SAMPLE QUESTIONAIRE

I. Directions: Put a check mark on the space provided for your

answers.
A. Age: /15-25 ____ 26-35 __/__ 36-45
B. Educational Attainment
____Elementary level ____High School level
/College level ____College Graduate
C. Ethnicity
____ Ibaloi ____ Kankanaey ____ Ilocano
Others, please specify: Ibontoc____
D. Primary care giver of the children. (Kayo ba ang nagaalaga
sa mga anak ninyo?
____ With nanny ___/_ No nanny
E. Number of months & years in Pinsao Pilot
____ Less than 6 months ____6-12 months ____more than 1 year
F. How many children do you have?
____ 0 children _____ 1-2 children
__/__ 3-4 children _____ more than 4 children
II. Directions: Put a check mark under the appropriate choices
according to the culture practiced.
LEGEND:
4 - AP = Always Practice = Practice at all times
3 - OP = Often Practice = Practice many times
2 - SP = Sometimes Practice = Practice occasionally
1 - NP = Never Practice =Practice not at any times

Cultural Practices AP
4
OP
3
SP
2
NP
1
1. I offer animals to the gods. /
2. I refer to a albularyo. /
3. I refer to a hilot. /
4. I let sick family member to take a
bath with boiled herbal medicine.
/
5. I make/buy herbal medicine. /
6. I put boiled water in a basin, put it
beside the sick family member and
cover with a blanket to promote steam.
/
7. I put oil on the chest and back of my
family.
/
8. I used 2-3 drops of breast milk to
cure sore eyes.
/
9. I let my family member take a bath at
night.
/
10. I used boiled water with guava
leaves to wash wounds.
/
11. I let family member that is sick
to rest.
/
12. I let sick family member to
take a bath.
/
13. I will let my family wear
jacket/bonnet when the weather is
cold.
/
14. I boil ginger with brown
sugar/honey for sore throat.
/
15. I use garlic for toothache. /
16. I let her take a bath when she
has menstruation.
/
17. I put hot water in a bottle wrap
it with towel and apply it to the
stomach.
/
18. I offer food to unseen
creatures.
/
19. I let my family member pee on
their feet or hands.
/
20. I put garlic for dog bite. /