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Health Literacy Survey Batch 2018

Health Literacy of Primary Care Givers of Young Children


Common to all to be interviewed:
Primary Care-Give: one responsible for daily needs of child, including nutrition, hygiene,
administration of medications, visits to doctor, immunization, and general care
Child/children under his/her care between the ages of 1 to 12 years old

Manner of survey : One-on-one interview with translation into vernacular

Demographics:
Primary Care-Giver information:
Age _____ Gender _____ Relationship to child______________________
Occupation __________ Educational Attainment__________________________

Child/Children: State the age and gender of child/children under care


1. ________ 2. __________ 3. __________ 4. __________

Geographic Location: Province/city/municipality_____________________________ Rural__ Urban__

Questions [place a check mark where applicable]


A. Regarding Physician Med Prescriptions
1. What is the degree of difficulty in your understanding the doctors instructions about how to give
medications to the child under your care?
Very difficult ___ Have to ask for clarification/explanation ____ Not difficult at all ____
2. If the medications call for a liquid or syrup, how many teaspoons would you give if 10 milliliters is
prescribed?
1 teaspoon ____ 2 teaspoons ____ 3 teaspoons ____ 4 teaspoons____
3. Do you ask the pharmacist to explain to you about what the medicine is and how to give it?
Yes____ No____
4. What is the degree of difficulty in your understanding the doctors explanation about the side
effects of medications?
Very difficult____ Have to ask for clarification/explanation____ Not difficult at all___
5. If the prescription states that the medicine should be taken for a full week/7 days, do you follow
the full week duration?
Full week, yes____ I stop when the child gets better_____
6. Do you go back to the doctor as instructed?
Yes___ No, because____________________________________________________________
B. Regarding Soft Drinks
7. To your knowledge, is giving the child soft drinks good or bad?
No harm ___ Maybe____ Bad_____

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Health Literacy Survey Batch 2018

8. Do you have soft drinks available for the family?


Yes___ No, because_____________________________________________________
9. To your knowledge, how many tablespoons of sugar does a bottle of soft drink contain?
___ tablespoons No idea____

C. Regarding vegetables
10. To your knowledge, how do vegetables benefit the health of a child?
_________________________________________________________________________
11. Do you give the child vegetables for every meal?
Yes ____ No, because__________________________________________________
12. How do you prepare the vegetables to be given to the child?
Cooked_____ Washed and eaten as salad_____; Water comes from__________
D. Regarding hygienic practice
13. To your knowledge, can a child get sick when walking/running around on bare feet/without
footwear?
Yes, the child can get_____________________________ No______
14. Do you make sure the childs hands are washed before meals?
Yes, because ___________________________________________________________
No, because _______________________________________________________________
E. Regarding Immunization
15. To your knowledge, what is the reason for immunizing the child?
_________________________________________________________________________
16. To your knowledge, what is the vaccine being given by mouth?
_________________________________________________________________________
17. Do you know where to avail of immunization?
Yes, at the _____________________________________________ No____
18. Is the child under your care up to date with his/her immunizations?
Yes, because______________________________________________________________
No, because_______________________________________________________________
19. What is the degree of difficulty in your understanding of the immunization schedule that your
doctor/barangay nurse/midwife has instructed?
Very difficult ___ Have to ask for clarification/explanation ____ Not difficult at all ____

Information gathered by: _____________________________________Date: _________________

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