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SAMPLE QUESTIONNAIRE

I. BIOGRAPHICAL INFORMATION

Name (optional): _______________________ Age: _________________

Sex: ____________

Highest educational level attained: ( ) Elementary graduate ( ) High school

graduate ( ) College student / graduate

Ethnic Group: ( ) Kankana-ey ( ) Ibaloi ( ) Ilocano

II. QUESTIONNAIRE PROPER

Instruction:

Please answer the following questions by putting a check mark (/) on

the appropriate space that corresponds to your answer.

1.) Do you adopt cultural health practices for your health?

___ Yes

___ No (If no, end of questionnaire)

2.) What are factors that influenced you to adopt cultural health practices

in relation to your health? (check all that apply)

Internal factors:

__1. Belief that it is more effective than commercial medicine

__2. It makes me feel better compared to when I use commercial medicine

External factors:
__1. It is more accessible than commercial medicine

__2. It has long been a traditional cultural practice in our ethnic group

__3. Work-related

__4. It is cheaper

__5. It has lesser side effects

Others (please specify): _______________________________________________________

3.). What are different health-related cultural health practices that you do?

(Select all that apply)

A. Health Promotion

B. Illness Prevention

( ) “Tang-gad”( mothers observed like not taking a bath, doing house hold

chores, and working immediately after childbirth.)

( ) Not eating twin fruits like banana if pregnant for fear of having

conjoined twins.

( ) Not eating sour fruit during menses as it may cause blood clotting and

menstrual cramps

C. Disease Management

( ) Kan-yao ( butchering native pigs or chicken if illness is not treated.)

( ) Suob ( boiled guava leaves as feminine wash for fast healing after birth.)

( ) Am amling or Usog

( ) Chewing guava shoots to treat diarrhea

( ) Garlic and onions used to thin blood and lower blood pressure
( ) Beke (mumps) from an earthen nest which is made up of soil carried

and accumulated piece-by-piece by a ‘mason’ bee.

( ) Coconut oil (applied on the chest and back of the child to relieve

asthma.)

Others (specify): _______________________________________________________

4.) Please rank the level of applicability of the cultural practices that you

usually practice or apply with 1 being the most applicable.

___ “Tang-gad”( mothers observed like not taking a bath, doing house hold

chores, and working immediately after childbirth.)

___ Not eating twin fruits like banana if pregnant for fear of having

conjoined twins.

___ Not eating sour fruit during menses as it may cause blood clotting and

menstrual cramps

___ Kan-yao ( butchering native pigs or chicken if illness is not treated.)

___ Suob ( boiled guava leaves as feminine wash for fast healing after birth.)

___ Am amling or Usog

___ Chewing guava shoots to treat diarrhea

___ Garlic and onions used to thin blood and lower blood pressure

___ Beke (mumps) from an earthen nest which is made up of soil carried

and accumulated piece-by-piece by a ‘mason’ bee.

___ Coconut oil (applied on the chest and back of the child to relieve asthma.)