CHAPTER I INTRODUCTION

Background of the Study Diabetes mellitus is a significant health problem by itself. Among the growing number of diabetic population, its complication is myriad. The improvement of medical treatment for this disease and also some diabetic person may go undiagnosed; this contributes to the increasing number of diabetic individuals developing the long-term complications of diabetes mellitus. This just signifies that the blood glucose level has been elevated for a long time before it can be diagnose. It is estimated by health authorities that about one-third of diabetics are totally unaware and undiagnosed of this disease. Blindness, congenital abnormalities, lower extremities amputation, renal failure and the susceptibility of the diabetic individual to several kinds of infections are the major complications of a diabetic person, especially having that disease for a long time. It can develop at any age and susceptibility gradually increases up to age 40, and then rapidly increases. The fundamental problem in diabetes is the bodys inability to metabolize glucose, the simplest form of carbohydrates, fully and continually. This is a vital process in creating body cell energy, because glucose is the main source of nutrient giving energy to all activities happening inside the body. The unused glucose is stored under normal conditions in the form of glycogen, or animal starch, in the liver and muscle for later use at which time it is reconverted to glucose.

Diabetes is not an all or nothing phenomenon. It can be mild, moderate, or severe and can fluctuate in degree in any one individual over a long period of time, or even from day to day. Very little is known about the reasons for these differences and changes. It is known, however, that diabetes generally gets worse in the presence of illness particularly infections (even cold). It is also affected adversely by hyper functioning diseases of the anterior pituitary, thyroid and adrenal glands, by emotional and physical stress and during pregnancy.1 This disease has been known for several thousand years, because people with the disease when untreated, may urinate copiously and frequently, the Ancient Greeks named it diabetes (meaning siphon). In the late seventeenth century the name mellitus (meaning sweet) was added. In the early days, diagnosis was made by tasting the urine. The sweetness caused by the presence of glucose in the urine; its presence distinguishes diabetes mellitus from much rarer diabetes insipid us which is entirely different problem. 2 Since the discovery of insulin 1921, deaths attributed to diabetes have decreased dramatically. New knowledge and techniques have made it possible to do more and more for diabetics. Dr. Elliot Joslin, a pioneer in the treatment of diabetes, realized that the diabetic patient needed to have a full understanding of his disease that he could take care of himself. He contended that diabetic individuals with the chronic abnormality of a delicate and dynamic metabolic process could not be cared for successfully solely by knowledgeable physicians. The patient and his family had to be informed about the disease and have to make day-to-day decisions about managing it.

The New Complete Medical and Health Encyclopedia, Volume Two, (Chicago: J.G, Feguson publisher Cmpany), Copyright 1993 2 Ibid

In the United States there are more than 10 million diabetic which is increasing rapidly.3 In the Philippines as of 2001, it was estimated that there was 4 million Filipinos with diabetes, and is roughly 5% of the 80 million or so population of the country: of the 4 million diabetics, about 65% are not aware that they have the condition. It is obvious that from the growing cases of diabetes mellitus in our country that prompt diagnosis and treatment are essential. 4 Consequently, this study primarily envisions in providing additional inputs for the development of diabetes management, not only with regards to metabolic abnormalities but also in maintaining and attaining physiologic stability and postponement of the possible complications that are inevitable, if not carefully managed. In time, not only the physical side is being focused but also the psychological awareness of the diabetic patients. In the Municipality of Bobon, Northern Samar there is a lot of people who are not adequately informed regarding the proper diet and exercise treatment for diabetic individuals. In fact, many of them also are not totally aware of their diabetic condition a situation that is very dangerous health-wise. While others may have known about their disease but refuses/ not willing to follow the prescribe treatment given to them. Their adherence to the treatment is affected by being financially capable, the knowledge they have believe about their disease and by the level of acceptance of their disease.

B. Seeman, How To Live With Diabetes, 5th edition, (New York: Downstate Medical Center, 1991).

Frances Prescilla L. Cuevas, RN, MAN, Ed., Public Health Nursing in the Philippines, 10th ed., (Philippines National Legue of the Philippine Government Nurses, Inc.,2007) Copyright 2007, p.178).
4

For these reasons, this study could significantly address this rather problematic situation on misinformation relative to diabetes as a disease, and in essence establish an information base that could alter peoples beliefs and practices towards the positive side of the health continuum

Statement of the Problem This study was generally concerned with the health beliefs and practices among individuals with diabetes mellitus in selected barangays of Bobon, Northern Samar. It further determined the implications of the health beliefs and practices to the development of a health care management program. Specifically, the study sought to answer the following questions: 1. What is the demographic profile of the respondents in terms of: 1.1 age, 1.2 gender, 1.3 civil status, 1.4 educational attainment, 1.5 occupation, 1.6 monthly salary? 2. What are the common health beliefs of the respondents in terms of: 2.1 diet and nutrition, 2.2 hygiene, 2.3 exercise, and 2.4 disease and treatment?

3. What are the common health practices of the respondents in regards to their diabetic treatment? 4. Is there any significant relationship between the respondents profile and their health beliefs and health practices? 5. What implications to health care management can be drawn from the proposed program or findings of the study?

Objectives of the Study This study attempted to present the health beliefs and practices of individuals with diabetes mellitus in selected barangays of Bobon, Northern Samar. It will aim: 1. To present the demographic profile of the respondents in terms of: 1.1 age, 1.2 gender, 1.3 civil status, 1.4 educational attainment, 1.5 occupation, 1.6 monthly salary. 2. To know the health beliefs of the respondents in terms of: 2.1 diet and nutrition, 2.2 hygiene,

2.3 exercise, and 2.4 disease and treatment. 3. To know the health practices of the respondents as regards to their diabetic treatment; 4. To determine the relationship between the respondents health practices and the health care management, and 5. To draw implications to health care management from the proposed program or findings of the study.

Significance of the Study This study will provide factual information regarding one of todays most known, yet poorly understood, disease---diabetes mellitus. The results of this study will be useful to many individuals and institutions, such as; Health Policy Makers. The top personnel of the Department of Health can gain significant insights from this study on the beliefs and practices of diabetic individuals. In essence, they may be able to formulate corrective and strengthening policies aimed at controlling the

effects of diabetes mellitus on the population in general,and at assisting diabetic individuals in the diagnosis and treatment of this disease. The General Public. The study will likewise inform and educate the people on the myths and facts regarding diabetes mellitus. Consequently, the people will be able to live a healthy life and avoid the affliction diabetes mellitus if possible. Public Health Nurses. The data and information that will be generated by this study will

be a useful source of knowledge in the formulation of appropriate nursing intervention protocols designed to promote the health of diabetic individuals. The Families of Diabetic Individuals. Moreover, the families will be educated also as to the proper health care management for their diabetic family member, and for them to be an effective support system for diabetic individuals. The Diabetic Individuals. The study is an education and information campaign material to educate diabetic individuals regarding the myths and facts of diabetes mellitus. In this regard, they will be in a better position to care for themselves through proper health practices specifically recommended to diabetic individuals. The Researchers. The data and information of this study could serve as inputs in researches involving the diagnosis and treatment of diabetes mellitus in affected individuals. Student Nurses. The study will be an additional reference material on the existing pool of data and information regarding diabetes mellitus. Consequently, student nurses may be able to acquire more knowledge on this disease thereby making them more equipped, theoretically and practically, in devising patient care for diabetic individual.

Scope and Limitations of the Study The study primarily dealt on determining how the respondents beliefs regarding diabetes mellitus are translated into practices, and how their beliefs and practices bears implications to health care management for diabetic individuals. Likewise, this study will aim to enrich the research database by including the respondents knowledge about their illness, and their conception on the kind of treatment they receive or should receive. Moreover, the reactions of

the diabetic individuals regarding their disease were also assessed. Finally, the study was limited to the list of diabetic individuals taken from the record at the Municipal Health Center of Bobon, Northern Samar as of 2010-2011, with a total population of fifty-five individuals in the different barangays of Bobon. These fifty five persons are the patients who had or having a check-up at the Municipal Health Center of Bobon.

Theoretical Framework The study was fundamentally conceptualized and organized based on some theories pertaining to beliefs and practices. They served as springboard and operational basis for this study. This study had its theoretical foundation primarily taken from the Values Theory since it is the operant concept underlying our beliefs. Frank Lynch5 defines values as deep-rooted motivations of behavior. They define what is important to us and are the bases of our choices, decisions, reactions and behavior. Men are determined, at least in part, by their ideas of the relative value of different activities, therefore, the quality of desirability or undesirability believed to be inherent in an idea, object, and action. It is our values which define what is most important to us. It refers to any aspect of a situation, event, or object that is considered good, bad, desirable and the like. Furthermore, shared values are considered cultural values and social values are those regarded as essential or conducive to the welfare of a given group. They constitute models of personal behavior in social interaction and are people's conception of the desirable, their choice of alternatives, and the direction of their attention, interest, or emphasis.6

Chester L. Hunt,et.al.,Sociology in the Philippine Setting; A Modular Approach,(Manila;Rex Book Store),Copyright 1987. 6 Hunt,et.al.,Ibid

The health Belief of Model postulated by Becker7 claims that health- seeking behavior is influenced by a person's perception of a threat posed by a health problem and the value associated with actions aimed of reducing the threat. The major components of HBM includes perceive susceptibility, perceived severity, perceived benefits and cost, motivation, and enabling or modifying factors. Perceived susceptibility refers to a person's perception that a health problem is personally relevant or that a diagnosis of illness is accurate. Even when one recognizes personal susceptibility, action will not occur unless the individual perceives the severity to be high enough to have serious organic or social implications. Perceived benefits refer to the patient's beliefs that a given treatment will cure the illness or help prevent it, and perceived costs refer to the complexity, duration and accessibility of the treatment. Motivation includes the desire to comply with a treatment and the belief that people should do what is prescribed by health care personnel. Among the modifying factors that have been identified are personality variables, patient satisfaction, and socio-demographic factors.

Conceptual Framework The researcher fundamentally assumed that diabetic individuals have varied beliefs and notions regarding diabetes mellitus, and that they place certain values upon their belief. Therefore, the profile of the respondents in terms of age, gender, civil status, educational attainment, occupation and monthly salary and their beliefs and practices has implication to the health care management. The left schema shows the independent variable consisting of the respondents demographic profile and their health beliefs and practices, which affects the implication of the
Denise F. Polit and Bernadette P. Hungler, Nursing Research;Principles and Methods, 6thEdition, (USA;Lippincott,Wilkins), Copyright 1999.
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health care management. Furthermore, this dependent variable in the right schema will have an effect on the respondents health beliefs and practices. This could result to changes on the health beliefs and practices that the respondents have known before the implication health care management is done. Therefore, the health beliefs and practices of the respondents will have a great impact to the implication of health care management and vice versa. To concept, a paradigm is shown below: reinforce this

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Paradigm

Independent Variables

Dependent Variables

1. Demographic Profile of the respondents 1.1 age; 1.2 gender; 1.3 civil status; 1.4 educational attainment; 1.5 occupation; and 1.6 monthly salary. 2. Health Beliefs of the Respondents 2.1 diet and nutrition; 2.2 hygiene; 2.3 exercise; and 2.4 disease and treatment. 3. Health Practices of the Respondents Implication to Health Care Management

Figure 1.A schematic diagram between the independent and dependent variables.

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Null Hypotheses The following null hypotheses were tested for significance: Ho1: The demographic profile of the respondents has no significant influence upon their health beliefs and health practices. Ho2: The health beliefs of the respondents have no significant influence over their health practices.

Definition of Terms Some important terms used in this study are herein defined conceptually and/or operationally to facilitate appropriate understanding of their usage. Age. Operationally, this refers to the length of time during which a diabetic individual has live or existed. Beliefs. Conceptually refers to probable knowledge or mental conviction; that which is believed and accepted as true or actual. Operationally, this means the accepted knowledge of the diabetic individuals. Civil Status. Conceptually, this means the marital status of each individual in relation to the marriage laws or customs of the country.8In this study, this is use as the status of

Merriam Webster Dictionary, 2000

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the diabetic individual whether the respondent

is married, single, widowed, etc.

Demographic Profile. In this study, demographic profile refers to the characteristics of the diabetic individuals as respondents of the study with respect to the age, sex, civil status, educational attainment and occupation.9 Diabetes Mellitus. A disease characterized by the bodys inability to metabolize glucose, a common form of sugar, fully and continually. It is metabolic disease affecting carbohydrate, protein, and lipid metabolism. researchers respondents. Diet. Conceptually defined as the food and drink normally taken by an individual or a group, or as prescribed course of what is to be eaten and what is not.11 Operationally, it is used as the respondent kinds of food and drinks that he/she normally takes in from the time of diagnosis of his/her disease. Disease. Conceptually, it is defined as the departure from state of health caused by interruptions or modifications of any of the vital functions and characterized by a definite train of symptoms.
12 10

Operationally, this means as the disease affecting the

Operationally used as the respondents state of illness having the disease of

diabetes mellitus.

10

Oxford Dictionary, Ibid The New Complete Health and Medical Encyclopedia, op.cit. 11 The New Webster Dictionary of the English Language, International Edition, p. 265. 12 Blackwells Nursing Dictionary, Second Edition, page 186.

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Educational Attainment. The highest diploma or degree, or level of work towards a diploma or degree, an individual has completed. 13 Operationally, this means the respondents achievement based on educational level. Exercise. Conceptually, this means the performance of physical exertion for the purposes of improving ones health, correcting a deformity, or developing a particular skill. 14 Operationally, this is used as the diabetic individual form of activity in terms of controlling his/her disease. Gender. This refers to the biological and physiological characteristics that define men and women. 15 Operationally used as the biological and physiological characteristics of the diabetic individual. Health. Conceptually this means the state of complete physical, mental, and social wellbeing, not merely the absence of disease or infirmity. It is also refers to the optimum level of the functioning by individuals, families, and communities in factors such as political, behavioural, hereditary, health care delivery system, and in the influences of social, economic, and environmental factors.16Operationally used as the status of a diabetic individual in regards to their optimum level of functioning whether physically, mentally or socially. Health Beliefs. Operationally, this refers to the respondents knowledge and acceptance of ideas, objects, or actions related to their mental and physical wellness. It may refer to the accepted knowledge of respondents regarding diabetes mellitus.

13

Merriam Webster Dictionary, Loc cit. Blackwells Nursing Dictionary, 2nd Ed., page 221. 15 Merriam Webster Dictionary, Ibid. 16 Oxford Dictionary, 2000
14

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Health Care. Its defined as the services sought by people who need help for physical or emotional problems. 17 In this study this means the care or services that are given to the diagnosed diabetic individuals. Health Care Management. Operationally, this means to the services render to attain the goal on how to control the disease of these diabetic individuals. Health Practices. Operationally, this refers to the action or actual activities of the respondents in relation to the maintenance of their mental and physical wellness, and especially with respect to their reactive behaviour towards diabetes mellitus. Health practices include among others diet and nutrition, exercise and hygiene. Health Status. As used in this study, health status refers to the condition of the diabetic individuals with respect to the following indicators: body weight, blood sugar level, average blood pressure, other diagnosed ailments or diseases. Hygiene. This is conceptually defined as the condition or practice , such as cleanliness, that is conducive to the preservation of health. 18 In this study, this means the beliefs of the respondents on the proper way to maintain cleanliness in their environment and to their selves. Implications. Operationally, this refers to the direct effects of the respondents health beliefs and health practices upon the health care management program for diabetic individuals. It may involve patient education program on diabetes mellitus and how it is affected by the health beliefs and health practices of respondents.

17 18

Blackwells Nursing Dictionary, 2nd Ed., p. 269. Blackwells Nursing Dictionary, 2nd Ed., page284.

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Management. Conceptually defined as to being controlled.19 Operationally used as how diabetic individuals control their blood sugar level. Monthly Salary. Wages received on a regular basis, Sometimes the term is used to include other benefits, including insurance and a retirement plan. Nutrition. Defined conceptually as the sum total of the processes by which the living organism receives and utilizes the materials necessary for survival, growth and repair of tissues, the creation and liberation of energy, and the elimination of waste products and of unusable portions of the materials.20 Operationally used as the type of food and fluid a diabetic individual take in that gives him/her the necessary components in the body to maintain his/her homeostasis despite of having a disease. Occupation. A persons usual or principal work or business, especially as means of earning a living, or the activity that serves as ones regular source of livelihood.21Operationally used as the diabetic individual work in which where the respondents sustain his/her daily living. Treatment. This means as the medical, surgical or psychological care of a person, aimed at relieving symptoms of a disease or injury or curing the condition. Operationally, it is the medical and nursing service given to the diabetic population having there check-up at the municipal health center.22

The New Websters Dictionary of the English Language, International Edition, p. 605. Blackwells Nursing Dictionary, 2nd Ed., p. 403. 21 Merriam Webster Dictionary, 2000 22 Blackwells Nursing Dictionary, 2nd Ed., p.623.
20

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CHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES

Related Literature The foregoing literature which are herein presented and reviewed has been instrumental in the conceptualization of this study. They specifically contributed to the formulation of the theory, statement of the problem, paradigm and hypothesis. TYPES OF DIABETES. Diabetes occurs when the body becomes unable to handle glucose (sugar) which builds up to dangerous levels in the blood. The problem revolves around insulin, a pancreatic hormone that enables body cells to use glucose and thus brings down high blood sugar levels. There are two kinds of diabetes, both of which are characterized by excessive urination and thirst as follows: Type I which afflicts about 5% of diabetics is often hereditary and usually begins in the childhood or youth and is commonly called Juvenile Diabetes. Since these diabetics cannot survive without insulin, it is now officially called as Insulin Dependent Diabetes Mellitus (IDDM). The peak onset of type one diabetes mellitus is at age 11-13 years old and rarely younger than 1 year and adults older than 30 years. Type II is different and often called Adult Onset Diabetes or Non-Insulin Dependent Diabetes Mellitus (NIDDM). It afflicts millions of people and generally hits after age 40, so as people gets older and fatter. In contrast to juvenile diabetics, most Type II diabetes when diagnosed has plenty of insulin in their bodies. The etiology of diabetes mellitus includes a combination of genetic and environmental factors. The recent increase in the frequency of the disease is probably the result of trends toward

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more sedentary lifestyles, increasing consumption of high caloric foods and resultant obesity, and increased longevity. Studies demonstrate a strong relationship to fat, both fat in diet and fat on the body. The disease is rare in areas of the world where fat intake is low and obesity uncommon. Most of the time, the problem in adult onset diabetes is not a defective pancreas unable to produce sufficient insulin but lack of sensitivity to insulin. This resistance of cells to insulin apparently relates directly to obesity and to excess fat in the diet.23 Specific environmental factors linked to type 1 diabetes are the rubella virus where 40% of individuals infection develops type 1 diabetes mellitus later, also the cytomegalovirus. Persistent cytomegalovirus infections appear to be relevant to the pathogenesis of some cases of type 1 diabetes mellitus. 24 For the child or adolescent who has diabetes, there are psychosocial and cultural considerations of compliance with medication and dietary regimen. Even if diagnosed early in life (with learned behaviors regarding the disease parameters), the elementary school years can be difficult for some children with diabetes. Social events such as birthday parties, field trips, and after- school snack time, where sweet treats are the norm, serve as psychological and physical temptation. During adolescence, when the teen wants to fit in with a peer group, the diabetic regimen can become difficult. It is during this time that failure to take insulin or follow dietary guidelines becomes an issue that negatively affect present and future health. Some teens may have insulin pumps and can more easily take extra insulin to cover foods not usually on their diet. The ability
23

Aileen Ludington and Hans Diehl,Disarming Diabetes, Health and Home, (Caloocan City: Philippine Publishing House), Vol. 35-No. 1, January-February 1994. 24 Sue E. Huether and Kathyryn L. McCance, Uderstanding Pathopysiology, 3rd ed. (Library of congress Cataloging in Publication Data), Copyright 2004, p.489.

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to do this helps teens feel less different from peers, but carried to excess, this practice can also lead to problems. In the geriatric population also represents with specific problems with regard to maintaining a normal blood glucose level. If geriatric clients have been diabetic for most of their life, they may choose to ignore their recommended therapy regimen because they feel it will make little difference at this time in their lifespan. Also, elderly clients frequently display cognitive impairment that distorts their judgement and their desire to maintain their prescribed diet. 25 DIABETES TREATMENT. Several treatment centers have convincingly demonstrated that Type II diabetes can normalize their blood sugar levels, often within weeks, by following a simple diet which is very low in fat and high in fiber coupled with daily exercise. Lowering the amount of fat, oil and grease in the diet plays a crucial role. When less fat is eaten, less fat reaches the bloodstream. This begins as complicated process which gradually unblocks the insulin which can then facilitate the entry of sugar from the bloodstream into the body cells. Eating fiber-rich foods plays an important role in stabilizing blood sugar levels. Normalizing body weight is likewise necessary to bring the blood sugar back to normal. Insulin dependent or juvenile diabetes will need to take insulin for life unless pancreatic transplant become feasible.26 The treatment of diabetes involves the following: (a) Diet-the goal is to lessen fat intake and increase ingestion of fiber-rich food. In obese clients the primary importance is the restriction of total caloric intake in order to lose weight that could lead to increase insulin sensitivity of the cells. (b) Exercise- that is at same time and same amount everyday, with a slow

Michael Patrick Adams, et. al., Pharmacology for Nurses: A Pathophysiological Approach, 2nd ed., (Pearson Education Soauth Asia Pte. Ltd.), Copyright 2007, pp. 683-688. 26 Ludington and Diehl,, Ibid.
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and gradually increase in the exercise period. Proper diet and exercise can sometimes increase the sensitivity of insulin receptors to the point that drug therapy is unnecessary for type 2 diabetes mellitus. (c) Oral Drugs-has a common function in lowering blood glucose levels when taken on a regular basis. Therapy is usually initiated with single agent. If therapeutic goals are not achieved with monotherapy, two agents are administered concurrently. Failure to achieved normal blood glucose levels with two oral hypoglycemic agents usually indicates a need for insulin. (c) Insulin- is more commonly used by type I diabetic client. It is necessary for both the storage and reconversion of glucose. The desired outcome of insulin therapy is to prevent the long-term consequences of the disorder by strictly maintaining blood glucose level within the normal range. Several types of insulin are available, differing in their source, onset and duration of action. Until 1980s, the source of all insulin was beef or pork pancreas. Almost all insulin today, however, is human insulin obtained through recombinant DNA technology because it is more effective, causes fewer allergies, and has lower incidence of resistance, which is given by injection (subcutaneous) because it is destroyed by gastric secretions when taken orally; (d) The Insulin Pump-development of a pump for infusion of insulin into the body offers alternatives of treating diabetics with keto-acidosis or ketosis. The insulin pump includes a reservoir for insulin, a peristaltic pump that impels the fluid by contracting and expanding, and a power pack to activate the pump. 27 Stevia (stevia rebadaudiana) is a herb belonging to the sunflower family that may be helpful to clients with diabetes. Although widely used in Japan and other Asian countries as a sweetener, the Food and Drug Administration (FDA) has not approved it is use for this purpose because there are concerns that substance in the herb may cause mutations. Thus, although not
27

Medical and Health Encyclopedia, Ibid

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permitted as food additive, the powdered extract is readily available as a dietary supplement and can be used in place of sugar. Its sweetening power is 300 times that of sugar but does not appear to have negative effect on blood glucose or insulin secretion. In animal experiments, stevia significantly elevated the glucose clearance, an effect that may be helpful to those with diabetes. Another study done on type 2 diabetic clients showed that stevia reduces postprandial (after eating) blood glucose levels. 28 Prolonged hyperglycemia or excess sugar in the blood, from insufficient insulin activity can cause diabetic coma. This condition involves the increasing build up of ketone bodies, the by-products of fat metabolism, which creates an acedotic condition (chemical imbalance in the blood marked by excess acid). When this has been present for several days, symptoms begin to develop that are similar to those associated with the onset of diabetes. They include excessive urination and thirst, dry and hot skin, drowsiness and finally coma. The earliest stage of the problem is called diabetic ketosis; a slightly later is known as diabetic acidosis.29 DIABETES INCIDENCE. The Genera-based World Health Organization (WHO) published global estimates on the prevalence of diabetes. It described its findings as alarming especially for developing countries and ethnic minorities in industrialized countries. Communities in these categories have shown dramatic increases in diabetes prevalence particularly in the eastern Mediterranean and Middle East, Southeast Asia, and Western Pacific. In such areas, diabetes can often affect about 20 percent of the adult population, rising to 50 percent in some cases.

Michael Patrick Adams, et. al., Pharmacology for Nurses: A Pathophysiological Approach, 2nd ed., (Pearson Education Soauth Asia Pte. Ltd.), Copyright 2007, p. 691. 29 Ibid.
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In the United States, diabetes is the third leading cause of deaths. From 1980 through 2001, the number of Americans with diabetes has more than double and increased in all age groups. Currently, it is estimated that more than 23 million people newly diagnosed with diabetes increase by about 1 million per year. Diabetes has far-reaching and devastating physical, social and economic consequences, that includes (a) being the leading cause of nontraumatic amputations, blindness in working-age adults and end-stage renal disease,(b) diabetes as the 3rd leading cause of death due to high rate of cardiovascular disease among people with diabetes, (c) hospitalization rates for people with diabetes are 2.4 times greater for adults and 5.3 times greater for children than for the general population. Diabetes Mellitus is one of the leading causes of disability in persons over 45 years old. Moreover, the Diabetes Foundation of the Philippines said that more than four million Filipinos are afflicted with the disease. Diabetes mortality rate in the total population has increased by ninety-two percent over a ten-year period from 5.1/100,000 in 1986 to 9.8/100,000 in 1995.30 The economic costs of the diabetes continue to increase because of increasing health care costs and aging population. Half of all people who have diabetes are hospitalized each year and severe and life-threatening complications often contribute to the increased rates of hospitalizations. The consequences of these disease is staggering in terms of the productivity

30

Frances Prescilla L. Cuevas, RN, MAN, Ed., Public Health Nursing in the Philippines, 10th ed., p.178-

194.

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loses, not withstanding the emotional and psychological havoc it brings to those who are afflicted and their families.31

Related Studies Ravussin and colleagues surveyed a closely related population of Pima Indians in the remote region of North-Western Mexico. They found that individuals in this community ate a diet lower in fat that is typically consumed in Arizona, and both men women were physicallyactive. The men and women of Mexico weighed in the average of 50 pounds less than the PimaIndians of Arizona. More important, diabetes was diagnosed in about 10 percent of the Mexican Pimas compared with almost 50 percent among the Arizona Pimas. The main staples of the Mexican Pimas are beans, corn (astorillas), and potatoes. Several essential nutrients are lacking because of the relative absence of fruits and vegetables. Diet analysis reveals the following: 13 percent protein, 23 percent fat, 63 percent carbohydrates, and less than 1 percent alcohol containing five grams of fiber. This is sharp contrast to the diet of the Arizona Pimas. The Mexican Pimas are hard workers with high level of physical activity averaging 40 hours a week. Interventions involving increased physical activity and a reduced fat and energy diet slowed the progression of Type 2 diabetes in high risk population of Pima Indians.32

Henrylito D1Tacio, What You Should Know About Diabetes, Health and Home, Vol. 37-No.1, (Kalookan City: Philippine Publishing House), January-February 1996. 32 Eric Ravussin, et. al., Effects of a Traditional Lifestyle on Obesity in Pima Indians (http://care.diabetesjournals.org/content/17/9/1067), 1994, 10 March.

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Another study conducted by Arayakul33in 1996 investigated the reactions of tuberculosis patients regarding their illness. The study revealed the following: (a) the respondents had no knowledge about tuberculosis and did not see the impotence of having an x-ray examination previous to their sickness. Among the subjects, about 90 percent were confined when the disease was far advanced. Some patients had treatments before hospitalization and they understood the purpose of their confinement as well as the rules and regulations of their medication and the hospital; (b) As to cause of their illness, about 26 percent of the respondents attributed their sickness to causative germs in the environment, and 4 percent blamed it on bad luck and ill-will of other people; (c) As to sources of information regarding their disease, medications, and nutrition- about 61 percent were taken from physicians, 27 percent from nurses, and 10 percent from attendant; and (d) Reactions to illness- about 96 percent were willing to accept and follow strictly the physicians advice, hospital rules and regulations, as well as health teachings. About 72 percent of the females and 68 percent of the males were worried about additional expenses, effects of illness on their families, jobs, friends, and their future. A study on the health beliefs of African-Caribbean people with Type 2 diabetes was conducted by Ken Brown and Associates 34 to gain an understanding of how health beliefs influence the way diabetic respondent manage their illness. Purposive samples of 16 African-Caribbean people with Type 2 diabetes were interviewed. Participants took part in semi-structured and in-depth interviews which were audio-

MullikaArayakul, Reactions of Tuberculosis Patients Towards Their Illness and Their Treatment as a Basis for Patient Education Program, (Graduate Thesis, Philippine Womens University), 1996. Ken Brown, Mark Avis and Michelle Hubbard, Health Beliefs of African-Caribbean People with Type 2 Diabetes: A Qualitative Study, School of Nursing University of Nottingham, Nottingham UK, April 10, 2007.
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taped, recorded and transcribed. Transcripts were analyzed for emergent themes and validity was checked by an independent researcher and through discussion with a local community group. Participants were strongly influenced by memories of growing up in the Caribbean, migration to the UK, and friends and families accounts of diabetes as well as their own experiences of the illness. Knowledge and understanding of diabetes was sometimes poor. There was some mistrust in the value of advice and treatment offered by professionals and a preference for natural treatments. Health professional were generally praised but some interviewees felt that the NHS did not cater properly for black people. Insulin treatments were feared and dietcontrolled or tablet-controlled diabetes was seen by some as a mild form that did not warrant serious concern. A study conducted by H.C. Cooper, K. Booth and G. Gill focused on patients perspectives on diabetes health care education formulated the following questions: Would participation in an intervention program have an impact upon patients illness beliefs? Would it lead to changes in self-care behaviour of the patients? Would it have an impact upon blood glucose control? A total sample size of 48 patients were required to achieve a 1% change in blood glucose levels as measured through blood tests, and to participate in intervention program for diabetic patients. This longitudinal study was conducted for a period of 6 months continuous health care intervention management program to determine changes in patients perspectives on their illness. Conclusions : While education can empower patients to take on greater responsibility for the management of their disease, they cannot achieve long-term success without the cooperation of health professionals who can support and facilitate achievement of patients goals; the argument for integration of medical and social sciences into professional education so that partnerships

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with patients can be realized becomes imperative; and the responsibility for the management of the disease resides with patients and the primary role of the health professionals becomes one of a supporter and educator.35

Similarities and Differences The study of Ravussin and colleagues is similar with this present study the fact that both dealt on the prevalence of diabetes , the fundamental difference between the two studies are the types of respondents and geographical location of the study. Moreover, the study of Arayakul is somewhat similar with this study because the former dealt on the reactions towards illness of a certain group of patients and how they specifically feel towards treatment. In this regard, the present study is similarly aiming to determine reactions to illness through an evaluation of beliefs and practices. The basic difference between the two studies is the type of disease being investigated, the former dealt on tuberculosis while the latter is on diabetes. The studies of Brown and Associates and Cooper, et. al. are similar with this present study for the reason that both dealt on diabetes as focus of research. However, the difference in all the studies reviewed lies in their basic design and focus of evaluation. This present study attempted to describe the relationship between health beliefs and practices and their implications to health care management. Meanwhile the two studies reviewed have their focus on the effects of intervention program on the health care management of diabetic patients, and the health beliefs of Type 2 diabetic people.

H.C. Cooper, K. Booth and G. Gill, Patients Perspectives on Diabetes Health Care Education, (Department of Primary Care- MacMillan Nursing Practice Development Unit), Manchester University, UK.

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CHAPTER III RESEARCH METHODOLOGY

Locale of the Study Northern Samar is one of the 3 provinces created by virtue of Republic Act No. 4221 on June 19, 1965. It is one of the six provinces that comprise Region VIII. It is located on the Eastern Visayas Region of the Philippine archipelago, bounded in the north by the San Bernardo Strait; on the west by the Samar Sea; on the south by the Eastern and Western Samar; and on the east by the Philippine Sea. This province is subdivided into two congressional districts, 24 municipalities and 569 barangays. It ranks 35 in size among 75 provinces of the Philippines, with a total land area of 3, 498 square kilometres. This accounts for approximately 1.2% of the total land area of the country and about 16.22% of the Region VIII.36 The capital of Northern Samar is the Municipality of Catarman situated at the northern portion of the island. To its west is the municipality of Bobon where the researcher had conducted their study in its selected barangays: namely; Barangay Magsaysay, Barangay Sta. Clara, Barangay General Lucban, Barangay San Juan, Barangay Salvacion and Barangay Dancalan. Bobon is virtually situated in the central portion of the province composed of 18 satellite barangays scattered all over its 130 square kilometre total land area. The municipality is bounded on the north by the Pacific Ocean; on the east the municipality of Catarman; on the west by the municipality of San Jose and on the south by the municipality of Lope de Vega.

36

Provincial Government of Northern Samar, Provincial Physical Framework Plan, November, 2003, p.1.

28

By income classification, Bobon is considered as fifth-class municipality. Bobon is primarily an agricultural community with fishing and household level industries as the secondary-tertiary means of livelihood for the people. The Municipal Health Center is situated in the government center in the town proper and assisted by 18 Barangay Health Station. The health personnel is composed of a Municipal Health Officer, community health nurses, community health midwives, barangay health workers, barangay nutrition scholars, and the Municipal Sanitary Inspector.37

The Respondents The respondents or subjects of the study were the diabetic individuals presently residing within the selected barangays of Bobon, Northern Samar. Based on the records of the Municipal Health Office in Bobon as of 2010-2011 there are fifty-five diagnosed diabetic individuals who are having their check-up in the center. These diagnosed diabetic individuals specifically provided the needed information in the survey questionnaire.

Variables of the Study The focus of the study was to determine the health beliefs and health practices among individuals with diabetes mellitus in selected barangays of Bobon, Northern Samar and it's implication to the health care management.

Poverty Incidence Among Barangay Residents of Three Selected Barangays of Bobon, Northern Samar: Its Implication to Health Status, (Undergraduate Thesis, Colegio de San Lorenzo Ruiz de Manila), October, 2008, page 31.

37

29

There were two sets of variables in this study; one were the independent variables that consisted of the demographic profile of the respondents in terms of age, gender, civil status, educational attainment, occupation and monthly salary. The independent variables consisted of the respondents health beliefs and health practices. The other set of variable was the dependent variable which was the implication of health care management of the respondents. These data were gathered through distribution of the research instruments in a form of survey questionnaire.

Research Design The primary objective of the study was to gather information regarding the health beliefs and health practices of diabetic individuals, and for this reason, the descriptive method of study was utilized. Furthermore, the study used the 3 sub-types of descriptive method: the survey method, the documentary analysis method, and the correlational method.38 In the data gathering, a survey questionnaire was used which was structured in relation to the statement of the problem. The survey questionnaire was administered to the pre-identified diabetic individuals from selected barangays of Bobon, Northern Samar. The descriptive method of study has many advantages, both to research and to the researcher. First, descriptive method is designed for the investigation to gather information about present existing condition. In this way, the researchers may be able to gather relevant information on the health beliefs and health practices of diabetic individuals. Second, descriptive research involves the collection of data in order to test hypotheses. 39As such, the researchers

38

Consuelo G. Sevilla, et. al., Research Methods, Revised Edition, (Manila: Rex Book Store), Copyright Ibid, pp. 95-97.

1987
39

30

may be able to determine whether health beliefs of diabetic individuals have bearing upon their health practices. Third, descriptive method lends itself appropriately to investigations which provide normative standards based on what is present. Consequently, the researchers may be able to evaluate and compare the health beliefs and health practices of diabetic individuals against the standard health care management for diabetes patients. Descriptive-survey method was used to cover the entire population of diabetic individuals in selected barangays of Bobon based on the census of the municipal health office. Surveys can be very useful for descriptive purposes as well as in the study of relationships between variables. This method can assist in comparing existing conditions with predetermined criteria or for evaluating the effectiveness of programs. Likewise, this may aid in testing hypothesis. The researchers used another type of descriptive method which is the documentary analysis or content analysis method. This study involves gathering information by examining records and documents. The data about the respondents population was gathered by means of analysing documents in the municipal health office. Correlational study was also utilized in an attempt to measure a number of variables and then compute the correlation coefficient between them, so as to find which variables are related. This method helped to determine the relationship between the independent and dependent variables as shown in the paradigm of this study.40

Research Instruments The study utilized the survey questionnaire to gather data for the study, and it was administered to the respondents through interview technique. The design of the research
40

Ibid, p. 110.

31

instrument was modelled after the specific questions raised by the study in the statement of the problem section. Part 1 of the survey questionnaire evaluated the demographic profile of the diabetic individuals with regards to their age, gender, civil status, educational attainment, occupation and monthly salary. Part 2 dealt on assessing the health beliefs of the diabetic individuals. Part 3 dealt on determining the health practices of the diabetic individuals.

Population and Sampling The researcher determined the population of the respondents using complete enumeration of all diagnosed diabetic individuals according to the list of the Municipal Rural Health Unit and that these individuals were presently residing in the selected barangay of Bobon, Northern Samar.

Validation of Research Instruments Considering that the research instrument structured and designed by the student researchers, it was expected that some errors in its construction were present. To remedy these probable errors, the survey questionnaire was given to the research adviser for checking, suggestions and comments. The survey questionnaire was then revised according to the comments and suggestion of the research adviser. This served as the validation process.

32

Scoring and Interpretation of Data Likerts five system management style was used to establish the health beliefs and practices of diabetic individuals in the selected barangay of Bobon, Northern Samar. The respondents indicated the descriptions of their age, gender, civil status, educational attainment, occupation and monthly salary, and included also their health beliefs and health practices. To determine the health beliefs of the respondents, the following scale was used: 4.50 - 5.00 3.50 - 4.49 2.50 - 3.49 1.50 - 2.49 1.00 -1.49 Strongly Agree (SA) Moderately Agree (MA) Moderately Disagree (MDA) Strongly Disagree (SDA) No Comment (NC)

To determine the health practices of the respondents the following were used: 4.50 -5.00 3.50 - 4.49 2.50 - 3.49 1.50 - 2.49 1.00 -1.49 Always (A) - when you do the item all the time Almost Always (AA) - when you do the item almost all time Never (N) - when you do not do the item Rarely (R) - when you occasionally do the item No Comment (NC) - when you are undecided

33

Data Gathering Procedure The data gathering procedure involved the following steps: STEP 1: Asking permission to the Adviser, the Dean of the College of Nursing, the Municipal Mayor and the respondents. STEP 2: Structuring, and validating of the survey questionnaire. STEP 3: Finalization and mass production of the survey questionnaire. STEP 4: Identification of the population. STEP 5: Distribution of the survey questionnaire to the identified respondents. STEP 6: Retrieval of the accomplished survey questionnaires from the respondents. STEP 7: Scoring of the accomplished survey questionnaires and construction of the raw data sheet. STEP 8: Statistical analysis of data. STEP 9: Tabulation and interpretation of data. STEP 10: Preparation of the research manuscript for oral defense.

Statistical Analysis Technique The data that were gathered by survey questionnaire were analyzed in two treatments, as follows: First Statistical Treatment Statistical tools such as tally, frequent count, percentage computation, average or mean were used in the initial data analysis.

34

Percent Computation41 P = _F_ x 100 N Where: P is the percentage of responses in relation to the total number of respondents, F is the frequency of responses for each item in the survey questionnaire, N is the total number of respondents. Sample mean42 X = Ex_ n Where: X is the sample mean Ex is the sum of sample observation n is the sample size. Second Statistical Treatment (Correlational) to test the relationship between personal profile and health beliefs and practices, and between health beliefs and health practices, the following formula was used: Chi-Square Correlational Method43 X2 = E ( fo fe ) 2 Fe Where: X2 is the chi-square computation, E is the summation of values, Fo is the observed frequency, Fe is the expected frequency.

41 42

Antonio S, Broto, Statistical made Simple,(Manila: Melbros Printing Center). Ibid. 43 Broto, Ibid

35

CHAPTER IV

PRRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA This chapter includes the assessment on the health beliefs and practices of individuals with diabetes mellitus in selected barangays of Bobon, Northern Samar: its implications to health care management. The data considered was on the basis of the 72.73 percent retrieval rate obtained by the researchers and in this treatment are arranged according to the statement of the problems on a one-on-one response scheme. Inferences and implications were included to make such findings more in depth, meaningful and relevant. Respondents Profile It can be gleaned in the frequency distribution from table 1, that out of forty respondents a greater percentage 12 or 30 percent have age ranged 51-60 years old, 10 or 25 percent were 4150 years old and 61-70 years old, however, the least number were 31-40 years old respectively. From the figures it can be deduced when a person reaches at their middle age they are mostly affected with diabetes mellitus. As shown in the same table the gender majority 22 or 55 percent of the respondents are female as compared to the 18 or 45 percent male, likewise majority 33 or 82.5 percent married, 6 or 15 percent widowed and least 1 or 2.5 percent single. This implies that majority of the respondents are married. As to the level of education of the respondents majority 19 or 47.5 percent were college graduate, 10 or 25 percent high school graduate and the least 5 or 12.5 percent college level and as well as elementary level. This implies that majority of the respondents obtained a college degree program in their respective field of specialization. In terms of occupation respondents were arranged from greater percentage a distributed as follows; 17 or 42.5 percent unemployed, 12 or 30 percent government employees, 8 or 20 percent other

36

occupation and only 3 or 7.5 percent privately employed. This implies that majority of the respondents were unemployed. As to the salary of the respondents a greater 15 of 37.5 percentage have earning Ph 7,000 and above and as well as Ph1, 000 and below. While the rest earned from Ph3, 000 to Ph7, 000 of lesser frequency distribution. This implies that only of relative majority earned as high from Ph7, 000 and above respectively.
Table 1 Age Frequency Distribution of the Respondents AGE: Profile of the Respondents 61 70 years old 51 - 60 years old 41 - 50 years old 31 40 years old Total GENDER: CIVIL STATUS: Male Female Single Married Widowed Total EDUCATIONAL ATTAINMENT: College graduate College level High School graduate Elementary level Total OCCUPATION: Unemployed Government Employee Privately Employed Other occupation Total SALARY Ph 7,001 & above Ph 5,001 Ph 7,000 Ph 3,001 - Ph 5,000 Ph 1,001 - Ph 3,000 Ph 1,000 & below Total Frequency 10 12 10 8 40 18 22 40 1 33 6 40 19 5 10 6 40 17 12 3 8 40 15 2 3 5 15 40 Percent 25 30 25 20 100 45 55 100 2.5 82.5 15.0 100 47.5 12.5 25.0 15.0 100 42.5 30.0 7.5 20.0 100 37.5 5.0 7.5 12.5 37.5 100

37

It can be gleaned in Table 2a, the mean distribution of the health beliefs and practices of the respondents how their diet are being managed with the highest mean 4.93 that they eat food to live, grow, to keep health and well, and to get energy for work and play. Food is made up of different nutrients needed for growth and health. With mean 4.80 identified foods responsive to the amount of nutrients needed in the body as influenced by age, sex, size, activity and state of health. While the least identified as the way food is handled influences the amount of nutrients in food, its safety, appearance and state. Likewise, all the people throughout life have the same need of nutrients but in varying amounts. Thus, most nutrients do their work when teamed with others nutrients. This implies that basic and primary to have good food was premised on the way food are handled and prepared and looking into the influences on the amount of nutrients in food, safety, and appearance and state.

38

Table 2 Mean Distribution of the Health Beliefs and Health Practices the Respondents 5 SA 2a DIET 1. We eat food to live, grow, to keep healthy & 38 well, & to get energy for work and play (an pagkaon kahinahanglan nato para mabuhi, magkusog ug maging maupay an laws ug para tagan kit sin enerhiya para sa ato hihimoon sa kada adlaw). 2. Food is mad up of different nutrients needed 37 for growth & health (an pagkaon ay ginkokomponer sin damo nga nutrisyon na kahinahanglan para magtubo ug magkusog) 3. All nutrients needed by the body are 28 available through food. (Natanan nga nutrisyon nga panginahanglan san aton lawas in imo makukuha sa pagkaon) 4. Many kinds of food can lead to a well34 balanced diet. (Damo nga klases sin pagkaon an makakahatag s aim sin maupay ug balance nga pagkaon) 5. No food by itself has all the nutrients needed 26 for full growth and health (wara sayo la nga klase sin pagkaon an makakahatag sa tanan nga nutrisyong kinahanglan nato para magkusog ug magupay at laws) 6. Each nutrient has specific uses in the body 34 (kada sayo ng klase sin nutrisyon ay may particular na gamit sa aton lawas) 7. Most nutrients do their work when teamed 25 with other nutrients (an kadam-an san mga nutrisyon ay nahihimo an kanra gamit kun ig-papadis sa iba pa nga klase nga nutrisyon) 8. All people throughout life have the same 27 need of nutrients but in varying amounts. (Tanan nga tawo sa bug-os nya nga kinabuhi ay parapareho an kinahanglana nga nutrisyon pero sa iba-iba nga kadamo) 9. The amount of nutrients needed is 31 influenced by age, sex, size, activity, & state of health (an kadamo san nutrisyon na kahinahanglan sa ato lawas ay nakadepende sa edad, pagkatawo, aktibidades ug san estado san ato lawas). 10. The way food is handled influences the 24 amount of nutrients in food, its safety, appearance, and taste. (An pamaagi san pagpreparar san pagkaon nakka-apekto san nutrisyon na ada sa pagakaon ug an kanya rasa) Grand Mean 4
MA

3
SDA

2
MDA

1
NC

Total

Mean 4.93

Interpretation Strongly Agree

197 3 197 11 1 187 4 1 1 191 10 2 2 4.50 Strongly Agree 4.78 Strongly Agree 4.68 Strongly Agree 4.93 Strongly Agree

180 5 10 1 2 1 191 3 4.38 Moderately Agree 4.78 Strongly Agree

175 8 1 3 4.30 Moderately Agree

172 8 1 3 4.80 Strongly Agree

192 6 3 3 4 4.08 Moderately Agree

163 4.62 Strongly Agree

39

It can be gleaned in 2b the mean distribution of the health beliefs on the hygiene of the respondents. Data shows that out of ten (10) indicators it shows that the highest mean score 4.98 that one of the hygiene techniques was to have brushing the teeth after eating is a must for the individual regardless of age and sex. Likewise, it also consider the way of preparing food, cooking, and dinning availability of utensils that must be thorough washed before and after eating. Henceforth, all foods must also be thoroughly washed before cooking and eating. This implies that inasmuch the three practices is ultimately needed this must be practice appropriately to minimize occurrences of the inadequacy for good health. Thus, from the above health beliefs and practices the least mean score can be deduced to quantify the adequacy and inadequacy of its meaning in terms of practices. Data revealed that waste water should be disposed in covered drainage, and sources of drinking water must be periodically examined for the presence of water-borne microorganisms, thus, hand washing should be done before and after eating, and more significantly all foods must be cooked thorough at least 70 degrees centigrade temperature. This implies that with this health practices and techniques the possibility of attaining good health would most likely to happen to individuals.

40

Table 2b Mean Distribution of the Health Beliefs and Health Practices of the Respondents 5 2b HYGIENGE / KALIMPYO 1. We need to take a bath everyday (Kahinanglan ta magparigo kada adlaw) 2. Brushing the teeth after eating is a must (kinahanglan nato magsipilyo kada pagkatapos magkaon) 3. All foods must be thoroughly washed before cooking and eating (tanan nga pagkaon dapat hugasan sin tuhay bag-o lutuon ug kaunon) 4. Cooking & dining utensils must be thoroughly washed before and after eating (an mga kagamitan sa pagluto ug pagkaon dapat hugasan sin tuhay bag-o ug pagkatapos kumaon) 5. Sources of drinking water must be periodically examined for the presence of water-borne microorganisms (an ginkukuwaan inumon nga tabig dapat permi gin tse-tse kun may ada mikrobyo) 6. Solid wastes should be properly segregated (an mga basura kahinahanglan paglain-lainon) 7. Kitchens & confort rooms must be periodically disinfected (an kusina ug an kubeta kinahanglan pirme limpyoho) 8. Waste water should be disposed in covered drainage (an marigsok nga tubig kahinanglan ig tapok sa kanal o luho na may takop) 9. Hand washing should be done before & after eating (an paghugas kamot kahinanglan himuon bag-o ug pagkatapos kumaon) 10. All foods must be cooked thoroughly at least 70 degrees centigrade temperature (tanan nga pagkaon kahinahanglan lutuon sin maupay sa kalayo nga may 70 degree centigrade nga kapasuon) Total SA 35 39 39 4 MA 5 195 1 199 1 196 38 2 4.95 Strongly Agree 4.90 Strongly Agree 4.98 3
SDA 2 MDA

1 NC
Tot al Mean Interpretation

4.88

Strongly Agree Strongly Agree

198 31 6 1 1 1 4.63 Strongly Agree

185 34 36 28 140 35 4 2 4 1 4 1 1 190 2 190 3 170 2 3 186 27 12 1 4.65 Strongly Agree 4.65 Strongly Agree 4.25 Moderately Agree 4.75 Strongly Agree 4.75 Strongly Agree

186 4.50 Strongly Agree

41

As shown in table 2c, revealed the data and mean distribution of the health beliefs on the exercise of the respondents. It can be gleaned from the table that three highest mean 4.85 that they strongly agree that exercise burns cholesterol and body fats, that a person should exercise daily by walking exercise is recommended for older individuals, thus, physical exercise should be attuned to the status of diabetic individuals. On the other hand, the least mean identified provide that jogging is an exercise for the young individuals. Hence, it is good to wash or take a bath every after exercise each group has its own recommended daily exercise regimen. This implies with the highest mean as well as its lowest mean this mark the positive health practices that individuals should make it to happen in his/her life style.

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Table 2c Mean Distribution of the Health Beliefs and Health Practices of the Respondents 2c. EXERCISE / EHERSISYO 1. A person should exercise daily (an tawo kahinahanglan mag-ehersisyo kada adlaw) 2. Erxercise burns cholesterol & body fats (an ehersisyo makakaiban sa cholesterol ug taba sa ato lawas) 3. Each group has its own recommended daily exercise regimen. (kada grupo san tawa ay mayaon kanya-kanya rekomendado nga ehersisyo) 4. Jogging is an exercise for the young individuals (an jogging an ehersisyo na angay sa mga bata pa an eded) 5. Walking exercise is recommended for older individuals (an paglakaw-lakaw ay rekomendado para sa mga mas arog nga tawo) 6. A person should first consult a doctor before exercising to determine the type of exercise that fits for him or her (an tawo dpat ngun-a magkonsulta sa doctor bag-o mag-ehersisyo para mahibaruan an angay sa iya nga ehersisyo) 7. It is good to wash or take a bath every after exercise (maupay na maghugas ug magparigo pagkatapos magehersisyo) 8. Diabetic individuals should reduce weight through exercise (an diabetic na tawo dapat mag paiban timbang sa pamaagi san pagehersisyo. 9. Physical exercise should be attuned to the status of diabetic individuals (an pag-ehersisyo kahinahanglan tama la sa pisikal nga estado san tawo nga may yaon diabetes) 10. Exercise helps control diabetes (an ehersisyo nakakabulig para makontrol an deiabetes) 5 SA 32 37 23 4 MA 6 2 8 1 1 3 SDA 2 MDA 1 1 NC 1 1 194 1 153 16 33 13 4 4 2 5 3 157 2 189 23 7 3 6 1 4.13 Strongly Agree 4.73 Strongly Agree 3.93 Moderately Agree 3.83 Moderately Agree Total Mean 4.65 4.85 Interpretation Strongly Agree Strongly Agree

186

165 17 9 8 4 2 155 29 10 1 186 32 7 1 4.73 Strongly Agree 4.65 Strongly Agree 3.88 Moderately Agree

189 31 155 6 2 1 184 4.00 Moderately Agree 4.60 Strongly Agree

Total

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Table 2d shows the mean distribution of the health beliefs on the disease treatment of the respondents. Data revealed through its mean computation that three highest score 4.88 interpreted that they strongly agree that every person should be tested for their blood sugar levels more frequently, diabetes can be controlled by proper diet and exercise, and untreated diabetes can be fatal. This implies that when the person ill-with diabetes when not properly treated it would cause fatal effect on his/her life as it could, so the need to meet this expectation is a necessity of the individual. However, the least mean score revealed that diabetes can be detected through the urine examination, diabetes caused by defect of the pancreas, and diabetes is a curable disease. This implies that basically, an individual having diabetes should have frequent blood sugar examination, proper diet and exercise, and when not treated would cause a fatal defect in life and perhaps cause to death.

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2d. 1.

2. 3.

4.

5.

6. 7. 8. 9. 10.

Table 2d Mean Distribution of the Health Beliefs and Health Practices of the Respondents 5 4 3 2 1 DISEASE TREATMENT SA MA SDA MDA NC Total Mean Every person should be tested for their 39 1 4.88 blood sugar levels (kada tawo kahinahanglan magpa-eksaminsa para sa lebels (kada tawo kahinahanglan magpa-examinsa para sa lebel sa asukar sa iyadugo 196 Diabetes caused by defects of the 15 10 3 12 3.33 pancreas (an diabetes resulta san pakakayaon depekto sa pancreas. 133 Diabetes is not caused by human ill25 2 5 2 6 3.95 will like sorcery or barang (an diabetes dire resulta san pag-mulay of ti-aw san tawo sugad sin barang) 158 Diabetes can be controlled by proper 36 2 2 4.75 diet and exercise (an diabetes puyde makontrol pinaagi san tame nga pag diet ug pageheersisyo) 190 Insulin helps in the utilization of blood 26 8 4 2 4.30 sugar (an insulin nabulig sa ato lawas para magamit ta an asukar na ada sa ato 172 dugo) Untreated diabetes can be fatal (an 35 3 2 4.73 diabetes na dire ginbubulong ay nakamatay) 189 Diabetes can be detected through the 9 5 17 3 6 3.20 urine examination (an diabetes puyde 128 mahibaruan sa eksamin san ihi) Diabetes is largely hereditary (an 20 11 2 6 1 4.08 diabetes nakukuha tikang sa mga kaganak o kaapo-apoyan) 163 Diabetes is a curable disease (an 18 14 5 2 1 4.15 diabetes na sakit ay nabubulong) 166 Diabetes is caused by too much sugar in 29 9 1 1 4.60 the blook (an diabetes nahihimo kay sa sobra ngaasukar sa ato dugo) 184 Total 4.20

Interpretation Strongly Agree

Strongly Disagree Moderately Agree Strongly Agree Moderately Agree Strongly Agree Strongly Disagree Moderately Agree Moderately Agree Strongly Agree Moderately Agree

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It can be gleaned in Table 3 the mean distribution of Mean Health Practices of disease treatment of the Respondents. Data revealed that on the basis of mean computation three highest score showed that respondents agreed they always consider ingestion of prescribed medication based on the prescription of the doctor, regular monitoring of blood sugar, and almost always follow doctors recommendation diet and exercise activities. This implies that following this prescribed activities by the individual person having diabetes they will be given more chances of minimizing the occurrence of the disease. With the least means however, diabetes can be determine through regular examination of urine analysis, regular consultation with the doctor, and avoiding too much ingestion of sweet foods and other carbohydrates rich food such as bread, rice, pasta, and etc. This implies that the person itself can do share in the treatment of his own illness of being diabetic considering those suggested items by the physician such as too much intake of food having adequate contents of sugar and that of having much carbohydrates. He should likewise take cognizance of the proper exercise to safeguard his own health every day.

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Table 3 Mean Distribution of the Health Beliefs and Health Practices of the Respondents 5 4 3 2 1 3. HEALTH PRACTICES A AA N R NC Total Mean 1. Daily exercise (adlaw-adlaw nga pag17 17 1 5 4.15 ehersisyo) 166 2. Weight control (pagknontrol sa tama 16 11 6 6 1 3.88 nga timbang san lawas) 155 3. Avoiding too much ingestion of sweet 19 10 3 5 3 3.93 foods and other carbohydrates rich foods such as bread, rice, pasta, etc. (paglikay sa mga pagkaon na masyado matam-is ug damo an carabohydrates parehas sa tinapay, luto, pasta ug ibapa) 157 4. Avoiding oily and fatty foods (paglikay 19 12 4 4 1 4.10 sa mga pagkaon na damo an taba os 164 ma-asyete) 5. Minimum necessary intake of 21 13 1 4 1 4.23 carbohydrates (pagkaon san tama la nga kadamo sa pagakaon namay carbohydrates) 169 6. Avoiding over-eating (paglikay sa 18 15 1 5 1 4.10 sobra nga pagkaon) 164 7. Ingestion of prescribed medication 29 10 1 4.70 based on the prescription of the doctor (pagtumar sa bulong na ginhatag sa 188 doctor base sa iya ginsugad ug surat) 8. Following doctors recommended diet 21 13 1 5 4.25 and exercise program (pag-sunod sa rekomendado nga pagakon or ehersisyo san doctor) 170 9. Regular monitoring of blood sugar 21 13 2 4 4.28 level (regular nga pag-pa eksamin sa 171 asukar san dugo) 10. Taking regular urine analysis. (regular 7 9 6 16 2 3.08 nga pagpa-eksamin san ihi) 123 11. Regular consultation with a doctor. 15 14 11 3.83 (regular nga pagpackeck-up ngadto sa doctor) 153 Total 4.05

Interpretation Almost always Almost always Almost always

Almost always Almost always

Almost always Always

Almost always

Almost always Never Almost always Almost always

Table 4 shows the chi-square test between the profile and the health beliefs and practices of the respondents. Data revealed through its mean derived from its computation related to age, gender, civil status, educational attainment of parents, occupation and monthly family income. It showed that the computed chi-square value 199.67 was greater than the tabular 112.825 with 72 degrees of freedom as basis on the treatment which reject the null hypothesis of significant

47

relationship as well as difference as perceived by the respondents which considerably found to be significantly related to the respondents profile in connection with the variables indicated to the health beliefs and practices of the respondents. This implies that health beliefs and practices were significantly related to the profile of respondents, and this can likewise be inferred that good health habit of the respondents would help them ease out the problem in the occurrence of the disease respectively.
Table 4 Chi-square Test of Relationship between Profile and Health Beliefs and Practices of the Respondents
Profile of the Respondents

No. 1 2 3 4 5 6 7 8 9 10 11 12 13
Total

O 10 12 8 10 18 22 1 33 6 0 0 0 0
120

e .71 .57 .31 .02 1.01 4.97 4.33 19.99 2.13 5.70 5.98 2.24 3.72
51.48

O 19 5 10 6 17 12 3 8 15 2 3 5 15

e 3.41 1.95 .05 1.08 .83 .10 1.43 3.15 2.09 2.19 1.30 3.78 36.76

O 4.93 4.93 4.68 4.78 4.50 4.78 4.38 4.30 4.80 4.08 4.62 0 0

e .06 .18 .08 .14 .38 .19 1.20 .77 .01 1.16 1.73 .95 1.57

HEALTH BELIEFS AND PRACTICES O e O e O e 4.88 .10 4.65 .06 4.88 3.37 4.98 .16 4.85 .25 3.33 .04 4.90 .11 3.83 9.25 3.95 .01 4.95 .17 3.93 3.78 4.75 .32 4.63 .38 4.73 .16 4.30 .25 4.75 .24 4.13 .34 4.73 .06 4.75 1.62 3.88 .80 3.20 .29 4.25 6.00 4.65 .38 4.08 .59 4.65 8.57 4.73 .04 4.15 2.40 4.65 1.95 4.60 1.19 4.60 2.65 4.50 1.41 4.00 1.08 4.20 1.57 0 .97 0 .90 0 .86 0 1.61 0 1.49 0 1.43
51.89 23.29 47.98 19.72 46.17 13.84

O e 4.15 .24 3.88 2.30 3.93 2.54 4.10 .01 4.23 .40 4.10 .38 4.70 1.94 4.25 .65 4.28 1.85 3.08 .26 3.83 .84 4.05 11.90 0 1.50
48.55 24.81

Total 52.59 38.97 39.29 38.51 57.39 55.49 24.91 62.53 43.61 23.01 24.15 9.05 15.00
484.5

115 58.12

50.78 8.42

X2cv = 199.67

df = 72

X2tab .05 = 112.825

Ho: Rejected Interpretation: Significant

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CHAPTER V SUMMARY, CONCLUSIONS AND RECOMMENDATIONS This study is an evaluation of the respondents health beliefs and practices being a diabetic individual in selected barangays of Bobon, Northern Samar: its implications to health care management. The data revealed that 72.73 percent retrieval rate obtained by the researchers and treatment was made through its arranged statement of the problems made on a one-on-one response scheme. It deduced an inferences and implications included to make the findings more in depth, meaningful and relevant. Questions were posed to know the respondents profile on the basis of the statement of the problem which study tried to find out the problem as intended by the researcher to elicit data from them. Respondents of the study were only forty distributed to the selected barangays of Bobon, Northern Samar. The study is evaluative design to determine the health beliefs and practices of the respondents using the questionnaire as the primary tool in data gathering and treated with simple statistics through frequency counts, mean and chi-square test to determine the significant relationship and differences on the perception of the respondents. Aside from the instrument follow-up interview was also undertaken with the following findings: 1. That out of forty respondents a greater percentage 12 or 30 percent have age ranged 51-60 years old, 10 or 25 percent were 41-50 years old and 61-70 years old, however, the least number were 31-40 years old respectively. From the figures it can be deduced when a person reaches at their middle age they are mostly affected with diabetes mellitus. 2. That gender of the respondents, majority 22 or 55 percent of the respondents are female as compared to the 18 or 45 percent male, likewise majority 33 or 82.5 percent married, 6

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or 15 percent widowed and least 1 or 2.5 percent single. This implies that majority of the respondents are married. 3. That educational Attainment of the respondents majority 19 or 47.5 percent were college graduate, 10 or 25 percent high school graduate and the least 5 or 12.5 percent college level and as well as elementary level. This implies that majority of the respondents obtained a college degree program in their respective field of specialization. 4. That occupation of occupation respondents were arranged from greater percentage and distributed as follows; 17 or 42.5 percent unemployed, 12 or 30 percent government employees, 8 or 20 percent other occupation and only 3 or 7.5 percent privately employed. This implies that majority of the respondents were unemployed. 5. That respondents family monthly income, greater number 15 of 37.5 percentage have earning Ph 7,000 and above and as well as Ph1,000 and below. While the rest earned from Ph3,000 to Ph7,000 of lesser frequency distribution. This implies that only of relative majority earned as high from Ph7,000 and above respectively. This implies that profile of the respondents have significant relationship with regards the health beliefs and practices for diabetics persons in selected barangay of Bobon, Northern Samar. 6. That on the mean distribution of the health beliefs and practices of the respondents how their diet are being managed with the highest mean 4.93 that they eat food to live, grow, to keep health and well, and to get energy for work and play. Food is made up of different nutrients needed for growth and health. With mean 4.80 indentified foods responsive to the amount of nutrients needed in the body as influenced by age, sex, size, activity and state of health. While the least identified as the way food is handled influences the amount of nutrients in food, its safety, appearance and state. Likewise, all the people throughout life have the same need of

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nutrients but in varying amounts. Thus, most nutrients do their work when teamed with others nutrients. This implies that basic and primary to have good food was premised on the way food are handled and prepared and looking into the influences on the amount of nutrients in food, safety, and appearance and state. The hygiene of the respondents shows that out of ten (10) indicators it shows that the highest mean score 4.98 that one of the hygiene techniques was to have brushing the teeth after eating is a must for the individual regardless of age and sex. Likewise, it also consider the way of preparing food, cooking, and dinning availability of utensils that must be thorough washed before and after eating. Henceforth, all foods must also be thoroughly washed before cooking and eating. This implies that inasmuch the three practices is ultimately needed this must be practice appropriately to minimize occurrences of the inadequacy for good health. Thus, from the above health beliefs and practices the least mean score can be deduced to quantify the adequacy and inadequacy of its meaning in terms of practices. Data revealed that waste water should be disposed in covered drainage, and sources of drinking water must be periodically examined for the presence of water-borne microorganisms, thus, hand washing should be done before and after eating, and more significantly all foods must be cooked thorough at least 70 degrees centigrade temperature. This implies that with this health practices and techniques the possibility of attaining good health would most likely to happen to individuals. Health beliefs on the exercise of the respondents three highest mean 4.85 that they strongly agree that exercise burns cholesterol and body fats, that a person should exercise daily by walking exercise is recommended for older individuals, thus, physical exercise should be attuned to the status of diabetic individuals. On the other hand, the least mean identified provide that jogging is an exercise for the young individuals. Hence, it is good to wash or take a bath

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every after exercise each group has its own recommended daily exercise regimen. This implies with the highest mean as well as its lowest mean this mark the positive health practices that individuals should make it to happen in his/her life style. Health beliefs on the disease treatment of the respondents, revealed through its mean computation that three highest score 4.88 interpreted that they strongly agree that every person should be tested for their blood sugar levels more frequently, diabetes can be controlled by proper diet and exercise, and untreated diabetes can be fatal. This implies that when the person ill-with diabetes when not properly treated it would cause fatal effect on his/her life as it could, so the need to meet this expectation is a necessity of the individual. However, the least mean score revealed that diabetes can be detected through the urine examination, diabetes caused by defect of the pancreas, and diabetes is a curable disease. This implies that basically, an individual having diabetes should have frequent blood sugar examination, proper diet and exercise, and when not treated would cause a fatal defect in life and perhaps cause to death. Respondents agreed they always consider ingestion of prescribed medication based on the prescription of the doctor, regular monitoring of blood sugar, and almost always follow doctors recommendation diet and exercise activities. This implies that following this prescribed activities by the individual person having diabetes they will be given more chances of minimizing the occurrence of the disease. With the least means however, diabetes can be determine through regular examination of urine analysis, regular consultation with the doctor, and avoiding too much ingestion of sweet foods and other carbohydrates rich food such as bread, rice, pasta, and etc. This implies that the person itself can do share in the treatment of his own illness of being diabetic considering those suggested items by the physician such as too much

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intake of food having adequate contents of sugar and that of having much carbohydrates. He should likewise take cognizance of the proper exercise to safeguard his own health every day. The chi-square test between the profile and the health beliefs and practices of the respondents, revealed through its mean derived from its computation related to age, gender, civil status, educational attainment of parents, occupation and monthly family income. It showed that the computed chi-square value 199.67 was greater than the tabular 112.825 with 72 degrees of freedom as basis on the treatment which reject the null hypothesis of no significant relationship as well as difference as perceived by the respondents which considerably found to be significantly related to the respondents profile in connection with the variables indicated to the health beliefs and practices of the respondents. This implies that health beliefs and practices were significantly related to the profile of respondents, and this can likewise be inferred that good health habit of the respondents would help them ease out the problem in the occurrence of the disease respectively. CONCLUSIONS In the light of the following findings derived from this study, the following conclusions are hereby introduced, namely: 1. That out of forty respondents a greater percentage have age ranged 51-60 years old, 10 or 25 percent were 41-50 years old and 61-70 years old, however, the least number were 3140 years old respectively. From the figures it can be deduced when a person reaches at their middle age they are mostly affected with diabetes mellitus. 2. That gender of the respondents, majority of the respondents are female as compared to the 18 or 45 percent male, likewise majority are married, widowed and least 1 or 2.5 percent single.

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3. That educational attainment of the respondents majority were college graduate, high school graduate and the least are college level and as well as elementary level. 4. That occupation of occupation respondents were unemployed, government other

occupation and only few privately employed. 5. That respondents family monthly income have earning Ph 7,000 and above and as well as Ph1,000 and below. While the rest earned from Ph3,000 to Ph7,000 of lesser frequency distribution which implies that only of relative majority earned as high from Ph7,000 and above which significantly diabetics persons in selected barangay of Bobon, Northern Samar. 6. That health beliefs and practices of the respondents how their diet are being managed with the highest mean 4.93 that they eat food to live, grow, to keep health and well, and to get energy for work and play. Food is made up of different nutrients needed for growth and health. With mean 4.80 indentified foods responsive to the amount of nutrients needed in the body as influenced by age, sex, size, activity and state of health. While the least identified as the way food is handled influences the amount of nutrients in food, its safety, appearance and state. Likewise, all the people throughout life have the same need of nutrients but in varying amounts. Thus, most nutrients do their work when teamed with others nutrients. The hygiene of the respondents shows that out of ten (10) indicators it shows that the highest mean score 4.98 that one of the hygiene techniques was to have brushing the teeth after eating is a must for the individual regardless of age and sex. Likewise, it also consider the way of preparing food, cooking, and dinning availability of utensils that must be thorough washed before and after eating. Henceforth, all foods must also be thoroughly washed before cooking and eating. Thus, from the above health beliefs and practices the least mean score can be deduced to quantify the adequacy and inadequacy of its meaning in terms of practices. Data

54

revealed that waste water should be disposed in covered drainage, and sources of drinking water must be periodically examined for the presence of water-borne microorganisms, thus, hand washing should be done before and after eating, and more significantly all foods must be cooked thorough at least 70 degrees centigrade temperature. Health beliefs on the exercise of the respondents three highest mean 4.85 that they strongly agree that exercise burns cholesterol and body fats, that a person should exercise daily by walking exercise is recommended for older individuals, thus, physical exercise should be attuned to the status of diabetic individuals. On the other hand, the least mean identified provide that jogging is an exercise for the young individuals. Hence, it is good to wash or take a bath every after exercise each group has its own recommended daily exercise regimen. Health beliefs on the disease treatment of the respondents, revealed through its mean computation that three highest score 4.88 interpreted that they strongly agree that every person should be tested for their blood sugar levels more frequently, diabetes can be controlled by proper diet and exercise, and untreated diabetes can be fatal. However, the least mean score revealed that diabetes can be detected through the urine examination, diabetes caused by defect of the pancreas, and diabetes is a curable disease. Respondents agreed they always consider ingestion of prescribed medication based on the prescription of the doctor, regular monitoring of blood sugar, and almost always follow doctors recommendation diet and exercise activities. The chi-square test between the profile and the health beliefs and practices of the respondents, revealed through its mean derived from its computation related to age, gender, civil status, educational attainment of parents, occupation and monthly family income. It showed that the computed chi-square value 199.67 was greater than the tabular 112.825 with 72 degrees of freedom as basis on the treatment which reject the null hypothesis of no significant relationship

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as well as difference as perceived by the respondents which considerably found to be significantly related to the respondents profile in connection with the variables indicated to the health beliefs and practices of the respondents. RECOMMENDATIONS After a careful evaluation on the merits of the problem and case in point relative to the analysis of the findings, the following recommendation was presented: 1. While the respondents are already within the middle ages of their life, they need to be very prudent in all course of action they should do in day to day life style, and it is recommended that they have to maintain good diet, frequent exercise. 2. It is recommended that frequent visit to physician and medical practitioner for checkup instead of making his/her own medicine prescription. A continuing physical exercise should be made as a habit most especially in the morning but should be given limit according to health condition, and 3. A follow up study be undertaken by nursing undergraduate or post graduate students as a continuing program in the field of nursing for future planning and development.

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Appendix A- Letter to the Municipal Mayor Colegio de San Lorenzo Ruiz de Manila Inc. J.P Rizal St. Catarman Northern Samar College of Nursing February 06, 2012 HON. RENY A. CELESPARA, RN, RM, MAN Municipal Mayor Bobon, Northern Samar Sir, Greetings! The undersigned are graduating students of Colegio de San Lorenzo Ruiz de Manila, Inc. taking up Bachelor of Science in Nursing. We are presently conducting a study entitled HEALTH BELIEFS AND PRACTICES AMONG INDIVIDUALS WITH DIABETES MELLITUS IN SELECTED BRGYS. OF BOBON NORTHER SAMAR in partial fulfillment for our requirements for graduation. In connection with this, we would like to ask permission from your good office to please allow us to conduct the study among diabetic individuals of your municipality. Thank you so much for your favorable consideration. Respectfully yours, Rochel R. Afable Katrina Kristel L. Arraiza Jovito M. Casi o Ronalyn P. Egang Ericka L. Ortega Mary Joy C. Reposo Aljhon Nel G. Siervo Melecia Irene Gold D. Tobes Noted by: JOAN R. NEBRIDA, RN, MAN Thesis Adviser

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APPENDIX B - Letter to the College Dean COLEGIO DE SAN LORENZO RUIZ DE MANILA OF NORTHERN SAMAR J.P. Rizal St., Catarman, N. Samar September __, 2011

MA. SARAH CARPIO-BALITE, RN, MPHEd, MAN Dean, College of Nursing Colegio de San Lorenzo Ruiz de Manila of Northern Samar J.P. Rizal St., Catarman, N. Samar Madam: Greetings! The researchers would like to inform your good office that they are currently conducting a research titled, HEALTH BELIEFS AND PRACTICES AMONG INDIVIDUALS WITH DIABETES MELLITUS IN SELECTED BARANGAYS IN BOBON, NORTHERN SAMAR: ITS IMPLICATIONS TO HEALTH CARE MANAGEMENT. In consonance of this, in order to be allowed by the offfice of the school administrator theresearchers would like to request from you for an approval to conduct the said study Your approval will be of great help for the completion of this study. Thank you and looking forward that this request be granted.

Respectfully, The Researchers

Approved: MA. SARAH CARPIO-BALITE Dean, College of Nursing

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APPENDIX C - LETTER TO THE RESPONDENTS

Dear Respondents: The undersigned Bachelor of Science in Nursing (BSN) students of Colegio de San Lorenzo Ruiz de Manila Inc. in Catarman, Northern Samar are respectfully requesting you to please fill out or answer the attached questionnaire. This is an undergraduate research entitled Health Beliefs and Practices Among Individuals with Diabetes Mellitus in Selected Barangays of Bobon, Northern Samar: Its Implications to Health Care Management. Your answers will be utilized to develop a health care management program for diabetic individuals. Please extend your time and cooperation for the study to be successful. Thank you!

Respectfully yours, AFABLE, ROCHEL ARRAIZA, KATRINA KRISTEL CASIO, JOVITO EGANG, RONALYN ORTEGA, ERICKA REPOSO, MARY JOY SIERVO, ALJHON TOBES, MELECIA IRENE GOLD

Approved: JOAN NEBRIDA, RN Research Adviser JEMMABELLE S. ALMAREZ Instructress