1

+CHAPTER I

INTRODUCTION

I.1 Background of the Study

“In an ever-changing medical landscape, patient satisfaction has become a focal point

for providers and health-systems. Therefore, preferences regarding physician attire have become

a topic of considerable interest as a means to improve first-impressions and perceptions

regarding quality of care.” (Petrilli, CM., et.al, 2015 )

In the year 1880s, wearing a white coat in medical practice begun when surgeons wore

them as a part of a “new aseptic” technique, non-surgical physicians were dressed in business

suit. Early of the 20th century, most physicians started wearing white coat and it has been

established as the “doctor’s uniform”. For decades now, the white coat ceremony reflected the

hurdles of medicine and a trophy of surviving them. The ceremony first held by Arnold P. Gold

Foundation of Columbia University College of Physicians and Surgeons, in the year 1993. By

the year 1997, majority of medical schools in the US started adapting this rite of passage.

Starting then the wearing of the white coat has been customary to physicians not until in the year

2007. During this year, the British government prohibited the wearing of long sleeved white coat

since it has been found to be a medium in spreading pathogens. (Wagner, P. et.al, 2007)

Fashion and tradition affects the choice of clothing of not only medical professionals but

of every professional as well. A major change to medical workforce and to societal expectations
 2

in the previous years led to change of mindset and perception towards dress and clothes

selection. One major factor that led to this change is the increasing number of female doctors that

enter the medical profession and traditionally, women does not have a well-defined “dress code”.

Another factor is the moving away from medical paternalism rendering a decreasing number of

physicians using the traditional white coat. Basing on the changes that happened in the previous

years, dress and clothing styles of doctors have become less and less formal. In an ever evolving

fashion and trends, the choice of clothing is leaning towards the comfort of the physician and

personal style and choices. (Lill, M., Wilkinson, T.J., 2005)

The goal of any medical intervention is to achieve a desired outcome with the patient.

However, foundation for all patient care is a good patient-physician relationship. Trust is an

important aspect of all human relationships. As a part of the patient-physician relationship, trust

comes from how patients perceive their doctors. Patients are not only more compliant to the

regimens when they perceive their doctor as being competent in both clinical and interpersonal

skills but are also more open to discuss important and sensitive personal information. In

situations where the patient is vulnerable; such as during out-patient consultations, and physical

examinations, it is important to establish trust. More importantly, initial consultation plays an

important role in establishing patient-physician relationship. During this visit, the patient will

develop a first impression of his or her physician.

Development of the patient’s first impression is based on his or her physician’s verbal

and non-verbal communication, as well as personal attributes like clothing, grooming, and

cleanliness. The choice of clothing and style of each medical professional has an important

impact on presentation, credibility and appearance. Researches and related literatures that tackle
 3

these issues have been conducted abroad where culture and tradition differ from that of the

Philippines and the locality.

I.2 Problem Statement

This study aims to find the association between the Physicians’ attire, Perceived

Physician Age and the Level of Trust and Confidence of Patients 18 years old and above in

Secondary-Private Hospitals.

More specifically, it seeks to answer the following questions:

1. What is the demographic profile of inpatients and out-patients in Secondary private

hospitals?

2. What is the association of Physician’s attire and Perceived Physician age to the Level of

Trust and Confidence of the patient?

3. What is the preferred Physician’s attire and Perceived Physician age of the Research

respondents?

I.3 Objectives

A. To identify the demographic profile of the respondents from the Research Locales

B. To evaluate the association of Physician attire to patients Level of Trust and

Confidence

C. To evaluate the association of Perceived Age of Physicians to patients Level of Trust

and Confidence
 4

D. To determine the association of Physician’s attire and Perceived Age of Physicians

patients Level of Trust and Confidence

E. To know the preferred Physician’s attire of patients.

F. To know the preferred Age of Physician of the patients.

I.4 Significance of the Study:

An understanding of when, why and how attire positively influences patient’s perception

is important. Several developed countries, such as Belgium, have conducted a study that states

patient prefers a physician to be in their professional attire. Some of these studies capture the

influence of physician’s attire to the Level of Trust and Confidence of patients without

considering the impact of perceived age, gender and cultural background of physicians in their

choice of clothing.

This study will primarily help physicians in reinforcing first impressions and establish

rapport, trust and confidence of their patients. In addition, the physicians will better understand

the relationship of their attire to the Level of Trust and Confidence of patients.

Secondly, this will also shed in light to patients on what usually influences their

perception towards their physicians. When trust is built, the patient-physician relationship will

lead to return in follow –ups and compliance in recommended medical regimen, the goal of

every medical consultation.

Thirdly, hospitals and health care facilities can improve their rules and policies regarding

physician uniforms in their respective institution. This study will be a basis to better enforce

proper attire or clothing when a physician is on duty especially in hospitals.

 5

Lastly, this research study aims to determine the association of Physician’s attire and

Perceived age to the Level of Trust and Confidence of the patients in the Philippine setting.

I.5 Scope and the limitation of the study

There are several factors that generate patient-physician trust and confidence. This study

aims to associate Physicians’ attire and Perceived Physician Age to the Level of Trust and

Confidence of patients. In addition, this research will identify the patient’s preference when it

comes to their primary physicians’ clothing or “looks” and Perceived age.

There is a vast classification of clothing when dealing with fashion and style, this

research will also be limited to only four typical hospital attires worn by physicians. In this

research, the male and female attires are separated not for comparison but to give the respondents

an idea and a visual representation of the physical difference of the four styles of clothing if

worn by the other sex. Nevertheless, the results will be treated and analyzed as a separate entity.

The four main styles that will be used in this research are Casual, Formal, Scrub suit, and White

coat. Each component of this style are described and elaborated in the operational definition of

terms.

In this research, the target respondents will be in-patients and out-patients of Metro Vigan

Multi-Purpose Cooperative Hospital and Northside Doctors Hospital that are 18 years old and

above.
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CHAPTER II

REVIEW OF RELATED LITERATURE

Clyde, J., (et. al), 2014 in their study entitled Medical professionalism: an experimental

look at physicians’ Facebook profiles concluded that by viewing a physician’s Facebook profile

a patient can accurately make inferences regarding the personality and characteristics of that

physician. Moreover, these inferences affect a patient’s perception of his or her doctor. More

specifically, the Facebook profiles affect the patient’s judgment regarding the doctor’s ability to

address their personal health care needs.

A total of 250 students were asked to participate in the study, the respondents were asked

to evaluate 3 categories of Facebook profile. The categories of the profiles include (1) solely

professional, (2) personal material that was strictly healthy and lastly (3), personal material

including an unhealthy behavior. In this same study, additional conclusions made states that self-

presentation of a physician whether it is face-to face or via Social Networking Services (SNS)

affects patients perception of the physician as an individual medical professional. A personal,

healthy profile may augment a patient’s perception of that physician’s character virtues if the

profile content upholds the decorum of the medical field.

Demographic Profile of Respondents

Several research studies were conducted to analyze the impact of physician’s attire to

patient trust and confidence. In one of these studies, Simon et, al. (2014), through survey

describes the epidemiologic profile of subjects who trusted their physicians more were U. S
 7

Chinese older adults aged 60 and above. Higher trust in physician was significantly correlated

with older age, female gender, lower educational level, being unmarried, having more children,

having lived longer in the United States, having lived longer in the community, China as the

country of origin, living with fewer persons, better overall health status, and those who had better

quality of life. Moreover, the researdh shows that older age was significantly associated with a

higher level of generalized trust, trust toward family members, friends, neighbors, and strangers

and this can be a coping strategy that buffers against the detrimental effect of declines in later

adulthood. Of the same study, trust toward strangers may be generally lower in countries with

greater income inequality.

Another detailed study done by Petrilli, CM., et.al, (2015), using previous researches

associating Physician attire to Level of Trust and Confidence, states that elements such as the age

of the patient, geography and population, and the context of care provided influences the

patient’s perceptions towards the attire of a physician. According to this study, older patients in

European and Asian nations leaned towards a more formal attire compared to those respondents

from USA. The result of the research gave a new perspective regarding the topic associating a

Physician’s attire and confidence of patients. Professional attire is an important modifiable facet

of physician-patient relationship but finding a “one-size-fits-all” physician dress code is

improbable. However, tailored and well-thought approaches to improve the Level of Trust of

patients through the physician’s attire should take into consideration the patient’s preference,

provider and contextual factors.

In the 3-year study of Croker et. al. (2013) with a 2 163 456 ages 18 years old and

above patients in the sample, registered under the care of General Physicians in England for at

least 6 months reported that patients’ confidence and trust in the doctor increased with the
 8

patient's age and was similar for men and women and was reported more frequently by those of

white ethnicity.

In the research conducted by Yamada, Y., et.al, (2010), entitled Patients’

Preferences for Doctors Attire in Japan. The researches administered a 10-point questionnaire. A

5-point Likert scale was used to estimate patient preference for four types of attire in both male

and female physicians, including semi-formal attire, white coat, surgical scrubs, and casual wear.

In addition, a 4-point Likert Scale was used to measure the influence of doctors’ attire on patient

confidence. Of 2,272 outpatients enrolled, 1483 (67.1%) of respondents were women. Mean age

of subject was 53.8 years (SD 16.2 years).

Rehman, S., et.al, (2005), studied the effects of the doctor’s attire to patient trust and

confidence. The research has 400 respondents with a mean age of 52.4 were enrolled. Of this

54% were men, 58% were white, 38% African-American, and 43% had greater than a high

school diploma.

The research entitled Judging a book by its cover: descriptive survey of patients’

preferences for doctors’ appearance and mode of address was done at Christchurch Hospital,

New Zealand conducted by researchers Lill, M., and Wilkinson, T., (2005). The 2-part survey

was administered within two weeks. Outpatients were first given the questionnaires and the

inpatients the second week. The sample population comprised 606 patient; 155 declined or were

unavailable. The researchers recruited 249 outpatients and 202 inpatients, comprising 214 men

and 232 women, the remaining did not identify their sex. A mean age of 55.9 years (SD 19.3

years), six people did not provide their age. In total, 127 people were aged less than 45 (28%),

144 were 45-65 (32%), and 174 were more than 65 (39%).
 9

Physician’s Attire and the Level of Trust and Confidence of Patients

When it comes to attire, Budny et.al, (2006) in his study involving 155 patient surveys

analysed- 68% indicated that they had more confidence in a physician who wore professional

attire, 17% preferred casual dress, and 15% preferred surgical scrubs. White coats inspired

confidence in 42% of all patients while only 2% responded that a white coat did not inspire

confidence in their provider. The study of Rehman, S.,et. al. (2005), showed respondents

answering that they were significantly more willing to share their social, sexual, and

psychological problems with the physician who is professionally dressed. These two initial

studies show that patients can better confide with a physician they perceive as professionally

dressed.

In the study of Chang et. al (2011), a sample population comprised 153 adult outpatients

with the mean age of 43.3 years were asked to assess identical photographs of the same medical

doctor wearing four different kinds of attires—Casual, Suit, Traditional, White Coat. Result

showed that patients preferred a doctor to wear a white coat, regardless of whether they thought

the doctor was a Western or Oriental medical doctor. They answered that the doctor looked

more competent and trustworthy in the white coat, and that they would also choose a doctor in a

white coat for their treatment. The same study was conducted by Chung et. al (2012), results

were consistent reporting highest scores in ‘competency’, ‘trustworthiness’ and ‘preference’

when the doctor was dressed with the white coat, and highest scores in ‘comfortableness’ and

‘contentment with the consultation’ when the doctor was dressed ‘Traditional’.

However in the study of Lill, M and Wilkinson, T., (2005) with a sample population of

202 inpatients and 249 outpatients, mean age 55.9 (SD 19.3) years, they found that patients

prefer doctors to dress in a semiformal style over formal suits and white coats but when
 10

accompanied by a smiling face it is even better which suggest a friendly manner. In line with

previous studies, casual dress styles were less popular. This finding, and the association with age,

suggests the beginnings of a trend away from patients preferring white coats. In general, patients

prefer more conservative items of clothing.

Yamada, Y., et.al, (2010), in his study conducted in Japan with outpatients in St. Luke’s

International Hospital learned that preference for male physicians’ attire was significantly

different between male and female respondents while for female physicians choice of attire did

not significantly vary between respondents of different gender. Relatively young respondents

with mean age of 46.6 years ranked casual attire the highest, surgical scrubs was chosen by

outpatients with mean age of 55.3 years while a mean age 0f 52.5 years preferred physicians

wearing white coats. In the preference of attire for female physicians mean ages of 55.1 years,

52.0 years old, 43.3 years selected surgical scrubs, white coat, and casual wear, respectively. The

researchers concluded that for male primary care physicians, pediatricians, and psychiatrists, the

white coat was most preferred. Respondents who chose white coats as best attire for physicians

said so because of hygiene and confidence of physician associated with wearing the coat.

Respondents who preferred casual dress as the best attire expressed that physicians wearing this

category of attire shows friendliness and approachability. Finally, most patients thought that

physician’s attire had an influence on their confidence in their physician’s ability to provide

trusted, quality care.

In the parallel study of Gherardi, G., et al. (2009) surveyed 586 adult patients at Airedale General

Hospital, West Yorkshire, England in their research study. The respondents were found to be

more confident in doctors wearing white coats across all demographic groups because it serves

as a means by which to identify a doctor, besides an identification badge. Professional informal

 11

attire was the second most popular choice due to patients’ exposure to this dress type in clinical

settings, as well as patients’ perceptions of this attire being smart and professional. While many

found that professional formal attire was too intimidating and that even though it conveyed

authority, some regarded it as being slightly pretentious. Casual attire was found to be least

confidence inspiring as the unkempt appearance of the doctor was believed, by many patients, to

be associated with a lack of ability. Taylor, P., (1987), conducted his study for parents of

children admitted in a pediatric ward, using random sampling method. The results indicated that

parents were twice likely to attribute competence of the physician wearing formal dress

compared with physician wearing their scrub suits and four times more likely compared with

physician wearing an intern uniform.

After studying the attitudes of surgical patients, surgeons, and the non-hospitalized public

(NHP) regarding surgeons’ attire, Major, K. et.al (2005) concluded that a surgeon’s appearance

affects perceptions of the quality of medical care received. In this study, a questionnaire

regarding surgeon attire and professional demeanor was administered to surgeons and

consecutive surgical inpatients. The questionnaire was also placed on the internet at Med Help

International, a non-profit health information service, to survey the attitudes of the non-

hospitalized public. Responses were collected from 38 surgeons, 38 surgical in patients and 343

NHP by way of internet. Their surveys have shown that that both surgical patients and surgeons

agreed that white should be worn while only 42% of the NHP believed that white coats were

appropriate. Surgeons believed that scrub suits were appropriate attire whereas patients and the

NHP had mixed responses with regard to scrub suits. A physician wearing blue jeans while

seeing patients was found to be inappropriate by most surgeons and most patients. Most surgeons

believe that rubber clogs were appropriate whereas most patients and the NHP believed that
 12

rubber clogs were inappropriate. Finally, surgeons, patients, and the NHP all agreed that a

surgeon’s appearance influences their opinion of their medical care.

A study of the impact of physician attire and behavior on perceptions of care was done in

two ICUs in Japan with a total of 223 respondents visiting the ICU, it shows that a majority of

visitors agreed that doctors should wear a white coat and name tag, and address the patient by

last name. Fewer visitors agree that scrubs, short-sleeve shirts, sneakers and clogs are acceptable.

While, majority of visitors disagree that wearing blue jeans or carrying a snack on rounds are

acceptable. Overall, 50% of visitors scored “agree” that physician attire affects their overall

perception of care, and 36% scored “neutral” with just 8% scoring “disagree” (Lofers, A., et al.,

2018). However in the study of Ikusaka, M., et al, (1999) with 599 respondents, result shows that

Japanese outpatients do not feel that a white coat affected their perception of care.

Another Evidence-based study of Physicians’ dressing in Australia participated by 1,680

patients, shows that patient confidence was highest with the “respectable” dress protocol but

confidence levels did not deteriorate significantly with the loss of the white coat or a tie (Nair et

al., 2002).

Physician attire affects the Level of Trust and Confidence of Patient but is affected by

several other factors. Basing on the studies presented in the previous paragraphs, the use of white

coat is still conflicting but most researches suggested that physicians should wear professional,

casual or formal attire when attending to their patients. These clothing of choice impacts the

perception of patients towards their primary physicians. Physicians wearing these type of

clothing were seen to be trustworthy, sociable, competent, friendly and confident by their

patients.
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Perceived Physician Age and Level of Trust and Confidence of Patients

The study of Budny,et.al., (2006), results reflected that respondents preferred physicians

aged 31 to 40 years and 41 to 50 years, and commented that physicians in these groups will have

adequate clinical experience yet still be young enough to be familiar with the latest medical

technology. In the same study, 84% of the total population preferred age of physician was 41-60

years, however less than 10% of the population prefers physicians with age< 30 years.

This reasonable comment however, have been proved otherwise by several studies, that

young physicians have better knowledge about latest medical guidelines, in the study of Tsugawa,

Y., et.al (2017), young physicians have lower patient mortality rate, with knowledge of newest

medical guidelines compared to older physicians.The overall 30 day mortality rate in a final

sample of 736 537 hospital admissions in US acute care hospitals was 11.1%. After adjustment

for patient and physician characteristics and hospital fixed effects, older physicians had

significantly higher patient mortality than younger physicians. These associations were found

among physicians with low and medium volumes of patients but not among those with high

volumes. These findings suggest that differences in practice patterns or process measures of

quality between physicians with varying years of experience might have a meaningful impact on

patient outcomes.

After studying the factors associated with patient's choice of physician in the Korean

population, Kim et.al. (2018) came to the conclusion that the physician's age and medical school

were significant influencing factors for patient's choice of physician at the first visit with the

majority preferring younger physicians. However, a study conducted by Mason, L and Mason, J,
 14

2017 negated the results found by Kim et.al. (2018) , the studies showed that the age, gender and

race of the physician were not significantly associated with patient's trust.

A study taken in Boston, Chicago, and Los Angeles with a sample of 186 physicians

afforded the opportunity to test the effect of physicians' personal characteristics (age, gender, and

ethnic group) on patient adherence in a sample with an adequate number of physicians of each

gender, of White and number of physicians of each gender, of White and of non-White ethnic

status, and with good distribution across the age range of 31 to 55. Result found no significant

effects of these personal characteristics on patient adherence despite adequate power to detect

such differences (DiMatteo, R., et. al., 1993).

No researches were found to directly relate Physicians’ Perceived Age and the Level of

Trust and Confidence of Patients. Most of the researches found only suggest that the Age of the

Physician does not necessarily correlate with the Level of Trust and Confidence given by their

Patients. In one study Tsugawa, Y., et. al., 2017, presented above, categorized the age of the

physician as younger and older-physician. The result of this study is in conflict to majority of the

studies that were reviewed and analyzed.

Physician’s Attire, Perceived Age and Level of Trust and Confidence

In Belgium, Hartmans, C., et.al (2014) stated that patients trusted a female doctor and an

older male doctor most when wearing professional clothing—that is with white coat on. The

patients, on the other hand, preferred the young and middle aged General Physicians to wear

semiformal attire. Semiformal attire was defined as a shirt with possibly a sporty jacket, pants

and shoes for men, and for women, a skirt with tights or possibly a smart pants and shoes with a
 15

small heel. This led the researchers to a conclusion, that the physician’s age is also a variable

when dealing with patient’s preference of clothing for male physicians. However, patients were

most at ease with a female doctor wearing leisure outfit, regardless of age.

In Japan, on the other hand, Kurihara, H. et.al, 2014, Asia Pacific Family Medicine,,

13:2, the researchers evaluated the importance of Physicians’ attire and the factors influencing

the impression it makes on patients. In this study, the researchers surveyed 530 patients or their

carers who visited pharmacies in different regions of Japan. Using a questionnaire showing four

subsets of attire for male and female doctors separately, they found out white coats were the

most appropriate style of clothing, followed by scrubs, for both male and female. Patients also

perceived scrubs as almost appropriate as white coats, but the inappropriateness of the scrubs

differed according to the age of the physician and the regions where the questionnaires were

administered. Elderly respondents however, regarded scrubs as less appropriate.

In a cross-sectional study of the importance of physicians’ attire in inspiring confidence

in patients conducted at five pharmacies in three regions in Japan with a total of 1411

participants, white coat style ranked as the best for doctors of both genders. Elderly people aged

50 and above considered scrubs less appropriate for both male and female doctors compared with

the younger group. Regardless of physician gender, scrubs were rated significantly more highly

by female participants, whereas male participants ranked the smart casual style more highly for

female doctors (Kurihara, H., et al., 2014). Basing from the same study, participants rated a

doctor’s speech, reputation and attire as quite important in inspiring confidence and trust but age,

title and gender less so. However, each factor may make an important contribution to a patient’s

judgment of his or her doctor.

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CONCEPTUAL FRAMEWORK

Presented below is a conceptual framework of Patient-Physician Trust and Confidence

Map. This conceptual framework is an adaptation from Wagner, P., et.al (2007). This map, a

secondary themed map captures medicine as a unique profession, the congruence between

personal characteristics, outward appearance and behavior and the importance of peer

relationship. The diagram shows the triad of patient-physician relationship. Three cornerstones

are presented here namely: (1) Knowledge, and Technical Skill (2) Character virtues (3)

Relationship of patients with the physician. Focusing on the second cornerstone, Character

Virtue, is affected by personal congruence, and dress. Although not shown in the diagram, there

are other parameters also that comprise the two remaining cornerstone which are not central in

this research.

Figure 2.1 Conceptual Framework of Patient-Physician Trust and Confidence

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DEFINITION OF TERMS:

a. Research respondent – inpatients and outpatients ≥18 years old of Metro Vigan Multi-

purpose Cooperative Hospital (MVMCH) and Northside Doctors Hospital (NDH)

b. Perceived Physician Age- divided into two age groups: (1) 25-45 years old and (2) 46-

65 years old. This pertains to how young or old the physician is basing on his/her looks.

25-45 years old belongs to a “younger” looking physician and 46-65 years old pertains to

an “older” looking physician.

c. Casual:

i) Female: Denim Pants/Corduroy with sleeveless or short sleeved shirt with tennis

shoes, flats or low-heeled footwear and does not fall under the criteria of formal attire

ii) Male: Jeans with an upper of collared, short sleeved shirt, polo shirt and tennis shoes

with black or white socks and does not fall under the criteria of formal attire

d. Scrub suit – a pair of scrub suit of any color with rubber shoes as footwear

e. Formal:

i. Female: Buttoned down blouse, suit pants/slacks, jumpsuit or dress with high-

heeled footwear

ii. Male: Buttoned-down short or long sleeves polo, pant suit or slacks with black

leather shoes and white or black socks

f. White coat- an inner of casual attire with an overlay of long sleeved white coat

g. Patient Level of Trust and Confidence- determined by the set of questions adapted

from the study of Rehman, S., et.al, (2005) and Petrilli, CM., et.al, (2015). The

parameters of Trust and Confidence included are:

 18

• patient’s likelihood of return for follow-up

• following physicians’ advice

• confidence in making a diagnosis and treatment

• patients’ perception of the physicians’ knowledge and competence

• patients’ perception of the physicians’ ability to provide care and

compassion

• patients preferring the physician for a/an:

o routine physical examination

o emergency

o discussion about social life,

psychological and mental problems

 19

CHAPTER III

METHODOLOGY

Research Design

A cross-sectional study will be used, where the researcher will measure the

outcome in the population and study their association. This is an observational study design

(Maninder, S., 2016). Self-completion questionnaire will be distributed and written and verbal

consent will be obtained prior to the distribution. Patients will be interviewed afterwards with

regard to their answers. This will be helpful in assessing the importance of specific attire (white

coat, scrubs, casual attire, and formal attire) and the Perceived Age to the Level Trust and

Confidence of the patients to their physician and to evaluate the preferred physicians attire and

perceived age that influences the Level of Trust and Confidence of patients. No follow –up will

be done to the respondent after completion of the questionnaire and the post-survey interview,

thus the response of each patient is only taken by a single point in time.

Research Locale

Metro Vigan Multi-purpose Cooperative Hospital (MVMCH) is a secondary private

hospital located in Bantay, Ilocos Sur. MVMCH is easily accessible to public transportation and

is 200-hundred away from the national highway. On the other hand, Northside Doctors Hospital

(NDH), also a secondary private hospital is 2.6 kilometers away from Metro Vigan Multi-

purpose Cooperative Hospital. The research locales were chosen due to its accessibility, and the

number of patients that comes for admission and consultation. In addition, teaching physicians in
 20

the University of Northern Philippines also conduct consultations in the said hospitals making

the quota for respondents easily attainable with the help of tutors from the university.

Basing on the data provided by Northside Doctors Hospital and Metro Vigan Multi-

purpose Cooperative Hospital, a total of 250-300 patients aging 18 years and above, visits the

hospitals per week as out-patients. However, these numerical data excludes the number of

patients consulting on Sundays. NDH has a total bed capacity of 100 while MVMCH has an 80-

hospital bed capacity only.

Figure 3.1 Map of the research locale

Samples and Sampling Technique

Philippine Statistics Update on August 1, 2015 showed that a total of 35731 inhabit

Bantay, Ilocos Sur. According to the same survey, ages 18 years old and above comprises 65.1%
 21

of the total population. With this data on hand, it only goes to show that out of 35731 a total of

23261 is between ages 18 and above. Using an online calculator from

https://www.checkmarket.com/sample-size-calculator/, the researchers then calculated for the

representative size inputting the following data: Margin of Error equivalent to 5%, Confidence

Level of 95%, and Population size of 23261. Presented below are the results from the online

calculator showing a total sample size of 378.

Table 3.1 Number of Respondents

Sample Size

Population size: 23,261 Total population of 18 years old and above in Bantay,

Ilocos Sur

Margin of error: 5% This is the plus-or-minus figure. For example, if you

use a margin of error of 4% and 47% of your sample

picks an answer, you can be “sure” that if you had

asked the question to the entire population, between

43% (47-4) and 51% (47+4) would have picked that

answer.

Confidence level: 95% This tells you how sure you can be of the margin of

error. It is expressed as a percentage and represents how

often the true percentage of the population who would

 22

pick an answer lies within the margin of error.

Required sample: 378 Number of respondents needed to adequately represent

the population.

Table 3.2 will show the total respondents the researchers need to invite if only 80% of the

population can complete and answer the questionnaire. By doing this, the researchers will still be

able to attain the total 378 needed respondents despite foreseen setbacks such as incomplete

questionnaire. Therefore, a total of 473 respondents are needed to answer the questionnaire.

Table 3.2 Number of Respondents to invite

Estimated response rate: 80% What percent of those asked to participate in the survey

will do so. Response rates vary greatly depending on

many factors including the distribution method, type of

communication, quality of the invitation, use of

incentives, etc.

Number to invite: 473 This is the number of individuals out of the population

you need to ask to participate, in order to achieve the

required sample size based on the expected response

rate.

Quota sampling will be used in this research. To determine the correct proportion for the

respondents, the researchers first have to determine the average weekly admission and outpatient
 23

visits for both Metro Vigan Multi-purpose Cooperative Hospital and Northside Doctors Hospital.

The statistician will then help the researchers to determine a proportional number of respondents

from outpatient and inpatient from the two research locales. The respondents should meet a

certain criteria first. Initially, the patient should be 18 years old and then categorized whether the

respondent is inpatient or outpatient. Any patient that fulfills the criteria, and the categorization,

the patient will qualify as a respondent for the research until the researchers reach the quota for

both inpatient and outpatient from the hospitals. Fifty-percent of the respondents will be taken

from Metro Vigan Multi-purpose Cooperative Hospital and the remaining half from Northside

Doctors Hospital. According to the October, 2018 census of NDH, they have a total of 385 and

1143 adult in-patient and out-patient, respectively (Ratio of 1:3). MVMCH on the other hand,

has 1022 out-patients and in-patient of 411 for the month of October, 2018 (Ratio of 1:2.5).

Using the in-patient to outpatient ratio, the values found in Table 3.3 are calculated.

Table 3.3 Number of Respondents by Hospital Affiliation and Status

Hospital affiliation

Status In-patient Out-patient Total

Metro Vigan Multi- 69 171 240

purpose Cooperative

Northside Doctors 60 180 240

Hospital

Total 129 251 480

 24

Instrumentation

In this study, the researchers adapted two instruments from the researches of Rehman, S.,

et.al, (2005) and Petrilli, CM., et.al, (2015) with modification. The first section of the

questionnaire contains a brief cover letter and questions pertaining to the demographic data of

the respondent. A fill-up form is used to ask the respondent of his/her name, age, address, and

sex. Questions 1, 2 and 3, requires the patient to put and X mark in the box before their answer to

the corresponding question.

The second part of the research instruments shows four images of both female and male

physician lined up next to each other in a single page. The series of questions were replicated

from Rehman, S., et.al, (2005). The questions pertain to the Level of Trust and Confidence of

patients and are parameters of it. The images shown should be ranked from 1st to 4th in reference

to the question found in the adjacent column. Rank 1 is given to the image that represents the

primary choice of the respondent, 4 being the least among the respondents option. Separate

tables are allotted for female and male physician’s attire.

Below is a table showing the value in points of each rank for this section.

Table 3.4 Weighted Rank Table of Values

RANK WEIGHT (points)

1ST 4
2ND 3
3RD 2
4TH 1
 25

The third section of the questionnaire will assess the Level of Trust and Confidence of

the patient basing on Perceived Physician Age and Physician attire. This section is modified

from the study of Petrilli, CM., et.al, (2015). There is a separate page for female and male

physician attire, and Perceived age. In this section, the response to the questions is through a

numerical scale seen on Table 3.5.

Each question is a parameter of Level of Trust and Confidence of patients. For each

image depicted, the respondents are asked to scale and rate how likely they are to trust a

physician wearing the attire shown. The questions that will serve as parameters are: (1)How

knowledgeable does this doctor look? (2) How comfortable does this doctor make you feel? (3)

How caring does this doctor appear? (4) How likely are you to follow this doctor’s advice?

(5)How approachable does this doctor appear? (6) How confident are you of this doctor’s

treatment? In the last row of this section, an open ended question is asking the respondent to

provide their personal comment regarding the physician seen wearing the particular style or

manner of dressing.

The norm that will be used to determine the Level of Trust and Confidence of patients are

as follows:

Table 3.5 Norm Determination of Level of Trust and Confidence

Scale Descriptive Rating per Item Range of Values Overall Descriptive Rating

5 Extremely 4.21-5.00 Very High

4 Very 3.41-4.20 High

3 Moderately 2.61-3.40 Average

2 Slightly 1.81-2.60 Low

1 Not at all 1.00-1.80 Very Low

 26

Data Gathering Procedure

Initially, researchers will be developing their paper and the research questionnaire so as to

serve its intended respondents. The questionnaire will be formulated using suitable questions

adapted and modified from related research. The researchers will seek permission from the

Hospital Directors to administer the questionnaires in the research locales. In addition, a patient’s

informed consent will be attached in the questionnaire upon administration.

Researchers will be divided into two groups and will be distributing the questionnaires to

a total of 480 respondents. Each patient should first pass the inclusion criteria aforementioned in

this research. First, respondent must be at least 18 years old and above and finally, the

respondent should be either an in-patient or out-patient at the time being, of the research locale.

If a patient passes the inclusion criteria, the now research respondent will be asked to sign an

informed consent prior to participating in the study. Instructions will be given before

administering the questionnaires and are reinforced by written instructions in the material. The

respondents will be given time to respond to the survey tool and will be timed from the start of

filling up of the questionnaire up to the time it will be returned to the researchers. To reinforce

and countercheck the responses, the researches will observe the respondent while answering and

will also conduct a systematized post-survey interview.

After collecting all data required, the researchers with the aid of the statistician, will

tabulate, tally, analyze and interpret the responses. The tables that will be used in tallying the

data are adapted and modified, in accordance to the purpose of the study from the research by

Jennings JD., et.al, 2016. Along with primary data, the researchers also will make use of

secondary resources in the form of published articles and literatures to support the survey results.
 27

Methodological Issues and Ethical Considerations Identified

As it is for every study, this research is expected to have limitation. Listed below are

foreseen issues by the researchers and the accompanying plan to resolve it.

First, to resolve issues of privacy and confidentiality, the respondents, participants

modelling for the research, and the research locales were given informed consent that bears the

purpose of the research, the assurance of confidentiality, and that no reward or compensation will

be given.

Secondly, the research locale are hospitals where most tutors from the University of

Northern Philippines are on duty, to eliminate a change of course of action or the manner of

dressing of the physician, tutors from the university will not be informed about the research or

when will it be conducted.

Third, for reasons of confidentiality and bias, serving dual purpose, the faces of models

for this research study is blurred out to protect from unnecessary breach of confidentiality and

because the models belong to a single age group—pixelating faces will eliminate bias of

choosing the age group.

Statistical Treatment of Data

The following statistical tools will be used to treat and interpret the data gathered,

1. Frequency and percentage to describe the respondents in terms of demographic profile

and online sample size calculator.

2. Garrett’s Table of Values for Ranking

 28

3. Mean to determine the Level of Trust and Confidence in relation to Physician Attire and

Perceived Physician Age

4. Measures of association, to be determined by the statistician, to know the association of

the individual Physician Attire to the Level of Trust and Confidence of patients, and the

association of Perceived Age to Trust and Confidence.

Research Framework

Input Process Output

• Identification and • Approval from • Demographic profile of

Courtesy Ethical Review out-patient and in-
visitation to Board patient respondents.
research locale • Securing a consent • Preferences of the
• Construction of from the research respondent in terms of
questionnaire locale and from the Physician attire and
• Quota sampling respondents Perceived Age
• Administration of • Association of
• Identification of questionnaire and Physician Attire to
respondents: observation Level of Trust and
• (1) in-patient • Post-survey Confidence
and out-patient interview • Association of
from research • Collating data Perceived Age to Level
locale • Measures of of Trust and Confidence
• (2) demographic association • Association of
profile: age ≥18 • Data analysis Physician Attire and
y.o, gender • Data interpretation Perceived Age to the
Level of Trust and
Confidence

Figure 3.2 Research Framework

 29

DUMMY TABLES

Table 3.6 Demographic Profile

MVMCH NDH
Variable Inpatients Out-patients Inpatients Out-patients TOTAL
F % F % F % F %
Age
18 to 34
35 to 54
55 or older
Total
Sex
Male
Females
Total
Education
Elementary Undergraduate
Elementary Graduate
HS Undergraduate
High School Graduate
Vocational Course
College Undergraduate
College Graduate
Post- graduate
Total
Physician of Choice
Yes
No
Total
 30

Table 3.7 Garrett’s Table of Ranks

Particulars Calculated Weight (No. of Respondents x Weight) Total Mean Over all Rank

1st 2nd 3rd 4th

Follow
Casual
Formal
Scrub suit
White coat
Confidence
Casual
Formal
Scrub suit
White coat
Return
Casual
Formal
Scrub suit
White coat
P.E
Casual
Formal
Scrub suit
White coat
 31

Emergency
Casual
Formal
Scrub suit
White coat
Discuss
Casual
Formal
Scrub suit
White coat
 32

Table 3.7 Level of Trust and Confidence, Physician Attire, and Perceived Age

Knowledge Comfort Caring Follow Approachable Confidence Over-all Pertinent

Results and
(Level of Comments
Trust and
Variables Specifications Confidence)

̅
× DR ̅
× DR ̅
× DR ̅
× DR ̅
× DR ̅
× DR ̅
× DR

Age 25-45

Age 46-65

Female Casual

Female Formal

Female Scrub suit

Female White coat

Male Casual

Male Formal

Male Scrub suit

Male White coat

 33

APPENDICES
 34

Appendix “A”
Letter of Permission for Northside Doctors Hospital

Republic of the Philippines

University of the Northern Philippines
COLLEGE OF MEDICINE
Vigan City, Ilocos Sur, Philippines

November 13, 2018

Dr. Rosita P. Rialubin

Medical Director
Northside Doctors Hospital

Greetings!
We, the undersigned, are third year medical students of the University of Northern Philippines
College of Medicine, having a research proposal entitled “The association of Physician’s Attire and
Perceived Age to the Level of Trust and Confidence of Patients ≥18 years old in Secondary-private
Hospitals in Bantay, Ilocos Sur” in partial fulfillment of the requirements for the degree, Doctor of
Medicine.

In this regard, we would like to request from your good office to allow us to conduct this study in
your hospital and the patients. We would also want to ask your permission to take the daily, weekly, and
monthly census of the hospitals’ out-patient department and admissions. Further, we are requesting your
help in informing all doctors and faculties that we will be conducting this research.

We ensure that all information obtained will be confidentially maintained.

Your support to our research is highly appreciated. Thank you very much.

Respectfully yours,

Sheinna Laica Barcelona Philip Omar dela Cruz Cherry Faith Labtang

Jouris Simbolon Santhosh Kumar Lakshmanan

Noted:

Glenda Rabino, MD, DPOGS Pablo R. Quedado, MD

Group Adviser Dean, College of Medicine
 35

Appendix “B”
Letter of Permission for Metro Vigan Multi-Purpose Cooperative Hospital

Republic of the Philippines

University of the Northern Philippines
COLLEGE OF MEDICINE
Vigan City, Ilocos Sur, Philippines

November 13, 2018

Dr. Digna R. Ragasa

Medical Director
Metro Vigan Multi-Purpose Cooperative Hospital

Greetings!
We, the undersigned, are third year medical students of the University of Northern Philippines
College of Medicine, having a research proposal entitled “The association of Physician’s Attire and
Perceived Age to the Level of Trust and Confidence of Patients ≥18 years old in Secondary-private
Hospitals in Bantay, Ilocos Sur” in partial fulfillment of the requirements for the degree, Doctor of
Medicine.

In this regard, we would like to request from your good office to allow us to conduct this study in
your hospital and the patients. We would also want to ask your permission to take the daily, weekly, and
monthly census of the hospitals’ out-patient department and admissions. Further, we are requesting your
help in informing all doctors and faculties that we will be conducting this research.

We ensure that all information obtained will be confidentially maintained.

Your support to our research is highly appreciated. Thank you very much.

Respectfully yours,

Sheinna Laica Barcelona Philip Omar dela Cruz Cherry Faith Labtang

Jouris Simbolon Santhosh Kumar Lakshmanan

Noted:

Glenda Rabino, MD, DPOGS Pablo R. Quedado, MD

Group Adviser Dean, College of Medicine
 36

Appendix “C”
Letter of Consent for Models

Republic of the Philippines

University of the Northern
Philippines
COLLEGE OF MEDICINE
Vigan City, Ilocos Sur, Philippines

November 11, 2018

To whom it may concern:

I, ______________________________________, willingly give my permission to the

researchers of the study, The association of Physician’s Attire and Perceived Age to the Level
of Trust and Confidence of Patients ≥18 years old in Secondary-private Hospitals in
Bantay, Ilocos Sur, to take and print photos of myself wearing four different Physician Attires. I
expect the researchers to use my photos solely for the purpose of this research.

It is to my knowledge and understanding that the photos printed will blur out my face, and
that my posing for these pictures will be kept confidential by the researchers. Moreover, I will
willingly help the researchers without expectation of a reward or compensation. Most especially,
the researchers are obliged to keep my identity and whereabouts private and concealed.

Thank you and God bless!

Respectfully yours,

_______________________________
(Signature of Model)

Agreed by:

Sheinna Laica Barcelona Philip Omar dela Cruz Cherry Faith Labtang

Jouris Simbolon Santhosh Kumar Lakshmanan

 37

Appendix “D”
Letter of Consent for Respondent

Republic of the Philippines

University of the Northern
Philippines
COLLEGE OF MEDICINE
Vigan City, Ilocos Sur, Philippines

November 11, 2018

To whom it may concern:

I, _____________________________________, an in-patient/out-patient willingly and

voluntarily give my permission to become a respondent of the research study entitled, The
association of Physician’s Attire and Perceived Age to the Level of Trust and Confidence of
Patients ≥18 years old in Secondary-private Hospitals in Bantay, Ilocos Sur. I am also well-
informed of the fact that the researchers will be observing me as I answer the questionnaire. In
addition, I will be subjected to a post-survey interview to confirm my understanding and
responses for each item of the questionnaire.

Moreover, I will willingly help the researchers without expectation of a reward or

compensation

It is to my knowledge and understanding that my identity and responses will be kept

confidential by the researchers. I expect the researchers to uphold my right to privacy. I give my
full consent to the researchers to share my personal information ONLY for the purposes of this
study and that this information will not be disclosed in any other way without my permission..

Thank you and God Bless!

Respectfully yours,

____________________________________
(Signature of Respondent)
 38

Appendix “E”
Questionnaire in English
University of the Northern Philippines
COLLEGE OF MEDICINE
Vigan City, Ilocos Sur, Philippines

Thank you for taking the time to complete this questionnaire. Your answers will help us
understand better whether physician attire and perceived age affects the patient’s trust and
confidence with their doctors.
Your responses and opinions are important to us. There are no right or wrong answers
and we are very much interested in your honest responses. This questionnaire should only take a
few minutes.
All of your answers will be kept confidential. Your responses will also not be shared with any
of your doctors and hospital staffs.
Carefully read the instructions and questions found below. PUT AN X ON THE BOX
BEFORE YOUR CHOICE

NAME (OPTIONAL): AGE:

ADDRESS: SEX:

1. What is your highest educational attainment?

Elementary Undergraduate Elementary Graduate

HS Undergraduate High School Graduate

Vocational Course College Undergraduate

College Graduate Post- graduate

2. Is your present physician, your physician of choice? YES NO

3. I am currently an: In-patient Out-patient

INSTRUCTIONS: Carefully look at the images to below and the questions on the first
column, RANK (1ST, 2ND, 3RD, 4TH) these female physicians attire from 1 as your first option
to 4, your last option. DO NOT LEAVE ANY BOXES BLANK.
 39
Carefully look at the images to
the left and the questions on this
column, RANK (1st, 2nd, 3rd,
4th) these female physicians
attire from 1 as your first
option to 4, your last option.
DO NOT LEAVE ANY
BOXES BLANK.

WHICH OF THESE DOCTORS

Would you be more likely to
follow their advice?
Would you have the most
confidence in their diagnosis
and treatment?
Would you return for follow-up
care?
Would you prefer for a routine
physical examination?
Would you prefer for an
emergency (e.g, heart attack)?
Would you prefer to discuss
intimate social and
psychological problems?

Carefully look at the images to

the left and the questions on this
column, RANK (1st, 2nd, 3rd,
4th) these male physicians attire
from 1 as your first option to
4, your last option. DO NOT
LEAVE ANY BOXES
BLANK.

WHICH OF THESE DOCTORS

Would you be more likely to
follow their advice?
Would you have the most
confidence in their diagnosis
and treatment?
Would you return for follow-up
care?
Would you prefer for a routine
physical examination?
Would you prefer for an
emergency (e.g, heart attack)?
Would you prefer to discuss
intimate social and
psychological problems?
 40

INSTRUCTION: The proceeding items will assess your Trust and Confidence to your doctors using
their Attire and your Perception of your doctor’s age. Please, RATE AND ENCIRCLE THE
NUMBER that best represents your choice referring to the scale below. The last question on this table
requires you to give a comment. PLEASE FILL ALL THE ITEMS, do not leave items blank.

5- Extremely
4- Very
3- Moderately
2- Slightly
1- Not at all

25-45 years old 46-65 years old

(YOUNGER DOCTOR) (OLDER DOCTOR)

How knowledgeable does this 1 2 3 4 5 1 2 3 4 5

doctor seem to you?

How comfortable
does this doctor make you feel? 1 2 3 4 5 1 2 3 4 5

How caring does this doctor 1 2 3 4 5 1 2 3 4 5

appear?

How likely are you to follow this 1 2 3 4 5 1 2 3 4 5

doctor’s advice?

How approachable does this 1 2 3 4 5 1 2 3 4 5

doctor appear?

How confident are you of this 1 2 3 4 5 1 2 3 4 5

doctor’s treatment?

Give a comment on why you

prefer or least prefer a doctor
under this age group.
 41

5- Extremely
4- Very
3- Moderately
2- Slightly
1- Not at all

How
knowledgeable 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
does this doctor
look?
How comfortable
does this doctor 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
make you feel?
How caring does
this doctor appear? 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

How likely are you

to follow this 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
doctor’s advice?
How
approachable 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
does this doctor
appear?
How confident are
you of this 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
doctor’s treatment?
Give your
comment about
this doctor’s look.
 42

5- Extremely
4- Very
3- Moderately
2- Slightly
1- Not at all

How
knowledgeable 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
does this doctor
look?
How comfortable
does this doctor 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
make you feel?
How caring does
this doctor appear? 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

How likely are you

to follow this 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
doctor’s advice?
How
approachable 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
does this doctor
appear?
How confident are
you of this 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
doctor’s treatment?
Give your
comment about
this doctor’s look.
 43

Appendix “F”
Systematized Approach to Patient

Good day, Ma’am/Sir! We are Third-year Medical Students from the University of Northern
Philippines. We are here today, to ask permission from you to become our respondent for our research
study entitled The association of Physician’s Attire and Perceived Age to the Level of Trust and
Confidence of Patients ≥18 years old in Secondary-private Hospitals in Bantay, Ilocos Sur. The
purpose of this study is determine if the Level of Trust and Confidence you have for your Physician is
affected by the clothing he/she wears and his/her Age. This will greatly help us in completing our
course.

We have already asked permission from the hospital director to conduct our research here in the
hospital. And if you agree to taking the survey, we will give you a questionnaire and a written consent
for you to sign. While you answer the questionnaire, we will also observe you and after you pass your
filled-out questionnaire we will conduct just a short interview to know if you understood what each item
is asking and to confirm your answers in each item. This will only take just a while. We assure you that
your identity will be kept confidential.

Will that be okay, with you Ma’am/Sir?

(Either yes or no) Thank you and God bless!

(If yes…) So to fill out the questionnaire, please write down first your identification information.
The first two pages of the questionnaire, will ask you to put an X in the box before your answer. Items 3
and 4, asks you to state your reason for your answer, as much as possible, do not leave it blank.

The 3rd up to the last page of the questionnaire tells you to encircle a number that represents what
you think about the doctor in reference to the doctor. For example, I ask you “How handsome is this
doctor?” If you think the doctor is extremely handsome you encircle five, if you think he’s not
handsome at all encircle one. The description of each number from one to five is in the questionnaire.
Do you have any clarification before you start?
 44

Appendix “G”
Post-Survey Interview

Thank you Ma’am/Sir for responding to our questionnaire. Give us atleast 5-10minutes to go over
your responses to the questionnaire. For confirmation purposes, you are (name of respondent),(age)
years old, from (address) and (educational attainment, confirm and note last grade/year level
accomplished) . Note responses, facial expression, and gestures by patient all through out interview.

Ma’am/Sir, let us review your answers to the 2nd section of the questionnaire. This section asked
you to ranked the physician attire basing on the questions. For the question, who would you more likely
to follow advise, you rank the images as (rank 1 attire, pointing on the image at the same time) as 1, rank
2 is (rank 2 attire, pointing on the image at the same time), your 3rd is as (rank 3 attire, pointing on the
image at the same time) and you rated this as (rank 4 attire, pointing on the image at the same time) the
physician whose advice you’ll least likely to follow. Will you tell as if you have specific reasons why
you ranked this attire in this order? Wait for answers or reasons. Observe non-verbal cues.

This section asked you to ranked the physician attire basing on the questions. For the question,
Would you have the most confidence in their diagnosis and treatment? , you rank the images as (rank 4 attire,
pointing on the image at the same time) as 4, rank 3 is (rank 3 attire, pointing on the image at the same
time), your 2nd is as (rank 2 attire, pointing on the image at the same time) and you rated this as (rank 1
attire, pointing on the image at the same time) the physician whose advice you have the most confidence
in. Again, will you tell as if you have specific reasons why you ranked this attire in this order? Wait for
answers or reasons. Observe non-verbal cues. Do the same for the next four questions under Section two
for both male and female physician attire.

We are now on the last part of the questionnaire. Kindly, bear with us as we review the answers you
gave. Is that alright? Are you okay? Thank you. Let us go first with the young and old doctors. For you,
a younger doctor is (numerical rating and description) knowledgeable and the older doctor is (numerical
rating and description). Do you mean to say that an (age group with a higher rating) is more
knowledgeable than (age group with lower rating)?Note response and write-down reason or comment
given, if there are any.

You also noted that you are more comfortable with a (age group with a higher rating) because you
rate it as (numerical rating and description) than (numerical rating and description) of the (age group
with lower rating). Is that right?

In your opinion, a (age group with a higher rating) appear to be more caring with a rating of
(numerical rating and description) than the (age group with lower rating). Note response and write-down
reason or comment given, if there are any.You are also more likely to follow the advice of the (age
group with a higher rating) than that of (age group with lower rating), am I right? Note response and
write-down reason or comment given, if there are any.You rated a younger doctor’s approachability as
(numerical rating and description) and an older doctor as (numerical rating and description), right? So,
for you a (age group with a higher rating) is more approachable, correct? Last question for age, your
confidence of a younger doctor’s treatment is (numerical rating and description) and older doctors as
(numerical rating and description), meaning to say you are more confident of a (age group with a higher
 45

rating) treatment, am I correct? Can you give comment on the younger /older doctors? If respondent
finds this hard to answer, use keywords and leading words e.g knowledgeable, friendly, approachable,
and caring.

Note: Use the interview structure for attire, reiterate to respondent what he/she rated highest, which
attires were rated the same, and attire rated least. Encourage patient to give comments on each attire.

We took so much of your time, Ma’am/Sir. We are sorry but thank you very much, for allowing us
to ask you questions. This will be a great help to us. We hope and pray and you will be out of the
hospital soon enough. Thank you again. God bless.

Legend:
Red and italized – for the interviewers only
(underlined) – answers given by patient in the questionnaire
 46

Appendix “H”
CONTENT VALIDATION FORM

Republic of the Philippines

University of the Northern Philippines
COLLEGE OF MEDICINE
Vigan City, Ilocos Sur, Philippines
Direction:

Using the criteria below, please assess the attached questionnaire on the “The association of
Physician’s Attire and Perceived Age to the Level of Trust and Confidence of Patients ≥18
years old in Secondary private Hospitals in Bantay, Ilocos Sur” by putting a check mark (✔)
on the appropriate column or box.

5- Excellent
4- Very Good
3- Good
2- Fair
1- Poor

Kindly include your comments and suggestions for the improvement of our study.

Criteria 5 4 3 2 1
1. Focused (all questionnaires are directed on the association of
Physician Attire and Perceived Age to the Level of Trust and
Confidence of patients)
2. Clear (statements are simple and easily understood)
3. Relevance (questions are within the topic)
4. Concise (adequately short enough to read and understand targeted
respondents)
5. Simple (terms used suits the level of the respondents)
Comments and Suggestions:

Validator:

_________________________ Position:
(Signature over Printed Name) Department/Agency
 47

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