you gone O yes O no
to a dentist? 19.Has the baby been given Vit.
O yes O no A?
8. Have you been examined by O yes O no
a doctor in this or the
previous pregnancy? STD/RTI/HIV/AIDS
O yes O no 1. What kind of sickness do
9. Have you been examined by you know of that is from a
a Health Worker (doctor, girl or boy that is in your
nurse, midwife) for six purok?
weeks after giving birth? A.
O yes O no B.
C.
D.
E.
G. F.
H. 2. Have it been examined in
I. the health center?
J. O yes O no
2. What symptoms do you 3. What medications do he/she
know of from this sickness? is taking?
A. O Antifungal Ointment
B. O Antibiotics
C. O Caladryl
D. O Harax
E. 4. From where did he/she have
F. the medicine?
G. O doctor
3. From where do we get these O pharmacy
kind of sickness?
A. Cardiovascular
B. 1. Is there any family member
C. who has high blood
D. pressure, heart problems,
E. diabetes?
4. What effects do you know of O yes O no
that you can get from this 2. Have it been examined in
kind of sickness? the health center?
A. O yes O no
B. 3. What medicines are being
C. taken?
D. O Insulin
E. O ACE inhibitor
F. O Diamicron
5. What methods do you know O Aspirin
to avoid STD/RTI/HIV/AIDS? O Adalat
A. O Betaloc
B. 4. Is there any family member
C. who has cough for two
D. weeks or more?
O yes O no
Adolescent Reproductive 5. What are your actions
Health regarding this condition?
1. In the previous years, is A.
there any family member B.
 who marries at the age of 18 C.
and below? 6. Has he/she take medicines
O yes O no for the lungs?
2. In the previous years, is O yes O no
there any family member 7. If taking, what medicine?
that got pregnant at the age O Solmux
of 18 and below? O Robitusin
O yes O no 8. From where does is come
3. In the previous years, is from?
there any family member O doctor
that experienced O pharmacy
miscarriage? 9. How many months do
O yes O no he/she takes the medicine?
4. Do you talk about sexuality? A.
O yes O no B.
C.
Integumentary D.
1. Is there any family member 10.Does phlegm been
who has skin problems that examined?
takes long time to heal? O yes O no
O yes O no

Community
Involvement/Participation
1. What are the organizations 4. The sanitary control
in your barangay? encourages the owners to
A. let their employees secure a
B. health certificate before
C. they let them work?
D. O yes O no
E. 5. If the answer is no, what are
2. Are you a member of this the reasons?
Organization? A.
O yes O no B.
3. Do you contribute C.
something to the society? D.
O yes O no 6. If your answer is yes in
question 4, how many
Information, Education and workers have a certificate?
Communication A.
1. From where do you get B.
information regarding C.
services for good health? 7. How often do you get your
A. workers to be examined by
B. the personnel of the City
C. Health Office?
D. A.
E. B.
2. What kind of information do C.
you usually hear? D.
A. E.
B. 8. Do you have Sanitary Permit
C. to operate this kind of
D. business?
E. O yes O no
3. Does this give big change 9. If your answer is no, what
 regarding your insight about are the reasons?
good health? A.
O yes O no B.
C.
Environment Sanitation D.
1. What kind of CR are you 10.Has the personnel attended
using? the “Food Handlers Class”?
A. O yes O no
B. 11.If yes, who are among
C. them?
D. A.
E. B.
2. How do you dispose your C.
garbage? 12.If no, what is the reason?
A. A.
B. B.
C. C.
D. D.
E. 13.How do you keep the excess
F. food that has been served to
G. the customers?
3. Is your place reached by A.
NAWASA? B.
O yes O no C.
If no, D.
A. 14.Do you have pets?
B. O yes O no
C. 15.Does the dog been given
D. anti-rabies?
O yes O no
16.What are the problems that
you see in your community
that you want to be solved?
O Garbage
O Curfew Hours
O Stagnant Water
O Early Pregnancy
O Noise Pollution
O Air Pollution
O Water Supply
O Drainage
O Sanitation
O Malnutrition
O Overpopulation
O Road Construction
O Traffic Signs
O Water Pollution
O Information
Dissemination
O Peace
O Parking Space