Needs Assessment of Families in Brgy.

Mamalingling, Dagupan City: A Basis for Community Extension Services

Jan Patrick S. Arrieta, RN, RM Brando V. Solis, RN, MAEd, Ed.D.

Faculty Research

October 2010

Abstract Jan Patrick S. Arrieta, RN, RM, and Dr. Brando V. Solis, RN, MAEd. Needs Assessment of Families in Brgy. Mamalingling, Dagupan City:A Basis for Community Extension Services, College of Nursing, Colegio De Dagupan, Arellano St., Dagupan City, Pangasinan, Philippines, October 2010

Satisfaction of a need is integral for survival. However, it has now been realized that certain needs require fulfillment primarily before others. In the setting of a community, wherein there is a blend of different perspectives and prioritizations of needs, there is a requisite for assessing what they are and who are the people who demand them. In short a phrase, what is the profile and collective needs of Brgy. Mamalingling. The researchers used a Community Survey form to acquire data from a representative sample of 144 households. From there, the data are tabulated and computed using the UP Manila College of Nursing matrix for prioritizing needs. The study reveals that the top five needs are (1) diarrhea, being the most common illness or medical problem; (2) influenza as the leading cause of child mortality; (3) waste management; (4) low academic profile; (5) and presence of breeding sites of rodents and pests.

Acknowledgement

Gratitude is due to the following people, who in ways, minute or otherwise have imparted something which has made an immense impact in the completion of this work. To Colegio De Dagupan, for the opportunity to excel and prove oneself. To the College of Nursing, for the shared laughter. To our students, the reasons we go to work every day. To them, who shall be the spring of love flowing evermore, the source of our inspiration.

JPSA and BVS

Contents

Page Title Page Abstract Acknowledgement Contents List of Tables List of Figures Chapter 1 INTRODUCTION Background of the Study Theoretical Framework Conceptual Framework Statement of the Problem Assumptions Significance of the Study Scope and Limitations Definition of Terms 2 3 REVIEW OF LITERATURE AND STUDIES METHODOLOGY Research Design Sources of Data

Instrumentation Tools for Data Analysis 4 5 DISCUSSION OF FINDINGS SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS Summary Conclusions Recommendations Bibliography/References Appendices A B Community Survey Form Matrix for Scoring Community Health Problems/Health Needs from University of the Philippines College of Nursing Community Health Nursing Specialty C D E Organizational Chart of Brgy. Mamalingling Photographs Action Plan for Nursing Students in the Implementation of COPAR

Curriculum Vitae

List of Table

Table 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19

Title (Frequency and Percentage of) Age Group Gender Civil Status Educational Attainment Employment Status Religion Family Structure Decision Maker Income Profile Housing Material Ownership Status Ownership Status of the Lot Availability of Gardening Space Source of Drinking Water Drinking Water Storage Food Storage Drainage System Type of Dwelling Unit Structure Electric Supply

Page

4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31

Cooking Fuel Source Toilet Facility Garbage Disposal Use of Garbage Segregation Animals or Pets Breeding Sites for Insects, Rodents, or Pests Stillbirth Causes of Child Mortality Common Illness in the Family Family Planning Methods Health Resources Availed Computation Matrix for Academic pool of 14.43% who did not go to school and high school graduates of 45.25%

4.32

Computation Matrix for Unemployment rate of 16.77% or about 126 people aged 18 and above who do not have/hold jobs currently

4.33

Computation Matrix for 63.89% of families have a family income below PhP 5,000.00

4.34

Computation Matrix for Waste management: 20.13% Burning; 8.33% Open dumping; and 43.06% of not practicing garbage segregation

4.35

Computation Matrix for 47.92% of households have a breeding site for pests and rodents

4.36

Computation Matrix for Stillbirth occurrence of 9 in 144 families

4.37

Computation Matrix for Influenza is the leading cause of child mortality in 5 out of 14 cases

4.38

Computation Matrix for Diarrhea is the most common illness in the family in 62 out of 192 cases

5.1

List of Health Needs Identified and their Total Scores

List of Figures

Figure 1.1 1.2 1.3 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16

Title Maslows Hierarchy of Needs Maslows Hierarchy of Needs as Adapted by R. Kalish Paradigm of the Study Age Group Gender Civil Status Educational Attainment Employment Status Religion Family Structure Decision Maker Income Profile Housing Material Ownership Status Ownership Status of the Lot Availability of Gardening Space Source of Drinking Water Drinking Water Storage Food Storage

Page 6 7 11

4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30

Drainage System Type of Dwelling Unit Structure Electric Supply Cooking Fuel Source Toilet Facility Garbage Disposal Use of Garbage Segregation Animals or Pets Breeding Sites for Insects, Rodents, or Pests Stillbirth Causes of Child Mortality Common Illness in the Family Family Planning Methods Used Health Resources Availed

Chapter 1

INTRODUCTION Background of the Study Needs and wants are two entirely different things. One means it is of utmost importance that if absent would not allow progression of life while the other is the expression to acquire more beyond what is imperative. There are many needs of man and we necessitate identifying them, both individually and in a community setting. According to the famous writings of Abraham Maslow, needs could be arranged in a pyramidal schema where the most basic needs are located at the bottom and that if they are not met, the person is not able to reach higher level needs. All people have the same basic needs; however, each persons needs and reactions to those needs are influenced by the culture with which the person identifies. They could range from bodily needs, independence, privacy, and professional achievement may be important in one subculture but may not necessarily be of equal importance in another. Prioritization of these needs is based on a complex set of learned and situational influences. There are several characteristics of human needs. People meet their own needs relative to their own priorities. This is exemplified by a poor mother who might give up her share of food so that her child might have sufficient food to live. Although basic needs generally must be met, some needs can be deferred. An example is when someone is waiting in line but feels the urge to urinate, may defer urination to secure his place in the line. Another characteristic is that failure to meet needs results in one or more

homeostatic imbalances, which can eventually result in illness. Furthermore, a need can make itself known by either external or internal stimuli. A person may experience hunger as a result of physiologic processes (internal stimulation) or as a result of seeing a beautifully-decorated cake (external stimulation). Another characteristic of a need is exemplified when a person who perceives a need can respond in several ways to meet it. The choice of response is largely a result of learned experiences, lifestyle, and the values of the culture. For example, many peoples food choices at mealtimes and snack times are based on past experiences, lifestyle, and culture. Needs are interrelated. Some needs cannot be met unless related needs are also met. The need to main hydration or fluid balance can be influenced by the need to eliminate urine first. And finally, needs can be satisfied in healthy and unhealthy ways. Ways of meeting basic needs are considered healthy when they are not harmful to others or to self, conform to the individuals sociocultural values, and are within the law. Conversely, unhealthy behavior may be harmful to others or to self, does not conform to the individuals sociocultural values, or is not within the law. People who satisfy their basic needs appropriately are healthier, happier, and more effective than those whose needs are frustrated (Kozier, et. al. 2008). According to Maglaya (2000), before the needs could be solved, they must be assessed. The community health nurse is a product of, and interacts constantly with his/her physical, sociocultural, economic and political environment. Although nursing

seems to be universal, the nature, the practice of the profession is primarily determined by its context. The clients health needs and problems are a major determinant of the practice of community health nursing. The health care delivery system, particularly the nursing profession, should be responsive to these needs. In order to respond to these needs, community health nursing is the tool. It is the utilization of the nursing process in the care of the different levels of clientele individuals, families, population groups and communities. Through community survey, we will be able to identify the health needs of the client. We acknowledge that there are factors which change the needs of one family from another such as literacy and educational attainment. Literacy is a persons ability to read and write. People with higher education have better health status than those who spent lesser number of years in schools. They can take care of their health needs better than those who were not able to finish significant number of years in school. This is easy to explain because those who were not able to finish elementary or high school levels are the poor who could not afford the other basic requirements of good health. Another major reason for health problems of our people is poverty. Most of the leading causes of morbidity and mortality associated with factors could be attributed to poverty, illiteracy, unfounded health beliefs, harmful practices, inadequate nutrition, poor environmental sanitation, inadequate source of potable water, congested housing units, poor access to basic health services, and inability to make decisions on matters which are important to health (Cruz, 2000). It is therefore through careful assessment can we truly catalogue the needs of the people and as the nursing process dictates, the data can reveal or diagnose these

collective needs or problems which will be managed through careful planning, ready for implementation. And this will lead to the final step of evaluating the course of action if they are successful or otherwise. Theoretical Framework A variety of theoretical frameworks provide the nurse with a holistic overview of health promotion for the individual and families across the life span. Two major theoretical frameworks that nurse use in promoting health are Maslows Hierarchy of Needs and by adaption, Kalishs Hierarchy of needs. According to Maslow, there are five levels of needs arranged in an ascending manner. Physiologic needs. Needs such as air, food, water, shelter, rest, sleep, activity, and temperature maintenance are crucial for survival. Safety and security needs. The need for safety has both physical and psychologic aspects. The person needs to feel safe, both in the physical environment and in relationships. Love and belongingness needs. The third level of needs includes giving and receiving affection, attaining a place in a group, and maintaining the feeling of belonging. Self-esteem needs. The individual needs both self-esteem (i.e., feelings of independence, competence, and self-respect) and esteem from others (i.e., recognition, respect, and appreciation). Self-actualization. When the need for self-esteem is satisfied, the individual strives for self-actualization, the innate need to develop ones maximum potential and realize ones abilities and qualities. (Kozier, et. al., 2008)

Figure. 1.1 Maslows Hierarchy of Needs Also, in the work of Richard Kalish, he adapted Maslows hierarchy of needs into six levels rather than five. He suggests an additional category between physiologic needs and the safety and security needs. This category referred to as stimulation needs, includes sex, activity, exploration, manipulation, and novelty. Kalish emphasizes that children need to explore and manipulate the environments to achieve optimal growth and development. He notes that adults, too, often seek novel adventures or stimulating experiences before considering their safety and security needs. (Kozier, et. al., 2008)

Self-actualization Esteem Love Safety Sex Food Air Activity Water Exploration Temperature Elimination Belonging Security Manipuation Rest Self-Esteem Closeness Protection Novelty Pain Avoidance

Figure 1.2 Maslows Hierarchy of Needs, as adapted by Kalish Nursing Theory The nursing process is based on a nursing theory developed by Ida Jean Orlando. She developed this theory in the late 1950's as she observed nurses in action. She saw "good" nursing and "bad" nursing. From her observations she learned that the patient must be the central character; nursing care needs to be directed at improving outcomes for the patient, not about nursing goals; and that the nursing process is an essential part of the nursing care plan. The purpose of the nursing process is to identify a clients health status and actual or potential health care problem or needs, to establish plans to meet the identified needs, and to deliver specific nursing intervention to meet those needs. The client may be an individual, family or a group. (Kozier, et. al. 2008) Giving rise to the importance of planning is Willes (2007) who believed that evaluation is the process of making judgments that are to be used as a basis for planning. The effectiveness and success of any job of learning therefore is heightened by a valid and discriminating appraisal of all its aspects. It seems to be important to point out the centrality of evaluation in nursing too. The very essence of nursing requires the nurse to

evaluate constantly the clienteles nursing needs as well as her own activities in meeting these needs and guiding the clientele in his own evaluation of his health needs to maintain an optimal level of health. If nurses are to improve their practices, change their attitudes or alter their behavior, they must develop the habit of evaluating the outcomes/results of any programs implemented. Thus, evaluation is an essential part of nursing just as it is a part of teaching and learning. The perception focused on the health workers involves their awareness of the component thrusts of the program and the extent of their involvement in the attainment of the program objectives along with the component thrusts. Similarly, it focuses on the problems encountered by the health workers and their extent of seriousness, and the recommendations offered for the improvement of the implementation of the community health extension program. Nurses are part of a fast growing and changing community. They are affected by change just as they are agents of change. The profession must seek the relevancy with the community they serve. Nurses play a role in the community in the preservation and protection of public health. Nurses of this country have a grave challenge to meet. With the pace of the development of a community, the need of every member of the community is dynamic. As a representative of the institution where one is employed, nurses have to be prepared in bringing out the most relevant plan of action in response to changing needs of the community and at the same time, motivate them to develop a community based spirit that will lead to the ultimate goal of the Department of Health empowerment through selfreliance.

As what will be shown in the succeeding illustration, arising from the Needs Theories of Maslow and Kalish with the help of the nursing process of assessment and Community Organizing and Participatory Action Research are the multifaceted array of needs from a certain group of people community. All of these make a fine mesh of conglomeration that will aid us in our search for the needs of a particular individual and extending it to the community level. Conceptual Framework The main concept that is of relevance necessitated in this issue is Community Organizing and Participatory Action Research (COPAR). In the works of Maglaya (2000), this is integral in a community setting to resolve the problems. It is from here that the nurse-researcher can see a clear picture of what factors are lacking or that need attention. COPAR is a way for us to prioritize problems and that if we have a list of problems, manners and methods to resolve them can be initiated. In support of Maglaya, we have the writings of De Belen who says that when using primary health care as an approach to health, the community health nurse conduct community organization and participatory action research not only for the purpose of community health but also for community development. He further states that is an important tool for community development and people empowerment, as it helps the community health workers to generate community participation and to obtain information for developing a community plan for health as a key to development. He also states that in the two function of participatory action research, one is to obtain data for assessment and diagnosis of the community and the preparation of a community nursing care plan.

With the theoretical and conceptual frameworks we can clearly see the importance of a careful assessment in order for community health nurses and their ancillary partners to create a plan for furthering the health condition of the people. Most importantly, this is a cyclical approach which aims to continue seeking areas for improvement in the community setting, eyeing the family as the basic unit. Paradigm of the Study Figure 1 shows the schematic relationship of the Independent variables, Dependent Variables, and the Moderator Variables. In the diagram, rooting from Needs Assessment and COPAR is a directional line leading to the collective needs of Brgy. Mamalingling and the priority problems of the people. Here, Needs Assessment is the process with COPAR as a concept to ground and guide the process of gauging the community under study. The result of which will vary depending on the moderators of the assessment listed as the Family Profile, Family Characteristics, Home and Environment, Health and Health Practices; apropos by a straight solid line.

Processes Assessment on the Needs and Problems using COPAR

Outcome Needs Prioritized Problems

Moderator Variables I. Family Profile a. Age b. Sex c. Civil Status d. Highest Level of Schooling Attended e. Current Employment Status f. Religion Family Characteristics a. Type of Family Structure b. Family Decision Maker c. Family Income per Month Home and Environment a. Housing Material b. Ownership Status of the House c. Ownership Status of the Lot d. Available Space for Gardening e. f. g. h. i. Source of Drinking Water Drinking Water Storage Food Storage Drainage System Type of Dwelling-Unit Structure j. Electric Supply k. Type of Cooking Fuel Source l. Toilet Facility m. Garbage Disposal n. Use of Garbage Segregation o. Animal or Pets Kept p. Breeding Sites for Insects, Rodents, or Pests Health and Health Practices a. Stillbirth b. Causes of Child Mortality c. Common Illness in the Family d. Family Planning Methods e. Health Resource Availed Of

II.

III.

IV.

Statement of the Problem Assessment starts the nursing process and therefore is of primary importance in the formulation of a plan to tackle any problem. Specially, this study seeks to answer the following questions: 1. What is the demographic profile of the families/households in Brgy. Mamalingling, Dagupan City in Pangasinan in terms of the following: A. Family Members Chart i. Names ii. Position in the Family iii. Age iv. Sex v. Civil Status vi. Highest Level of Schooling Attended vii. Current Employment Status viii. Religion B. Family Characteristics i. Type of Family Structure ii. Family Decision Maker iii. Family Income in a Month C. Home and Environment i. ii. Housing Material Ownership Status of the House

iii. iv. v. vi. vii. viii. ix. x. xi. xii. xiii. xiv. xv. xvi.

Ownership Status of the Lot Which the House is Built Available Space for Gardening Source of Drinking Water Drinking Water Storage Food Storage Drainage System Type of Dwelling-Unit Structure Electric Supply Type of Cooking Fuel Source Toilet Facility Garbage Disposal Use of Garbage Segregation Animals or Pets Kept Breeding Sites for Insects, Rodents, or Pests

D. Health and Health Practices xvii. xviii. xix. xx. xxi. Stillbirth Causes of Child Mortality Common Illness in the Family Family Planning Methods Health Resources Availed Of

2. What are the collective needs of the families in Brgy. Mamalingling, Dagupan City as revealed by the following:

a. Health Status Problems b. Health Resource Problem c. Health-related Problems 3. What are the top five priorities revealed in the Typology of Community Health Nursing Problems? 4. After identifying the needs of the community, what are the steps which can be directed to resolve them? Assumptions 1. The needs of the members of Brgy. Mamalingling are multifaceted and highly variable. 2. The assessment part of the Nursing process will direct the accurate collection of data to elicit the needs of the barangay. 3. The needs can be prioritized using the criteria in the Community Organizing Participatory Action Research. Significance of the Study These findings of this study could be beneficial to the parties identified hereunder; Nursing Research. The study is an asset in the field of nursing research this could be used as a basis for future researches providing conglomerated data on a community level. This could also be the springboard in formulating an instructional education campaign for the barangay with the data presented. The proposed functional measures can be used by them as guidance in knowing the demographic profile of the respondents, their status, their knowledge and awareness, access and utilization of health

services by household in Brgy. Mamalingling, Dagupan City and assess the facet relative to health care and how professionals and the residents can be educated towards utilization of health care system, its benefits and importance to health. This is beneficial to the educators, policymakers, and community leaders identify key threats to sustainable development and explore possible approaches to addressing about issues on utilization of health services by household in Brgy. Mamalingling, Dagupan City. Nursing Practice. The study will aid in knowing what particular action to be adopted in such cases and what action to be applied to educate the households about family care and promote health among depressed areas of the Philippines. This would benefit the BHW, community nurses, doctors, midwives in order for them to understand the need of promoting health care delivery system, with this study they would be able to understand the households regarding the different contributors of poor health Nursing Education. This will be valuable as this will provide the nurses, students and educators with knowledge and essential concept towards the health care services. With a well-guided learning experience, evaluation of their competence can be easily outlined. This will also serve as an opportunity to initiate care at the very base of society, which should be emphasized in the curriculum. To consider also could be a coordinated plan with affiliate communities and the college, which will manifest in black and white to serve as an activity guide for a given academic year or postulated time frame. Residents and Health Personnel. This makes them increase their awareness that promoting health care is a dynamic and continuously evolving concept. Therefore, information sharing and collaboration will be needed to ensure that the approaches

developed and implemented are based on the most recent and relevant information available and on the evolving experiences of those working in the field. City Planning Office. Government agencies can benefit from this research report because of the information contained in it which will serve as an update regarding the situation facing Brgy. Mamalingling. This will aid in the formulation of plans to address the peoples concerns, particularly in the preparation of budget allocation. This research report may pave the way in giving Brgy. Mamalingling a second glance and be considered as a priority. City Health Office. As earlier stated, when needs are not met, it will result to illness. The City Health Office will have the opportunity to look at the data presented here and may alert them regarding the status of the peoples health. An ill nation is a poor nation, therefore, it is imperative that health be a priority. Moreover, along with the City Planning Office, they could collaborate with one another in the implementation of the programs the Department Health in whatever area that needs implementation. Scopes and Limitations The locale of the study will be conducted in Dagupan City and within the administrative locale of Brgy. Mamalingling as recommended by the Director for Extension Services of Colegio De Dagupan, Julinda Narvasa. Also, the barangay selected complies with the criteria for site selection. The community is economically depressed; has a population of 226 families; no resistance met; no tumultuous security problems; and the barangay is not receiving the same program. The study will be concerned with assessing the needs of the families in Brgy. Mamalingling, that is, they are residents

within the boundaries of the barangay. The time (in years) on how long they have resided in the barangay is difficult to allow exclusivity because of the turn-over in terms of residence, moreover the data is encompassing because it would include even temporary residents such as boarders or visitors during the time of data gathering. The variables under study are enumerated in the Moderator Variables using the Community Survey Form. The study concerns these variables but is not limited to them. Other pieces of information which would reveal needs and/or problems will be allowed a test for prioritization. Data gathering will start from January 20, 2010 until February 10, 2010. From here, data will be collated. As a theoretical limitation, the execution of COPAR in its entirety may not be reached. This is related to the fact that the assessment of or community diagnosis may not yield results entailing continuation of COPAR .Data gathered from the community survey form and other pertinent data not found in the survey form acquired from the Barangay Hall, School Records, and Midwives Records are the only sources of data. It means that no other health needs can be identified if not revealed in the survey form or other data sheets. Changes in the actual numbers of the population may not necessarily be up-todate in that census has been acquired in the year 2009 (for actual population). As for the School Records of enrolment, the pupils of Brgy. Mamalingling may not necessarily be bound to Brgy. Mamalingling Elementary School in that the school is located near the boundary of Brgy. Bolosan, where another school is located. Definition of Terms The following are define in order to provide additional information above the study:

Age. This is defined as the period of time that an individual has lived, usually expressed in years. To differentiate the age division, it shall be delineated by one day beginning the stated year and ends with one day before the next category assuming a 30 day/month calendar. Age Divisions: 1 day to 11 months and 29 days 12 Months to 2 years and 11 months and 29 days 3 years to 5 years and 11 months and 29 days 6 years to 11 years and 11 months and 29 days 12 years to 17 years and 11 months and 29 days 18 years to 39 years and 11 months and 29 days 40 years to 64 years and 11 months and 29 days 65 years and beyond Assessment. This is defined as the first phase of the Nursing Process comprising of collecting data, validating data, organizing data, and documenting data. Barangay. This is defined as the smallest administrative division in the Philippines. BHW (barangay health workers). This is defined as the provider of health services in a barangay or health workers working in a barangay. Collective Needs. This is defined as the surveyed factors or things which require attention and treatment. Community. This is defined as a collection of people who share some attribute of their lives.

Community Health Center. This is defined as the agency within a community or barangay which is responsible for delivering primary level of care and is committed to improving the health of its community. Department of Health. This is defined as the national agency that focuses on promoting health and wellness of the estate. Family. This is defined as the basic unit of society; a fraction of the population comprising a single household. Family Decision Maker. This is defined as the family member who makes critical decision regarding the best interest of the family. May be patriarchal (father is the decision maker), Matriarchal (mother is the decision maker), or Combination, even extended from the first filial generation (the grandfather or grandmother). Family Type. This is defined as the conglomerated characteristics of a household. a. Nuclear. This family type is composed of a husband, wife, and children. b. Binuclear. This is a family type where two nuclear families (commonly two siblings) are living together. c. Extended. This family type is also known as the multigenerational family; it includes not only the nuclear family but also other family members such as grandmothers, grandfathers, aunts, uncles, cousins, and grandchildren. d. Single Alliance e. Single Parent. A family type wherein there is only one parent who lives in the home.

f. Blended. Also known as a remarriage or reconstituted family, are divorced or widowed persons with children who marries someone who also has children. g. Cohabitation. A family type composed of heterosexual couples living together like a nuclear family but remain unmarried. h. Communal. This is also known as communes which comprise groups of people who have chosen to live together as an extended family, and their relationship to each other is motivated by social or religious values. i. Foster Family. This family type is a temporary home placement for a child whose parents can no longer care for them and is cared for by foster parents; foster parents may not have children of their own. Family Income. This is defined as the amount of money or its equivalent received during a period of time in exchange for labor or services, from the sale of goods or property, or as profit from financial investments. Health. This is defined as a state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity. Health Status Problems. This is defined as a community health problem described in terms of increased or decreased morbidity, mortality, or fertility. Health Resource Problem. This is defined as a state of lack or absence of manpower, money, materials, or institutions necessary to solve health problems. Health-related Problems. This is defined as the existence of social, economic, environmental, and political factors that aggravate the illness-inducing situations

in the community. Household. This is defined as a domestic unit consisting of the members of a family who live together along with nonrelatives such as servants. Illness. This is defined as the opposite of health or is a state of poor health Literacy. This is defined as the cognitive ability to read and write. Need. This is a condition necessitating supply or relief; a requirement for subsistence or for carrying out some function or activity. Needs Assessment. This is defined as a process employing varying methods of data acquisition within the framework of Community Organizing and Participatory Action Research. Priority Setting Criteria. This is defined as the factors considered in determining the rank or order of community health problems relative to the unique requirement of the community area under study. The following are the criterion with their descriptions: a. Nature of the problem presented . The problems are classified by the nurseresearcher as health status, health resources or health-related problems b. Magnitude of the problem . This refers to the severity of the problem which can be measured in terms of the proportion of the population affected by the problem c. Modifiability of the problem. This refers to the probability of reducing, controlling, or eradicating the problem d. Preventive potential. This refers to the probability of controlling or reducing the effects of posed by the problem

e. Social concern. This refers to the perception of the population or the community as they are affected by the population

Chapter 2

REVIEW OF LITERATURE AND STUDIES Nursing Process Theory Orlando's theory was developed in the late 1950s from observations she recorded between a nurse and patient. Despite her efforts, she was only able to categorize the records as "good" or "bad" nursing. It then dawned on her that both the formulations for "good" and "bad" nursing were contained in the records. From these observations she formulated the deliberative nursing process. The role of the nurse is to find out and meet the patient's immediate need for help. The patient's presenting behavior may be a plea for help, however, the help needed may not be what it appears to be. Therefore, nurses need to use their perception, thoughts about the perception, or the feeling engendered from their thoughts to explore with patients the meaning of their behavior. This process helps the nurse find out the nature of the distress and what help the patient needs. Orlando's theory remains one the of the most effective practice theories available. The use of her theory keeps the nurse's focus on the patient. The strength of the theory is that it is clear, concise, and easy to use. While providing the overall framework for nursing, the use of her theory does not exclude nurses from using other theories while caring for the patient (Tomey and Alligood, 2002).

The Nursing Process The nursing process is a systematic, rational method of planning and providing nursing care. Its purpose is to identify a clients health care status, and actual or potential health problems, to establish plans to meet the identified needs, and to deliver specific nursing interventions to address those needs. The nursing process is cyclical; that is, its components follow a logical sequence but more than one component may be involved at one time. At the end of the first cycle may continue with reassessment, or the plan of care may be modified. Assessing is the systematic and continuous collection, organization, validation, and documentation of data. In effect, assessing is a continuous process. For example, in the evaluation phase, assessment is done to determine the outcomes of the nursing strategies and to evaluate goal achievement. All phases of the nursing process depends on the accurate and complete collection of data. A nursing assessment should include the clients perceived needs, health problems, related experience, health practices, values, and lifestyles. To be most useful, the data collected should be relevant to a particular health problem. Therefore, nurses should think critically about what to assess. The assessment process involves four closely related activities: collecting data, organizing them; validation, and documentation of data (Orlando 1972). In addition to the content of Orlando, George (2002) explains further that collection of data includes only information relevant to identifying the patients need for help.

Wilkinson (2007) supports the statements aforementioned, saying assessment is the first phase in the nursing process, is the systematic gathering of relevant and important patient data. And that in effect, assessment is a continuous process carried out during all phases of the nursing process. In the context of community nursing, De Belen (2008) says that the best persons to assess the communitys health condition and status are the community health nurses or nursing students who interact with the community members and observe their social environment. The nurses assessment and diagnosis serve as the basis of rural health unit or health office for community health planning, because they provide information on the community health concerns, needs and priorities. All these information obtained from the community are useful in community nursing in particular and community health development in general. They are also useful for improving the health status of the community through strategic and operational planning in community health. Thus, community health assessment is a fundamental tool of community health nurses. Community Organizing and Participatory Action Research COPAR is a social developmental approach and a systematic, continuing process of people transforming themselves from their culture of silence to a collective voice and action through undergoing continuous education or collective conscientization and awareness building about their existing situations, identifying their own needs and formulating their own goals and objectives, developing their own capabilities, readiness and political will to respond or take action on their immediate long or short term needs or

problems, and mobilizing their constituents to collectively take action on such needs or problems. As applied to community health development, it is defined as an essential health care approach based on practical, scientifically-sound, and socially-acceptable methods of technology made universally accessible to individuals, families in the community through full participation at a cost that the community can afford to maintain at every stage of development in the spirit of self-reliance and self-determination. (Maglaya, 2000) Along with this idea is needs assessment which is a process for determining and addressing needs, or "gaps" between current conditions and desired conditions, often used for improvement projects in education/training, organizations, or communities. In the context of community improvement, it is known as community needs analysis. It involves identifying material problems/deficits/weaknesses and advantages/opportunities/strengths, and evaluating possible solutions that take those qualities into consideration (Gupta, 2007). Community needs assessment involves assessing the needs that people have in order to live in: 1. an ecologically sustainable environment 2. a community that maintains and develops viable social capital 3. a way that meets their own economic and financial requirements 4. a manner that permits political participation in decisions that affect themselves

Once you have collected the data, the process moves on to analysis of the data to determine the health status, the patient's coping mechanisms or lack thereof, his ability to use these mechanisms and to identify his problems related to his health status. (Roudy and Kusy, 1995). To deliver a more comprehensive approach to COPAR, we have an electronic source1 By definition, Community Organizing Participatory Action Research (COPAR) is a continuous and a sustained process of educating the people to understand and develop their critical consciousness. It is involved in working with people, to work collectively and effectively on their immediate and long term problems; and mobilizing with people, develop their capability and readiness to respond, take action on their immediate needs towards solving the long term problems. The process and structure through which members of a community are/or become organized for participation in health care and community developmental activities. COPAR emphasizes community working to solve its own problems; the direction is established internally and externally; development and implementation of a specific project less important than the development of the capacity of the community to establish the project; and that consciousness raising involves perceiving health and medical care within the total structure of society COPAR is important because it maximizes community participation and involvement; could be an alternative in situations wherein health interventions in Public
1

http://nursester.blogspot.com/2009/02/community-organizing-participatory.html

Health Care do not require direct involvement of modern medical practitioners; it gets people actively involved in selection and support of community health workers; and through COPAR, community resources are mobilized for selected health services. Likewise, COPAR improves both projects effectiveness during implementation. There are different phases in the COPAR process. The first is the Pre-Entry Phase which is the initial phase of the organizing process where the community organizer looks for communities to serve and help. Preparation of the institution is the first activity done in the Pre-Entry Phase. It is here that faculty and students are trained in COPAR, plans are formulated to institutionalize COPAR, revisions or enrichment of the curriculum and immersion program are done, and coordination with participants from other departments is carried out. Second activity is site selection to implement COPAR. Here, initial networking is done with the local government, a special preliminary investigation is conducted, and ocular survey is done. In order to select a site, the community must satisfy the following criteria: a population of 100 to 200 families; the community is economically depressed; there is no strong resistance from the community, there is no serious peace and order problem; and that no similar group or organization holding the same program. The second phase of COPAR is known as Entry Phase. This is sometimes called the social preparation phase. This phase is crucial in determining which strategies for organizing would suit the chosen community. The success of the activities depends on how much the community organizers have integrated with the community.

A key activity in the Entry Phase is called Integration, wherein rapport is established with the people in continuing effort to imbibe community life. Integration is carried out by living with the community; seeking out to converse with people where they usually congregate; and lending a hand in household chores. After integration, the settled group may continue with deepening social investigation/community study. During this time, the group verifies and enriches data collected from initial survey. After that, a core group is to be formed composed of key persons, or those approached by most people; and the opinion leader, or the one approached by the key persons. With this, isolates or those who are hardly consulted are sought out. The third phase is known as the Organization-building Phase. This entails the formation of more formal structure and the inclusion of more formal procedure of planning, implementing, and evaluating community-wise activities. It is at this phase where the organized leaders or groups are being given training (formal, informal, OJT) to develop their style in managing their own concerns/programs. And finally, the last phase is known as Sustenance and Strengthening Phase. This occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. At this point, the different committee setups in the organization-building phase are already expected to be functioning by way of planning, implementing and evaluating their own programs, with the overall guidance from the community-wide organization. It was according to Jimenez (2005), she proposed six phases in community organizing and participatory action research for community health nursing: Pre-entry

phase, entry phase, community study/diagnosis phase, community organization/capability building phase (research), community action phase, and sustenance and strengthening phase. And that these phases can be simplified into the four aforementioned phases. However, OBrien has specified a structure of COPAR following Diagnosing, Action Planning, Taking Action, Evaluating, Specifying Learning and back in a cyclical fashion. Citing OBrien (2001) and McNiff (2002), they said that action research involves utilizing a systematic cyclical method of planning, taking action, observing, evaluating (including self-evaluation) and critical reflecting before planning the next cycle. This is supplementary to the statements of Wadsworth (1998), saying participatory action research is essentially research involving all relevant parties in actively examining together current action (which they experience as problematic) in order to change and improve it. They do this by critically geographical and other contexts which make sense of it. Furthermore, he says that participatory action research is not just research which is hoped will be followed by action. It is an action which is researched, changed and reresearched within the research process by participants. Nor is it simply an exotic variant of consultation. Instead, it aims to be active co-research, by and people to get another group of people to do what is thought best for them whether that is to implement a central policy a genuinely democratic or non-coercive process whereby those to be helped determine the purposes and outcomes of their own inquiry.

Chapter 3

METHODOLOGY Research Design The descriptive design was used in the study. It is a method which seeks to gather information about existing conditions with an aim to describe the nature of a situation as it exists at the time of the study and to explore the causes of a particular phenomenon (Sevilla, et. al. 2001). Polit and Beck (2004) presents a more contemporary purpose in that it is a study which determines and reports the way things are and measures what already exists. The descriptive research seeks to observe, describe, and document aspects of a situation as it naturally occurs and sometimes to serve as a starting point for hypothesis gathering or theory development. This research design accurately portrays the characteristics of persons, situations, or groups and for the frequency with which certain phenomena occur. With the intention to observe and identify the needs of the families, the use of the descriptive research enabled the researchers to gather tangible information regarding their specific family needs, which in turn, could be amassed to list the collective needs or problems. The design will help in assessing the different needs as it is applied to the variable literacy and family income. This design also dictated the use of statistical methods in order to deal with the data gathered.

Sources of Data The study has put under the microscope of scrutiny the needs of the families within the confines of the barangay. The study was conducted in the City of Dagupan, in Brgy. Mamalingling. The barangay is located in the eastern part of Dagupan City in the province of Pangasinan. It is bounded by the municipality of Mangaldan on the east and the barangay of Bolosan on the south, by barangay Tambac on the west, and by barangay Bonuan-Boquig on the north. It is in this area occupied by about 1280 occupying 226 households (Barangay Report, Population Censal Year of 2009) covering a land area of 216.2 hectares. This area was chosen because the area is easily accessible, about 3 kilometers away from City Hall using public utility vehicles such as jeepneys that traverse through the national highway and local transport such as tricycles and pedicabs. And with the stated indicators in the above section of background of the study, the tendency points to a myriad of needs in the barangay. This barangay is divided into 3 (three) puroks, wherein there is one Barangay Health Worker assigned. The respondents chosen for this research is any family who are permanent residents and are currently living in the barangay. Application of Slovins Formula gave rise to the sample size being aimed for in this study. With a current population of 226 households with 5percent used as the margin of error equated to 144 needed households as respondents. These provided sufficient data to represent the collective needs or problems of the barangays. The purposive clustered sampling was used to collect the needed 144 household. The purposive sampling is needed because we have imposed

characteristics that we are looking for in the respondents/families, alongside cluster wherein we have preset the location of the families from which we will gather data from. Instrumentation and Data Collection The questionnaire is the main data gathering tool that was utilized in the study. Employing questionnaires has an advantage of uniformity of instructions to which the respondents are exposed to. The developed community survey form is currently being used for surveying purposes as part of Related Learning Experiences in the Community Setting. This survey form has been modified by Dr. Brando Solis from the antecedent version and has been blended with updated entries from Araceli Maglayas Nursing Practice in the Community. The community survey form is divided into 5 parts. Part A inquires about the household identification as to where the household is located. Part B asks about the family members names, position in the family, age, gender, civil status, educational attainment, employment status, and religion. Part C inquires about the family characteristics as to type, decision maker, and income. Part D asks about housing material, ownership, space for gardening, source of drinking water, storage of water, food storage, drainage system, unit structure, electricity supply, cooking fuel used, toilet facilities, garbage disposal and segregation, pets, presence of breeding sites for pests or rodents. Part E is all about health and health practices within the last 12 months; number of live children, stillbirth, deceased children, common illnesses in the family, use of family planning or contraceptive methods, available health resources, and the immunization status of children aged 0 to 5 years. The tool is no longer to undergo pilot

study nor face validity since it has been an established data gathering tool for community health nursing. After properly identifying the respondents for the study, the consent for participation was obtained. The anonymity of the residents and the confidentiality of the data was ensured. The completed questionnaires are kept under lock and key and was known only to the researchers and the family from which the data are acquired from. After data gathering, the data were tabulated and the frequency of the answers were tallied and totaled. This study was designed in such a way that it does not pose any physical or psychological harm to our respondents. The 10 research assistants were grouped into pairs and will be tasked to look for families. Families served as respondents after they have given their consent for participation. Each household was given one community survey form and the research assistant filled it up as the family representative, the one who could speak for the family, answered the guided questions. Then, the cycle was repeated until the 144 families have been interviewed. Data gathering started from the 20th of January for two weeks. Tools for Data Analysis Collected data were tallied per category of data starting from the family members chart particularly age, sex, civil status, educational attainment, employment status and religion. Collated data were tallied into each of the appropriate tables and from them; the frequency with which the situation occurs will reveal the most number. It is from here

that the total answers per category are acquired in order for the research team to calculate the percentages of each item in a category. The tools for data analysis are the accumulation of responses per question or category and they were presented using frequency. The total score per category revealed the frequency. And the percentage of each item was also be computed to reveal partition of the variables. Community health problems are categorized as: a. Health status problems b. Health resource problems c. Health-related problems After the problems have been identified, the next task for the researcher and the community is to prioritize which health problems can be attended to considering the resources available at the moment. In priority setting, the researcher considers the following criteria: a. Nature of the problem presented b. Magnitude of the problem c. Modifiability of the problem d. Preventive potential e. Social concern The problems were scored using the scoring system from the University of the Philippines College of Nursing Community Health Nursing Specialty (see Appendix D)

Each problem was scored according to each criterion and divided by the highest possible score multiplied by the weight. Then the final score for each criterion was added to give the total score for the problem. The problem with the highest score is given highest priority by the researcher.

Chapter 4

DISCUSSION OF FINDINGS Demographic Profile of Families/Households in Brgy. Mamalingling Table 4.1 Age Distribution n=769 Age group 0 to 12 Months 1 to 3 years 3 to 5 years 6 to 12 years 12 to 18 years 18 to 40 years 40 to 65 years >65 years Total Total 33 34 57 129 105 247 139 25 769 Percent 4.29 4.42 7.41 16.78 13.35 32.12 18.08 3.25 100.00

The findings of the survey, shown in Table 4.1 presents that the age group of 18 to 40 years comprise the largest population, followed by those in their middle adulthood. The smallest group is of old age.

Figure 4.1 Age Distribution

247 250 200 150 100 50 0 0 to 12 Months 1 to 3 years 3 to 5 years 6 to 12 years 12 to 18 18 to 40 40 to 65 years years years >65 years 33 34 57 25 129 105 139

To serve as a comparison for the above data, the Population Census (POPCEN 2007) press release by the National Statistics Office, they have placed the population at 88, 574, 614 as of August 1, 2007. Among the provinces, Pangasinan came third with 2.65 million after Cavite and Bulacan. Among the 4 cities and 44 municipalities, Dagupan City is the second most populated. Conferring to the data by the Department of Health (2005) in terms of estimated population by age and sex, 11.5% belong to the age group from 0 to 4 years. The difference in the data can only be attributed to the groupings made by the study and that of the DOH; if the age groups presented in this paper has been modified to follow suit with that of the DOH grouping, it may reveal a basis for comparison. The POPCEN 2007 also states that persons aged 5 to 9 years and 10 to 14 years had the highest proportions to household population with 11.9% and 11.8%, respectively. Albeit that way, the DOH data also shows that early age brackets are greater but will eventually wane with time. Furthermore, it could be inferred that the population bracket with the highest number is the second highest in range which makes it possible to

accommodate the frequencies, from this we can say that the population is mainly the working populace. Table 4.2 Sex Distribution n=769 Sex Male Female Total

Total 343 426 769

Percent 44.60 55.40 100.00

Table 4.2.shows the sex distribution, revealing that most of the population are females.

Figure 4.2 Sex Distribution

426 343

500 400 300 200 100 0 Male

Female

This data contradicted with that of the POPCEN 20072 data revealing that the sex ratio increased to 103 males to 100 females. The DOH 2005 data also shows that males are greater in number versus females in most age brackets with the exception of 30 to 34 year-olds 3.8% to 3.7% females against males, and 55 to 59 year-olds 0.9% to 0.8%

This data was the most recent and accessible during data acquisition.

females against males, and among more than 80 year-olds 0.4% to 0.3% females against males. The DOH data also exhibits the same inequity in the 2009 and 2010 projected population. These findings are gainsaying scientific genetic gender ratio of every three females is to one male. To illuminate on the matter, the femme outnumber the men due to one of two reasons; one, is that females have higher life expectancy than men and therefore beat them in longevity; second, females are less likely involved in lifethreatening events such as suicide, homicide, and accidents; third is the possibility that females leave the country for work leaving their male counterparts in the household. These factors outbalance the scale in favor of the female. Table 4.3 Civil Status n=769 Civil Status Single Married Widow/ Widower Divorced/ Separated Child Total
Total Percent

156 258 11 1 343 769

20.29 33.55 1.43 0.13 44.60 100.00

Table 4.3 shows civil status; here there are mainly children in the community, and that separated couples comprise the smallest. This data however does not show the distribution of males, females, and persons across age brackets; this merely reflects their totaled number.

Figure 4.3 Civil Status

343 350 300 250 200 150 100 50 0 Single Married Widow/ Widower Divorced/ Separated Child 11 1 156 258

In reference to the National Statistics Office data for 2007, the crude marriage rate (CMR) or the rate at which couples marry per thousand population, is 5.5 at the national level. In addition, there is a CMR of 8.1 in the Ilocos Region with 36,022 marriages. Marriage has experienced a boom compared to the number of singles. This could be related to the benefits of marriage such as economic security and companionship. Children on the other hand is the product of these marriages with the Philippines in 2006 registering a crude birth rate of 19.1 live births per 1000 population. Region I exceeded this with a CBR of 20.1. Table 4.4 Highest Level of Schooling Attended n=769 Highest Educational Attainment Elementary High School College Post-Graduate Did not attend school Total

Total 151 348 143 16 111 769

Percent 19.64 45.25 18.60 2.08 14.43 100.00

Table 4.4 shows the highest level of schooling attended by community members is high school, however, there are about 3 out of 20 who did not attend school. The field data may also be blemished in that it may not reveal whether the response given during the survey was the final schooling or highest schooling ever or is still a continuing climb in the academic ladder.

Figure 4.4 Highest Educational Attainment

348 350 300 250 200 150 100 50 0 Elementary High School College Post-Graduate Did not attend school 16 151 143 111

The 2003 Functional Literacy, Education and Mass Media Survey demarcated highest educational attainment, level currently attending, and persons not attending. In the highest educational attainment section for the Ilocos Region, out of 3,652,000 persons from 6 and over, the group with the most number is that of Elementary level with 894,000 and High School Graduate with 835,000; and Post-Secondary level as the smallest with 99,000. Here, there is a noticeable decline in the number of students as the educational hierarchy progresses, with High School as the peak period of education or may be said as the endpoint of educational hierarchy. The aftermath of this data would point out a blemish in employability citing that most jobs require a certain level in

collegiate education to be hired. To put it more bluntly, this limits employment options and weakens the overall economy of the barangay. Table 4.5 Employment Status n=769 Employment Status Government Employee Private Establishment Employee Employed in Private Household Self-Employed Employer in own Family-Operated Business Works with pay on own Family-Operated Business Worked without pay on own Family-Operated Business Overseas Worker Unemployed Retired Total Total 86 8 10 95 5 18 29 22 484 12 769 Percent 11.18 1.04 1.30 12.35 0.65 2.34 3.77 2.86 62.84 1.56 100.00

Table 4.5 shows the employment status; here, most of the people are unemployed which is inclusive of those not within the working age. And that the barangay is mainly a fishing community, giving us a little over a tenth of them as self-employed. We could deduce from the data that that 52.75% are wage and salary workers; 10.62% are unpaid family workers; and 36.63% are own account workers.

Figure 4.5 Employment Status

500 450 400 350 300 250 200 150 100 50 0 484

86 8 10

95 5 18 29 22 12

It could be said that the population has very little occupational or professional prowess. 256 working individuals versus 484 non-working individuals show dependence. The Labor Force Survey of April 2010 shows that the country has a 92.5% employment rate for those 15 years and over, a 7.5% unemployment rate, and 18.9% underemployment rate. Additional data from the 2008 Annual Survey of Philippine Business and Industry Preliminary Result, fishing had the least with 0.6% workers. To further economic data, the 2009 National Statistics Office Quickstat of January 2009 in coordination with the Philippine Overseas Employment Association reveals that there are 1.29 million OFWs deployed in 2008. Reflecting back on the antecedent table, since the schooling is low, the employment status is likewise low. Adding figures in Table 4.1 we

can acquire 386 people aged 18 to 65 (who are capable of working or could be said as employment age) is unbalanced with 273 employed people. This is yet another blow to the stability of the barangay in terms of economics. Table 4.6 Religion Distribution n=769 Religion Catholic Iglesi ni Cristo Protestant Born Again Christian Jehovahs Witnesses Mormon Muslim Baptist Total

Total 581 120 0 43 15 0 0 10 769

Percent 75.55 15.60 0 5.59 1.95 0 0 1.30 100.00

Table 4.6 reports piety which reveals that most of the people are of Roman Catholic faith.

Figure 4.6 Religion Distribution

581 600 500 400 300 200 100 0 120 0 43 15 0 0 10

This may be attributed to the fact that basing from the 2000 Census, it reveals that Roman Catholic 80.9%, Muslim 5%, Evangelical 2.8%, Iglesia ni Kristo 2.3%, Aglipayan 2%, other Christian 4.5%, other 1.8%, unspecified 0.6%, none 0.1%. This data coincides with the gathered statistics from the barangay. Religion is a considerable modifier in health status in a way that religious doctrines or principles disagree with medical protocol. For example, Jehovahs Witnesses are bound by their religion never to receive blood and blood products; and Roman Catholicism is strict with the use of contraception in the domain of reproductive health. In these examples, a possible lifesaving practice is negated by piety. Table 4.7 Family Structure n=144 Type of Family Structure Extended Single Parent Blended Nuclear Communal Cohabitation Single Alliance Foster Parents Binuclear Total

Total 29 4 3 94 0 0 12 0 2 144

Percent 20.14 2.78 2.08 65.28 0 0 8.33 0 1.39 100.00

Table 4.7 reveals the family structure and that most of them are nuclear families.

Figure 4.7 Type of Family Structure

100 90 80 70 60 50 40 30 20 10 0 94

29 12 4 3 0 0 0 2

The Filipino family has been characterized to be mainly nuclear families and extended families with a sociological perspective. Pilitteri (2003) adds that single parents and blended families are emerging family types and will eventually cause a decline in the number of nuclear families. Furthermore, a nuclear family is a basic unit wherein decision making (tackling the facets of budgeting, education, and health choices) is confined within this basic unit without possible meddling from outside forces (as in extended families) Table 4.8 Decision Maker in the Family n=144 Family Decision Maker Father Mother Combination Total

Total 62 27 55 144

Percent 43.06 18.75 38.19 100.00

Table 4.8 among those families, the father is the common decision maker or head of the family.

Figure 4.8 Decision Maker in the Family

70 60 50 40 30 20 10 0 Father Mother Combination 27 62 55

This shows that the community is dominantly patriarchal in nature as is the history of Philippine families. According to Philippine Portal, The family is patriarchal in nature, in which the father is the head of the family who carries out the decisions and orders in the house including the disciplining of the children. He is also regarded as the main provider of the house: food, shelter, clothing and finances. The mother, on the hand looks after the children, do the chores and assist the husband in putting the family together. She is responsible in the moral and spiritual upbringing of the children and unity in the house. She may question her husbands authority over the children but will mostly be overlooked. The rise of the democratic decision makers can be attributed to women becoming the equally levelled breadwinner for the family and must therefore have a say in family affairs.

Table 4.9 Family Income n=144 Family Income per Month Below PhP 5,000 PhP 5,000 to PhP 9,999 PhP 10,000 to PhP 14,999 PhP 15,000 to PhP 19,999 PhP 20,000 to PhP 24,999 PhP 25,000 to PhP 29,999 PhP 30,000 to PhP 34,000 Above PhP 35,000 Total

Total 92 32 16 1 2 0 1 0 144

Percent 63.89 22.22 11.11 0.69 1.39 0 0.69 0 100.00

Table 4.9 is the family income which tells us that majority of the families are earning below PhP 5,000.00. This indicates that most of the families are below the poverty threshold.

Figure 4.9 Family Income

100 90 80 70 60 50 40 30 20 10 0 92

32 16 1 2 0 1 0 Above PhP 35,000

Below PhP 5,000 PhP PhP PhP PhP PhP PhP 5,000 to PhP 10,000 to 15,000 to 20,000 to 25,000 to 30,000 to 9,999 PhP PhP PhP PhP PhP 14,999 19,999 24,999 29,999 34,000

In reference to the 2006 Family Income and Expenditure Survey, the Ilocos Region amassed PhP 134 million, averaging PhP 142,000 with both reflecting a 12-

month distribution among 947,000 families. We can conclude by economic classification that most of the families belong to Class D whose earnings amount to PhP 5,000.00 to PhP 15,000.00 for a months subsistence. The National Statistical Coordination Board plots the annual per capita poverty threshold in 2006 at PhP 15,057, with the poverty incidence at 26.9 percent for the same reference year. The National Wages and Productivity Commission states that in Region I, a non-agricultural minimum wage rate is at PhP 220.00 to PhP 240.00. In furtherance of this figure, we can compute that a family requires PhP 6,600.00 to PhP 7,200.00 to survive a month which clearly isnt met by the disclosed monthly income. Money is a big modifier in the life and health of a family. A low income family may not be able to allocate significant amounts to basic needs such as food, shelter maintenance, water, and the occasional health treatments. Table 4.10 Housing Material n=144 Material Concrete Wood Mixed Makeshift Total Total 75 35 34 0 144 Percent 52.08 24.31 23.61 0 100.00

Table 4.10 bares the type of housing material in the community which is mainly concrete.

Figure 4.10 Housing Material

80 70 60 50 40 30 20 10 0 Concrete Wood Mixed Makeshift 0 35 34 75

According to the 2007 Population Census, about 80% of the occupied housing units in Pangasinan had roofs made of galvanized iron or aluminum. Furthermore, about two in every five occupied housing units in 2007 had outer walls made of concrete or brick or stone. The National Statistical Coordination Board says that there are 14,891,127 occupied housing units in the country for the year 2000; and 4,587,978 houses made of concrete or brick or stone. The concrete type of house is most used because of its better structure compared to other materials. This clearly provides the qualifications of a shelter and those are stability, strength, and security. However, the housing material construction has a disproportionate relationship with that of family income. Despite the people having salaries less than PhP 5,000.00, they were able to build concrete houses. Table 4.11 Ownership Status n=144 Ownership Status of the House Caretaker/Free Rented/Leased Owned

Total 7 9 128

Percent 4.86 6.25 88.89

Total

144

100.00

Table 4.11 is the ownership status of the house declaring most own their houses.

Figure 4.11 Ownership Status of the House

140 120 100 80 60 40 20 0 Caretaker/Free Rented/Leased Owned 7 9 128

To make a congruent statement regarding real estate, Table 4.12 is the data stating the ownership of the lot where the housing unit is planted; it reveals that most of the lots are owned. Table 4.12 Ownership Status of the Lot n=144 Ownership Status of Lot Squatter Caretaker Common Property with Other Family Members Rented/Leased Owned Total

Total 6 6 2 9 121 144

Percent 4.17 4.17 1.39 6.25 84.03 100.00

Figure 4.12 Ownership Status of the Lot

140 120 100 80 60 40 20 0 Squatter Caretaker Common Rented/Leased Property with Other Family Members Owned 6 6 2 9 121

The figures points out that the people are capable of owning a home, which may not tally up with the family income data. We may infer that the people could be availing of home-financing schemes (via Pag-Ibig Fund-Home Development Mutual Fund). The study lacks scrutiny of how the lot and house were acquired and a further investigation is required to reveal ways in which families have built their properties. Table 4.13 Availability Gardening Space n=144 Availability of Gardening Space Yes No Total

Total 103 41 144

Percent 71.53 28.47 100.00

Table 4.13 divulges that most of the households have available plots for gardening.

Figure 4.13 Availability of Gardening Space

103

120 100 80 60 40 20 0 Yes

41

No

Economically and environmentally, a garden will provide a number of benefits for the owners. Primarily, this may be a source of food for the family. A variety of fruits and vegetables can be harvested from the garden with their variations dependent on the space and climate. Furthermore, if the family is able to procure food for themselves from their garden, this will reduce the expenditures dedicated to food and groceries. Activity can be acquired from tending to the garden and a reduction of stress has been reported. One question that requires answering is whether the family has actually employed the space for gardening. Furthermore, the space mentioned here does not necessarily state the require area dimensions in order to make gardening possible. Pots, plastic or metal containers can serve as alternatives to outdoor gardening and is worthy to be reconsidered; with the family still able to acquire the benefits of gardening stated above.

Table 4.14 Source of Drinking Water n=144 Source of Drinking Water Total Percent Rain 0 0 Spring, river, stream 3 2.08 Dug Well 12 8.33 Commercial Water 16 11.11 Shared tube or piped 27 18.75 Owned used tube/piped 31 21.53 Shared faucet, community water system 19 13.19 Own use, faucet, community water system 36 25.00 Total 144 100.00 Table 4.14 shows that a quarter of the households use their own water supply by faucet via a community water system, and that one in 48 families use water from a spring, river, or stream.

Figure 4.14 Source of Drinking Water

40 35 30 25 20 15 10 5 0 36 27 12 0 3 16 31 19

To elaborate, the community has a distributed pipeline which most of the houses are connected. This is the common plan for a community arising from a water district (Dagupan Water District).

To concur with this, the Water and Sanitation Program of East Asia and Pacific World Bank, in a report say that water consumers and providers treat water because water sources are not clean. Some households, especially the wealthier ones even purchase bottled water. The report plots about US$ 65.7 million for household treatment, US$ 4.0 million for purchased piped water, and US$ 46.8 million for purchased non-piped water. The supply of water is the supply of life. The potability of the water needs to be routinely checked because the community receives the same water from a water district; it could be inferred that a mishap in cleanliness can damage the health of the entire barangay. Water-borne disease abound the tropics and that Dagupan is an easy prey. The Environmental and Occupational Health Office also states that water coming from doubtful sources such as open dug wells, unimproved springs, wells that need priming and the like shall not be allowed for drinking unless treated through proper container disinfection Table 4.15 Drinking Water Storage n=164 Drinking Water Storage Tank Drum Earthen Jars/Pots Plastic Container Electric Powered Dispenser Others Total

Total 3 13 39 94 12 3 164

Percent 1.83 7.93 23.78 57.32 7.32 1.83 100.00

Table 4.15 shows that the community commonly uses plastic containers; trailing next is earthen jars and pots for water storage.

Figure 4.15 Drinking Water Storage

100 80 60 40 20 0 Tank Drum Earthen Jars/Pots Plastic Container Electric Powered Dispenser Others 13 3 12 3 39 94

Water storage plays a critical role in the health of the family. McCartney says that the lack of water is a major cause of food insecurity and poverty among the worlds poorest countries and that water storage can provide communities in dry areas. Furthermore, the type of storage has health implications. A tank can hold large quantities of fluid and is remained sealed, whereas a drum keeps exposed stagnant water. Earthen jars and pots may mar the water and decrease its potability. Plastic containers are reusable and may provide the highest benchmarks in storage but plastics also degrade in time and when exposed to heat. Table 4.16 Food Storage n=165 Food Storage Cabinet Open Shelves Refrigerator Others Total Total 80 36 49 0 165 Percent 48.48 21.82 29.70 0 100.00

Table 4.16 reveals that near half of the households store their food in cabinets followed by refrigeration as the next most often used option.

Figure 4.16 Food Storage

80 80 70 60 50 40 30 20 10 0 Cabinet Open Shelves Refrigerator Others 0 36 49

Food storage has a health impact in the sense of prolonging the shelf life of food. In this regard, open shelves may allow rodents or pests to plague the food and may likewise contaminate them with pathogens. Refrigeration may offer protection from rodents and pests, and allows for food to be stored for longer periods of time. Occurrence of food-borne diseases is also reduced with the use of refrigeration. Cabinets may only shield the food from physical entry of small rodents. Table 4.17 Drainage System n=144 Drainage System Not Available Open Blind Total

Total 29 80 35 144

Percent 20.14 55.65 24.31 100.00

Table 4.17 presents that the drainage system most commonly used is open.

Figure 4.17 Drainage System

80 80 70 60 50 40 30 20 10 0

29

35

Not Available

Open

Blind

No available drainage may pose flooding hazards to a community. The drainage serves as a waterway to prevent flooding and divert collected water away from inhabited areas. Dagupan City bore witness to the devastation of typhoons and the United Nations Disaster Assessment and Coordination blamed poor drainage systems and garbage disposal as the culprit to this cataclysm. Also, open drainage may pool and serve as breeding ground for a common disease vector, Aedes aegypti, a mosquito harboring the dengue virus. Table 4.18 Type of Dwelling Unit Structure n=144 Type of Dwelling Unit Structure Permanent/Concrete Semi-permanent/Wood Temporary/Nipa Total

Total 75 69 0 144

Percent 52.08 49.72 0 100.00

Table 4.18 supports Table 4.10 in showing most of the households are made of permanent-concrete material.

Figure 4.18 Type of Dwelling Unit Structure

75 80 70 60 50 40 30 20 10 0 Permanent/Concrete Semi-permanent/Wood Temporary/Nipa 0 69

This data agrees with prior data (See Table 4.10) pertaining to the choice of building materials. The Filipino family prefers to have houses built with permanent materials such as concrete, brick, or stone. Table 4.19 Electric Supply n=144 Electricity Supply No Connection Shared Connection Own Connection Total

Total 14 16 114 144

Percent 9.72 11.11 79.17 100.00

Table 4.19 exhibits that the households acquire electric current with their own connection and that less than a tenth has no connection.

Figure 4.19 Electricity Supply

114 120 100 80 60 40 20 0 No Connection Shared Connection Own Connection 14 16

Concurring with the results of the data from the 2004 Household Energy Consumption Survey, 14.6 million households or 87.6% of the 16.6 million households used electricity during the period October 2003 to September 2004. This also illustrates a certain degree of luxury acquired by the barangay showing that most of them are able to sustain and enjoy the benefits of electricity. Table 4.20 Cooking Fuel Source n=144 Cooking Fuel Source Collected Wood Purchased Wood/Sawdust Purchased Charcoal Kerosene/Gaas Liquefied Petroleum Gas Total

Total 42 2 24 15 61 144

Percent 29.17 1.39 16.67 10.42 42.36 100.00

Table 4.20 reveals that most of the households employ liquid petroleum gas as the main fuel source, followed closely by use of collected wood in about a third of the households.

Figure 4.20 Cooking Fuel Source

70 60 50 40 30 20 10 0 Collected Wood Purchased Wood/Sawdust Purchased Charcoal Kerosene/Gaas Liquefied Petroleum Gas 2 24 15 42 61

The users of liquid petroleum gas (LPG) summed to 4.2 million households, meaning that there is one in every two households in 2004. Moreoever, a total of 19 million households and 551 thousand households used gasoline and diesel, respectively, for power generation. Based on the results of the 2004 Household Energy Consumption Survey, there was a shift in the household preference on the source of fuel from nonconventional to conventional types. Specifically, the proportion of households using fuelwood reduced from 63.5% to 55.3%; the proportion households using charcoal from 38.5% to 34.2%. Among the conventional types of fuel, kerosene registered a decreased of 23.6% from 79.9% to 56.3% in 2004. Although LPG prices are finicky, it remains as the common household fuel because it is easily packaged, it is convenient, and relatively safe to use.

Table 4.21 Toilet Facility n=144 Toilet Facilities Not Available Open Pit Closed Pit Water-sealed, shared in other households Water-sealed, used exclusively by the household Flushed Toilet Total Total 0 13 16 25 66 24 144 Percent 0 9.03 11.11 17.36 45.83 16.67 100.00

Table 4.21 is that about half of the households have a water-sealed toilet exclusively by the household.

Figure 4.21 Toilet Facility

70 60 50 40 30 20 10 0 66

25 13 0 16

24

Apropos, the Water and Sanitation Program by the East Asia and the Pacific has stated the features of sanitation which primarily dealt with the disposal of human excreta. Along with this is making toilets cleaner and safer; hygiene (availability of water for anal cleaning and safe disposal of materials used therein, and handwashing); latrine access

(private, rather than shared or public); and isolation of human waste from water resource (improved septic tank functioning and emptying, flood-proof, with treatment and drainage system). The stated features determines the health, water-resource, welfare, tourism, and economic impacts of poor sanitation. Also the Proper Excreta and Sewage Disposal Program favors water carriage types of toilet facilities connected to septic tanks or to sewerage systems to treatment plants. Health implications can be seen noted in the possibility of food-borne diseases transmittable through fecal-oral route in that improperly disposed excreta can contaminate water and food sources. Table 4.22 Garbage Disposal n=144 Garbage Disposal Municipal Garbage Collection Communal Pit Open Dumping Burning Composting Others Total Total 103 0 12 29 0 0 144 Percent 71.53 0 8.33 20.14 0 0 100.00

Table 4.22 bares that the garbage is collected or disposed mainly by the municipal garbage collection; followed by burning as the second most preferred choice of disposal.

Figure 4.22 Garbage Disposal

120 100 80 60 40 20 0 Municipal Garbage Collection Communal Pit Open Dumping Burning Composting Others 0 29 12 0 0 103

Burning is a hazardous means to dispose of garbage: Health hazards abound with the use of burning; it causes the release of carbon dioxide and will therefore make an indelible carbon footprint. Open dumping is an avenue for pest proliferation and is outright unsightly and putrescent. More so, methane is released from rotting garbage, which is also detrimental to the ozone protection of the atmosphere. Table 4.23 Use of Garbage Segregation n=144 Garbage Segregation Yes No Total

Total 82 62 144

Percent 59.94 43.06 100.00

Table 4.23 shows that most of the households segregate their garbage into biodegrable or non-biodegrable sorts.

Figure 4.23 Garbage Segregation

100 80 60 40 20 0 Yes

82 62

No

Garbage segregation is a critical part in waste management. Dagupan City has decreed that segregation be practiced prior to the collection of garbage, to elaborate, nonsegregated garbage are left at the collection points in the barangay. The idea surrounding segregation is that biodegradable wastes can be used for composting, which is an alternative to using chemical fertilizers. Also, recycling can be made easier if the garbage has been presorted by the people.

Table 4.24 Animals or Pets Kept n=170 Animals or Pets Dog Cat Goat Cow Chicken Pigeon Turkey Duck Pig Total

Total 87 35 10 1 18 6 5 3 5 170

Percent 51.18 20.59 5.88 0.59 10.59 3.53 2.94 1.76 2.94 100.00

Table 4.24 is a list of the animals kept in the households showing that dogs are commonly kept, followed by cats with about a 30 percent difference.

Figure 4.24 Animals or Pets

90 80 70 60 50 40 30 20 10 0 87

35 18 10 1 Dog Cat Goat Cow 6 5 Turkey 3 Duck 5 Pig

Chicken Pigeon

Dogs are still the preferred pet of the Filipino family; they serve as guardians in the night with their barks as the alarms. Livestock are mainly used for food but may pose health risks as well. Sanitation is compromised with handling animal excreta and the smells emitted from it. The animals themselves may serve as reservoirs for

communicable diseases. Rabies, for example, can infect dogs; cows can fall victim to Mad Cow Disease; domesticated birds such as chickens, turkeys, ducks, and pigeons can be propagators of Avian Flu. A livestock farm in a residential area may not be agreeable. Table 4.25 Presence of Breeding Sites for Insects, Rodents, or Pests n=144 Presence of Breeding Sites Yes No Total

Total 69 75 144

Percent 47.92 52.08 100.00

Table 4.25 indicates that the presence of breeding sites for insects, rodents or pests is nearing a split but most households do not have breeding sites.

Figure 4.25 Presence of Breeding Sites

75 76 74 72 69 70 68 66 Yes No

These vectors are agents for communicable diseases. Leptospirosis may arise from rats especially during rainy months and flooding; dengue fever and malaria from mosquitoes, adding to the fact that the barangay is a fishing community; diarrheal diseases from flies.

Table 4.26 Stillbirth n=144 Stillbirth Yes No Total Total 9 135 144 Percent 6.25 93.75 100.00

Table 4.26 presents that there is one in every fifteen pregnancies resulting to stillbirth.

Figure 4.26 Stillbirth

135 140 120 100 80 60 40 20 0 Yes No 9

To cite the 2006 Fetal Death tally of the National Statistics Office, they have totaled fetal deaths to 8,458 cases. This shows a decrease of about 18.3% from the 2005 total of 10,351. The cause of stillbirth is a needed factor to be assessed, and therefore be dealt with. This assessment does not make it possible to reveal the culprits of stillbirths and that

Table 4.27 Causes of Child Mortality n=14 Causes Nutritional Deficiency Bronchitis Pneumonia Influenza Heart Disorders Accidents Malignant Neoplasm Enteritis Diarrheal Diseases PTB Measles Dengue Fever Typhoid Fever Malaria Infectious Hepatitis Fever Abortion Cough Total

Total 0 1 1 5 0 1 0 1 0 0 0 0 0 0 2 1 2 14

Percent 0 7.14 7.14 35.71 0 7.14 0 7.14 0 0 0 0 0 0 14.29 7.14 14.29 100.00

Table 4.27 shows that the most common causes of child mortality are influenza (5 cases) followed by fever and cough. These causes are reflective of the Department of Health Ten Leading Causes of Mortality (variations per gender) and that some entries are not actual disease entities, but are rather manifestations of the real disease. These responses are also affected by the ability of the informant to recollect definite medical history.

Figure 4.27 Causes of Child Mortality

5 5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 2 2

According to the Department of Health, in their 2005 Health Indicators, Mortality: Ten Leading Causes, Diseases of the Heart ranks first with 77,060 cases; followed by Diseases of the Vascular System (54,372 cases); third is Malignant Neoplasm (41,697 cases); fourth is Pneumonia (36,510 cases); next is Accidents (33,327 cases); succeeded by Tuberculosis (all forms with 26,588 cases); seventh is Chronic Lower Respiratory Diseases-which Influenza can be included (20,951); then there is Diabetes Mellitus (18,441 cases); and the ninth which is Certain Conditions Originating in the Perinatal Period (12,368 cases); and to complete the roster is Nephritis, Nephrotic Syndrome, and Nephrosis (11,056 cases). It could be noticed here that the national and local data are incongruent owing to the differences in the demographics. Influenza on the

other hand is a respiratory tract infection which is easily transferable from person to person especially in congested living spaces. Albeit communicable, it is also preventable. Furthermore, the next revealed causes are that of fever and cough, which may be manifestations of the influenza disease process. In such cases, the family may have wrongfully classified it as separate causes. Table 4.28 Common Illness in the Family n=198 Illness Diarrhea Upper Respiratory Infection Diabetes Mellitus Malaria Heart Diseases Chickenpox Anemia Parasitism Malnutrition Measles Fever Asthma Hypertension Total

Total 62 54 11 4 3 8 0 0 4 5 29 1 17 198

Percent 31.31 27.27 5.56 2.02 1.52 4.04 0 0 2.02 2.53 14.65 0.51 8.59 100.00

Table 4.28 shows that diarrhea is the most common illness experienced in the family followed by upper respiratory infection. Notice on fever as an accompanying manifestation or as part of the disease process but not an illness on its own.

Figure 4.28 Common Illness in the Family

70 60 50 40 30 20 10 0 62 54 29 11 17 4 3 8 0 0 4 5 1

Conferring with the Department of Health, the top ten leading causes of morbidity are: first Acute Lower Respiratory Tract Infection and Pneumonia with 690,556 cases; followed by Bronchitis/Bronchiolitis with 616,041 cases; third is Acute Watery Diarrhea totaling to 603, 287 cases; fourth has 406,237 cases of Influenza; fifth is Hypertension with a total 382,662 cases; ensued by Pulmonary Tuberculosis amassing 114, 360 cases; next is Dieseases of the Heart with 43,898 cases; eighth is Malaria accruing to 36,090 cases; trailing close behind is Chicken Pox with 30,063 cases; and finally Dengue Fever tallying a 20,107 count. In relation to water supply and water storage, diarrheal diseases can without difficulty be spread with consumption of unsafe water. To counter this, commercially prepared water or distilled water from distribution centers are preferable choices, in cases that the family cannot avail of them, boiling and proper storage are key in eliminating pathogens in the water. Respiratory infections ranks

second in that easy transferability is notable in the diseases chain of infection, as it is spread via droplets of respiratory secretions such as in coughing or sneezing. Table 4.29 Family Planning or Contraceptive Methods Used n=156 Family Planning Method Pills Condom IUD Injection Natural Methods Ligation Total

Total 39 81 0 4 31 1 156

Percent 25.00 51.92 0 2.56 19.87 0.64 100.00

Table 4.29 indicates that the condom is the majority contraceptive method used in the barangay.

Figure 4.29 Family Planning Method Used

90 80 70 60 50 40 30 20 10 0 81

39 31

0 Pills Condom IUD

4 Injection Natural Methods

1 Ligation

Conferring with the Final Results from the 2008 National Demographic and Health Survey, 51 percent of married women are using a family planning method or have a met need for family planning. Furthermore, the survey also states that there is 22

percent of married women with unmet need for family planning, 13 percent for limiting births and the remaining 19 percent for spacing births. These yields 73 percent of currently married women have a total demand for family planning. With the options presented, condoms are the preferred choice primarily because it is very affordable and very effective, likewise with pills. Ligation on the other hand is permanent and requires surgery, which tends to discourage couples from using it. When compared to the population of the barangay and the distribution of age, the data reveals that the population of those below 18 years exceeds that of the age group 18 years and above. This may suggest that a study on the effectiveness of the usage of family planning methods may need to be reexamined to determine the implications of contraception to the population statistics. Table 4.30 Health Resources Being Availed n=178 Health Resources Available Government Hospital Private Hospital Clinic Main Health Center Barangay Health Center Private Medical Station Barangay Health Workers Hilot Harbolario Total

Total 76 19 2 49 0 9 18 5 178

Percent 42.70 10.67 1.12 27.53 0 5.06 10.11 2.81 100.00

Table 30 displays the about two-fifths of health resources availed of is the government hospital.

Figure 4.30 Health Resources Availed

80 70 60 50 40 30 20 10 0 76 49

19 2 9 0

18 5

According to the 2005 to 2007 Philippine National Health Accounts, the country has spent 198,398 Million Pesos in total health expenditures. Also, the General government expenditure on health as % of total expenditure on health was at 43.7 percent last 2003 and was decreased to 39.8 percent last 2004. The most adjacent government hospital from the barangay is Region I Medical Center, which is also the biggest in the province. This proves that the barangay is well aware of the presence of and avails of the services of a government hospital. This is followed by a Barangay Health Center located in the neighboring barangay of Bolosan. The tradition of Hilot and Harbolario is also evident as a complementary alternative medical practice still being used by the barangay.

Problems Derived from Assessment Table 4.31 Computation Matrix for Academic pool of 14.43% who did not go to school and high school graduates of 45.25% Criteria Weight Computation Nature of the problem Health status 3 1 1/3 x 1 = 0.33 Health resources 2 Health-related 1 Magnitude of the problem 75% - 100% are affected 50% - 74% are affected 25% - 49% are affected <25% are affected Modifiability of the problem High Moderate Low Not modifiable Preventive Potential High Moderate Low Social concern Urgent Recognized as a problem but not needing urgent attention Not a community concern 4 3 2 1 3 2 1 0 3 2 1 2 1 0 Total 6.75

3/4 x 3 = 2.25

2/3 x 4 = 2.67

3/3 x 1 = 1

1/2 x 1 = 0.5

In this computation matrix, a score of 1 was given because the problem is categorized as a health-related problem (Education). In the magnitude of the problem, a score of 3 was given because about 60 percent are affected. Education is a moderately difficult area to modify in that it is contextual and relative to other factors (teacher, family preference, government policy), and a score of 2 was given. The problem has high

preventive potential because a school is present and is easily accessible. And the community folks assessed the problem to be non-urgent in terms of social concern. Table 4.32 Computation Matrix for Unemployment rate of 16.77% or about 126 people aged 18 and above who do not have/hold jobs currently Criteria Weight Computation Nature of the problem Health status 3 1 2/3 x 1 = 0.67 Health resources 2 Health-related 1 Magnitude of the problem 75% - 100% are affected 50% - 74% are affected 25% - 49% are affected <25% are affected Modifiability of the problem High Moderate Low Not modifiable Preventive Potential High Moderate Low Social concern Urgent Recognized as a problem but not needing urgent attention Not a community concern 4 3 2 1 3 2 1 0 3 2 1 2 1 0 Total 4.75

1/4 x 3 = 0.75

2/4 x 4 = 2

1/3 x 1 = 0.33

2/2 x 1 = 1

In this problem, this is classified as health-related (Economic), hence a score of 1 in nature of the problem. There is less than 25 percent affectation so a score of 1 is given for magnitude. The problem is viewed to be low in modifiability as the community is fishery-based with income-generating ventures as a solution not easily provided. The problem is also low in preventive potential citing business economics as fragile and

fluctuating without necessary control able to be imposed on to it. The community views this problem as their primary concern. 4.33 Computation Matrix for 63.89% of families have a family income below PhP 5,000.00 Criteria Weight Computation Nature of the problem Health status 3 1 2/3 x 1 = 0.67 Health resources 2 Health-related 1 Magnitude of the problem 75% - 100% are affected 50% - 74% are affected 25% - 49% are affected <25% are affected Modifiability of the problem High Moderate Low Not modifiable Preventive Potential High Moderate Low Social concern Urgent Recognized as a problem but not needing urgent attention Not a community concern 4 3 2 1 3 2 1 0 3 2 1 2 1 0 Total 5.25

3/4 x 3 = 2.25

1/4 x 4 = 1

1/3 x 1 = 0.33

2/2 x 1 = 1

The problem is a health-resource problem (Money) and 2 was the given score. The problem has affected about 64 percent and therefore, a score of 3 was given for magnitude of the problem. The problem is not modifiable in the sense that income is spontaneous or ecstatic and with very little control, so a score of 1 was given. The problem also has a low preventive potential as the problem is rooted in the economic

facet and that prevention of an economic downturn is very slim. The matter is likewise a major concern of the barangay. Table 4.34 Computation Matrix for Waste management: 20.13% Burning; 8.33% Open dumping; and 43.06% of not practicing garbage segregation Criteria Weight Computation Nature of the problem Health status 3 1 1/3 x 1 = 0.33 Health resources 2 Health-related 1 Magnitude of the problem 75% - 100% are affected 50% - 74% are affected 25% - 49% are affected <25% are affected Modifiability of the problem High Moderate Low Not modifiable Preventive Potential High Moderate Low Social concern Urgent Recognized as a problem but not needing urgent attention Not a community concern 4 3 2 1 3 2 1 0 3 2 1 2 1 0 Total 6.83

2/4 x 3 = 1.5

3/3 x 4 = 4

3/3 x 1 = 1

The problem is seen as a health-related problem (Environmental) with 1 point for nature of the problem. This has also affected less than 49 percent (based on practice for garbage segregation) and a score of 2 was given for this criterion. Next is a score of 3 for modifiability citing health information and campaign as the modifiers of the problem

which are relatively easy to provide. The problem is also highly preventable and a score of 3 was given for preventive potential. The problem is not a social concern. Table 4.35 Computation Matrix for 47.92% of households have a breeding site for pests and rodents Criteria Weight Computation Nature of the problem Health status 3 1 1/3 x 1 = 0.33 Health resources 2 Health-related 1 Magnitude of the problem 75% - 100% are affected 50% - 74% are affected 25% - 49% are affected <25% are affected Modifiability of the problem High Moderate Low Not modifiable Preventive Potential High Moderate Low Social concern Urgent Recognized as a problem but not needing urgent attention Not a community concern 4 3 2 1 3 2 1 0 3 2 1 2 1 0 Total 5.49

2/4 x 3 = 1.5

2/3 x 4 = 2.66

3/3 x 1 = 1

In this problem, this is catalogued to be a health-related problem (Environmental) and a score of 1 was given. A score of 2 was given for magnitude of the problem because 48 percent of households are affected. 2 points is given this moderately modifiable problem because rodents and pests are hard to eliminate due to their number and

resilience. The problem however is highly preventable with sanitation as the solution to the chain of this problem. This problem is not viewed as a social problem. Table 4.36 Computation Matrix for Stillbirth occurrence of 9 in 144 families Criteria Weight Computation Nature of the problem Health status 3 1 3/3 x 1 = 1 Health resources 2 Health-related 1 Magnitude of the problem 75% - 100% are affected 50% - 74% are affected 25% - 49% are affected <25% are affected Modifiability of the problem High Moderate Low Not modifiable Preventive Potential High Moderate Low Social concern Urgent Recognized as a problem but not needing urgent attention Not a community concern 4 3 2 1 3 2 1 0 3 2 1 2 1 0 Total 3.41

1/4 x 3 = 0.75

1/3 x 4 = 1.33

1/3 x 1 = 0.33

This problem is branded as a health status problem and is given a score of 3. Furthermore, the problem is fairly rare with less than 25 percent. The problem is modifiable only when the cause of stillbirth has been identified (here, there is a qualm to pointing since the problem could be genetic meaning the score will change). The problem is given 1 point because the medical-pathological origins of the problem is hard to

prevent (dependent on the cause of t stillbirth). This is not a social problem and so no points is given in the social concern criterion. Table 4.37 Computation Matrix for Influenza is the leading cause of child mortality in 5 out of 14 cases Criteria Weight Computation Nature of the problem Health status 3 1 3/3 x 1 = 1 Health resources 2 Health-related 1 Magnitude of the problem 75% - 100% are affected 50% - 74% are affected 25% - 49% are affected <25% are affected Modifiability of the problem High Moderate Low Not modifiable Preventive Potential High Moderate Low Social concern Urgent Recognized as a problem but not needing urgent attention Not a community concern 4 3 2 1 3 2 1 0 3 2 1 2 1 0 Total 7.5

2/4 x 3 = 1.5

3/3 x 4 = 4

3/3 x 1 = 1

The problem is a health status problem and is given a score of 3. The problem has occurred in 35 percent and so a score of 2 was given for magnitude. The problem is highly modifiable because influenza is an external force that can be controlled. Likewise, the problem is also highly preventable since influenzas mode of transmission can be hindered. This is not a social problem.

Table 4.38 Computation Matrix for Diarrhea is the most common illness in the family in 62 out of 192 cases Criteria Weight Computation Nature of the problem Health status 3 1 3/3 x 1 = 1 Health resources 2 Health-related 1 Magnitude of the problem 75% - 100% are affected 50% - 74% are affected 25% - 49% are affected <25% are affected Modifiability of the problem High Moderate Low Not modifiable Preventive Potential High Moderate Low Social concern Urgent Recognized as a problem but not needing urgent attention Not a community concern 4 3 2 1 3 2 1 0 3 2 1 2 1 0 Total 7.5

2/4 x 3 = 1.5

3/3 x 4 = 4

3/3 x 1 = 1

The problem is categorized as a health-status problem and is given a score of 3. The problem has occurred about 33 percent and therefore a score of 2 is given. Furthermore, the problem is highly modifiable for the reason that diarrhea and its causes can be manipulated with regards to causation halting it from progressing. Likewise, the problem is highly preventable because the causes of diarrhea can be averted with sanitation practices which are easily doable. The problem however is not a social concern.

Chapter 5 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

Summary The unveiling of the health needs is made possible by the data acquired from the community survey form. The health needs encompassed the three types of needs enumerated by Maglaya. Sines, Saunders, and Forbes-Burford (2009) say that an epidemiological approach uses largely quantitative-type data in order to create an accurate description of the size and nature of a health-related problem and its distribution around a community. However, the computations facilitate prioritization in the sense that what is perceived to be most urgent is the priority or that what is most severe should be first dealt with. According to Sykes (2009) , the view of the local people as part of the health needs assessment is important, but does not go far enough. Listed below are the problems deduced from the data acquired from the Community Survey Form; with the corresponding scores using the computation matrix.

Table 5.1 List of Health Needs Identified and their Total Scores Problem Score Rank Influenza is the leading cause of child mortality in 5 out of 7.50 1 14 cases Diarrhea is the most common illness in the family in 62 out 7.50 2 of 192 cases Waste management: 20.13% Burning; 8.33% Open dumping; and 43.06% of not practicing garbage 6.83 3 segregation Academic pool of 14.43% who did not go to school and 6.75 4 high school graduates of 45.25% 47.92% of households have a breeding site for pests and 5.49 5 rodents 63.89% of families have a family income below PhP 5.25 6 5,000.00 Unemployment rate of 16.77% or about 126 people aged 4.75 7 18 and above who do not have/hold jobs currently Stillbirth occurrence of 9 in 144 families 3.41 8

Conclusions The COPAR process makes it possible to study the community and its constituents at a very close level. A professional and close relationship will need to be established in order for the progression of the community to come into fruition. The process involves both parties in their attempts to increase the health status of the community and it is only through their joined efforts will the plan be completed. To qualify, carrying out the plans generated from the in-depth study of the community may be hindered by several factors: the changing population of the community; the work ethic of the agencies involved; the resources needed; the cooperative effort of the residents; and a host of other factors unforeseen at this time. To circumnavigate the presented obstacles, a plan (See succeeding discussion) will be made in order to provide a

scaffolding of some sort in building the great edifice, that is furtherance in the community. A barangay, however small it is, is as intricate as a spiders web. The tiniest gush of wind can tear it down. We need to study this web and reinforce it with the tools of modern health care and COPAR, so that it will stand the test of social, political, economic, ethical, and medical turmoil.

Recommendations Primarily, the concern of the authors is the progression of the community being dealt with; therefore, it is but imperative that this is a preliminary study, next publications should focus on a larger scale to include the entire barangay. This can be facilitated by the adoption of Colegio De Dagupan as one of the areas to provide community extension services to, wherein, the College of Nursing can deploy continuous assemblages to the barangay for a continuous and thorough assessment. Furthermore, the COPAR process should be exercised in the development of a plan or strategies to alleviate the aforementioned health needs. This can be enlightened by following goal, objectives, strategies and proposed activities. Goal: The nursing society and its auxiliaries know that the ultimate goal of community health nursing is the promotion of health and prevention of illness, and this can be started with a knowledge base. In this line, a short-term goal and long-term goal has been made.

o Short-term goal: The barangay will be able to execute healthpromotive behaviors following an information-education campaign to cover deficiencies in didactic foundations. o Long-term goal: The barangay and its residents has become a healthier community with them availing of health resources present. Strategies 1. The start of any action begins with a good foundation of information, and this could be achieved by increasing the peoples consciousness and knowledge on the following issues: a. Diet and its effects b. Exercise and/or activities c. Vices and their aftermaths d. Hygiene and maintenance of a clean environment e. Accident-proofing the environ f. Management of the home g. Waste disposal and environmental advocacy h. Ways of preventing illnesses and/or infections Proposed Activities 1. Information-education campaign a. Community classes focusing on the mothers; and trainings/seminarworkshops for the barangay health worker

b. Setting up of information boards where health or nutrition bulletins can be posted c. Home visits or clinic visits for case-finding and follow-up 2. Development Plans a. Livelihood Projects and a market survey for profitable ventures b. Implementation of Department of Health programs assisted by Student-Nurses 3. Evaluation a. Continued cyclical process of assessment to diagnosis, implementation, and evaluation until goals have been met. 4. Extension Services Colegio De Dagupan has been and is currently endeavoring to reach out and help the affiliated Community Health Nursing areas, and in this regard a developed Action Plan for the implementation of Community Organizing and Participatory Action Research (See Appendix E) was conceived by Dr. Brando Solis, Jan Patrick Arrieta, Dexter Corrales, and Joseph Michael Gascon. This plan serves as the backbone to instigate this essential tool in aiding the communities to further their status quo.

Bibliography Books Bastable, S., (2008) Nurse as Educator, Principles of Teaching and Learning for Nursing Practice (3rd Ed.) Massachusetts: Jones and Bartlett Publishers. Berman, A. and Snyder, A,Kozier, B.,Erb, G., (2008) Kozier and Erbs Fundamentals of Nursing, Concepts, Process, and Practice (10th Ed.). Jurong, Singapore: Pearson Education South Asia. Burns, N. and Grove. S., (2007). Understanding Nursing Research, Building an Evidenced-Based Practice (4th Ed.). Singapore: Elsevier. De Belen, R. and De Belen, D. V., (2008). A Praxis in Community Health Nursing. Quezon City: C and E Publishing, Inc. De Belen, R. and De Belen, D. V., (2007). Nursing Law, Jurisprudence & Professional Ethics. Quezon City: C and E Publishing, Inc. Ervin, N., (2002). Advanced Community Health Nursing Practice. New Jersey: Pearson Education Inc. George, J., (2002). Nursing Theories: The Basis for Professional Nursing Practice (5th Ed.). Jurong, Singapore: Pearson Education South Asia. Gesmundo, M., (2010). The Basics for Community Health Nursing, A Study Guide for Nursing Students and Local Board Examinees, Quezon City: C & E Publishing Inc. Gravetter, F. and Wallnau, L., (2008). Statistics for the Behavioral Sciences (7th Ed.). Singapore: Thomson Wadsworth Maglaya, A. and Cruz, R., Dones, L. B., Maglaya, M. C., Lao-Nario, M. B., (2000). Nursing Practice in the Community. Marikina; Arganauta Corporation. Marquis, B., and Huston, C., (2006). Leadership Roles and Management Functions in Nursing: Theory and Application.(5th Ed.).Lippincott Williams & Wilkins Penn, M., (2007). Microtrends, The Small Forces Behind Tomorrows Big Changes. New York: Twelve. Pillitteri, A., (2003). Maternal & Child Health Nursing Care of the Childbearing and Childbearing Family. (4th Ed.). Philadelphia: Lippincott Williams and Wilkins. Polit, D. and Beck C. T., (2004). Nursing Research Principles and Methods.(8th Ed.). Philadelphia: Lippincott Williams and Wilkins. Public Nursing in the Philippines. (2007). National League of Government Nurses of the Philippines Inc. Sevilla, C. and Ochave, J., Punsalan, T., (2004). Research Methods. Manila; Rex Bookstore. Sines, D., and Saunders, M., Forbes-Burford, J., (2009). Community Health Care Nursing. West Sussex, United Kingdom: Blackwell Publishing Ltd. Tomey, A. M., and Alligood, M. R., (2005). Nursing Theorists and Their Work (6th Ed.). Winsland, Singapore: Elsevier Inc. Venzon, L. and Nagtalon, J. M. V., (2006). Nursing Management Towards Quality Care (3rd Ed.). Quezon City: C and E Publishing, Inc.

Venzon, L. and Venzon, R., (2005). Professional Nursing in the Philippines (10th Ed.). Quezon City: C and E Publishing, Inc. Wilkinson, J., (2007). Nursing Process and Critical Thinking (4th Ed.). Jurong, Singapore: Pearson Education South Asia.

Electronic 2005 Annual Survery of Philippine Business and Industry, National Statistics Office, Retrieved June, 28, 2010, from http://census.gov.ph/data/aspbi2008/factsheets/2008%20ASPBI%20Factsheet%20 Economy-wide.pdf http://census.gov.ph/data/aspbi2008/factsheets/N%2008%20ASPBI%20factsheetr ev2.pdf Basic Literacy Rate of Population 10 Years Old and Over, by Sex, Age Group and Region, Philippines: 2003, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/sectordata/2003/fl03tabD.htm Benefits of Gardening, The., Retrieved August 16, 2010 from http://www.londonancestor.com/hobby/gardening.htm Change in Spending Pattern Among Filipino Families Seen in 2006, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/pressrelease/2007/ie06tx.html Community Organizing and Participatory Action Research (n.d.) Retrieved December 19, 2010, from http://nursester.blogspot.com/2009/02/community-organizingparticipatory.html Community Organizing and Participatory Action Research (n.d) Retrieved December 19, 2010, from http://www.scribd.com/doc/13730787/Community-OrganizingParticipatory-Action-Research Contraceptive Prevalence Rate Could Reach Over 70 Percent If All Family Planning Needs Were Satisfied, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/pressrelease/2010/pr1028tx.html Demographic Profile, Department of Health, Retrieved June 28, 2010, from Economy-wide Total Employment of 20 and Over, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/sectordata/aspbi2008tx.html Employment Rate Registered At 92.0 Percent in April 2010, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/pressrelease/2010/lf1002tx.html Estimated Population, Department of Health, Retrieved June 28, 2010, from Family Traditions and Customs in the Philippines, Retrieved July 15, 2010 from http://www.philippine-portal.com/arts-and-culture/traditions-andcustoms/family.html Fetal Deaths: 2006, National Statistics Office, Retrieved June 28, 2010, from http://www.census.gov.ph/data/sectordata/sr10474tx.html

FOCUS: Philippines Grapples with Garbage Disposal Problem Retrieved July 15, 2010 from http://findarticles.com/p/articles/mi_m0WDP/is_2001_Jan_8/ai_70384771/ Functional Literacy Rate of Population 10-64 Years Old, by Sex, Age Group and Group, Philippines: 2003, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/sectordata/2003/fl03tabE.htm Goal 7: Ensuring Environmental Sustainability, Retrieved July 15, 2010 from http://www.undp.org.ph/?link=goal_7 Half of the Women in the Philippines are Practicing Family Planning, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/pressrelease/2009/pr0929tx.html Mortality: Ten Leading Causes, Department of Health, Retrieved June 28, 2010, from Highest Income Earners Continue to Contribute More Than One-Third to the Income of All Families, National Statistics Office, June 28, 2010, from http://census.gov.ph/data/pressrelease/2008/ie06frtx.html Literacy Status of Filipinos, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/sectordata/fl03_lsf.html Live Births: Philippines, 2006, National Statistics Office, Retrieved June 28, 2010, from http://www.census.gov.ph/data/sectordata/sr10510tx.html Marriages: Philippines, 2007, National Statistics Office, Retrieved June 28, 2010, from http://www.census.gov.ph/data/sectordata/sr10511tx.html Maslows Hierarchy of Needs (n.d.) Retrieved June 19, 2010, from http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/mas low.htm Needs Assessment (n.d.) Retrieved June 19, 2010, from http://www.responsivemanagement.com/needsassessments.php NSO Takes Census of 1.7 Million Operators of Fisheries, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/pressrelease/2003/pr0362tx.html Nursing Research (n.d.) Retrieved June 19, 2010, from http://journals.lww.com/nursingresearchonline/pages/default.aspx October 2004 Household Energy Consumption Survey, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/pressrelease/2005/pr0554tx.html Official Population Count Reveals National Statistics Office, Retrieved June 28, 2010, from http://www.census.gov.ph/data/pressrelease/2008/pr0830tx.html Pangasinans Population Reached 2.6 Million Persons in 2007, National Statistics Office, Retrieved June 28, 2010, from http://www.census.gov.ph/data/pressrelease/2010/pr1014tx.html Percentage Distribution of Population 6-24 Years Old Who are Not Attending School by Reason for not Attending and Region, Philippines: 2003, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/sectordata/2003/fl03tabC.htm

Percent Distribution of Population 6 Years Old and Over by Age Group, by Highest Educational Attainment and Region, Philippines: 2003, National Statistics Office, Retrieved June 28, 2010, from http://census.gov.ph/data/sectordata/2003/fl03tabA.htm Philippines, Retrieved July 15, 2010 from http://www.wpro.who.int/NR/rdonlyres/368CD64E-E45D-47FD-A5EC881076EE143F/0/Philippines.pdf Philippine Demographics Profile, Retrieved July 11, 2010, from http://www.indexmundi.com/philippines/demographics_profile.html http://www.servinghistory.com/topics/Demographics_of_the_Philippines::sub::Re ligion http://www.sacred-destinations.com/reference/religious-affiliation-bycountry.htm Population Census (n.d.) National Statistics Office, Retrieved June 28, 2010 from http://census.gov.ph/data/census2007/index.html A Review of the Biology and Management of Rodent Pests in Southeast Asia, Retrieved July 15, 2010 from http://www.nri.org/projects/bandicoot/docs/review_of_rodent_biology_and_mana gement.pdf Seven in Ten Filipino Children Age 12-23 Months Received All Basic Vaccinations Before Reaching Age One, National Statistics Office, Retrieved June 28, 2010 from http://census.gov.ph/data/pressrelease/2010/pr1029tx.html Summary of Current Regional Daily Minimum Wage Rates, Department of Labor and Employment, Retrieved July 15, 2010 from http://www.nwpc.dole.gov.ph/pages/statistics/stat_current_regional.html Understanding Family Structures and Dynamics, Retrieved July 15, 2010 from http://health.howstuffworks.com/pregnancy-andparenting/parenting/understanding-family-structures-and-dynamics-ga.htm

Appendix A

Community Survey Form

Colegio de Dagupan COMMUNITY SURVEY QUESTIONNAIRE

A. HOUSEHOLD IDENTIFICATION 1. City/Municipality: ____________________________ 2. Barangay: ___________________________ 3. Address: (no. and street name)__________________ B. FAMILY MEMBERS CHART
Position in the Family 1 Head 2 Spouse 3 Son /Daughter 4 Father/ Mother 5 - Grandchildren 6 Grandparents 7 Other relatives 8 Other nonrelatives Current Employment Status 1 Government Employee 2 Private Establishment Employee 3 Employed in Private Household 4 Self-Employed without any Employee 5 Employer in own family-operated farm/business 6 Work with pay on own family familyoperated farm/business 7 Works without pay on own familyoperated farm/business 8 Overseas Worker 9 Unemployed 10 Retired Religion 1 Catholic 2 Iglesiani Cristo 3 - Protestant 4 Born Again Christian 5 Jehovas Witness 6 - Mormons

4. Household identification number:_____________________________ 5. Name of Respondent ______________________________________ 6. Name of the Household _____________________________________

Name

Age

Sex 1 Male 2 Female

Civil Status 1 Single 2 Married 3 - Widow or Widower 4 Divorced or Separated

Highest Level of Schooling Attended 1 Elementary 2 High School 3 College 4 PostGraduate

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

C. FAMILY CHARACTERISTICS 1. Type of Family Structure Extended Single Parent Blended Nuclear Communal 2. Family Decision Maker Cohabitation Single Alliance Foster Parents Binuclear

3. Ownership Status of the lot where house is built Squatter Caretaker Common Property with family members Rented/Leased Owned

4. Available space for gardening Yes Father Mother 3. Family Income/Month Below PhP 5,000 PhP 5,000 to PhP 9,999 PhP 10,000 to PhP 10,000 to PhP 14, 999 PhP 15,000 to PhP 19, 999 D. HOME AND ENVIRONMENT 1. Housing Material Concrete Wood Mixed 2. Ownership Status Caretaker/Free Rented/Leased Owned Makeshift Others 6. Drinking Water Storage Tank Drum Earthen Jars/Pots Plastic Containers Electric-powered Dispenser Others PhP 20,000 to PhP 24, 999 PhP 25, 000 to PhP 29,999 PhP 30, 000 to PhP 34,999 Above PhP 35,000 Cohabitation Single Alliance No

5. Source of Drinking Water Rain Spring, river, stream Dug Well Commercial Water Shared tube/piped Shallow Deep Owned used Shallow Deep tube/piped Shared faucet, community water system Own use faucet, community water system

7. Food Storage Cabinet Open Shelves Refrigerator Others 8. Drainage System Not available Open Blind 9. Type of Dwelling-Unit Structure Permanent (Concrete) Semi-Permanent (Wood) Temporary (Nipa) 10. Electric Supply No connection Shared connection (Shared electricity bill in other households) Own connection 11. Types of Cooking Fuel Source primarily used Collected wood Purchased wood Purchased charcoal Kerosene (gaas) Liquefied Petroleum Gas (LPG)

12. Toilet Facilities Not available Open pit Communal 13. Garbage disposal Municipal garbage collection Communal pit Open damping Burning Composting Others(pls.spicify) Foster Parents Binuclear

14. Observes of garbage segregation Yes No

15. Pets/animal kept in the yard/house:

16. Are there breeding sites of insects,rodents,etc. present? Yes No E. HEALTH AND HEALTH PRACTICES(within the last 12 months) 1. Number of children: Born alive______ Registered Stillbirth Registered

Yes

No

Yes

No

2. Number of Decreased Children________________ Causes a) Nutritional Deficiency b) Bronchitis c) Pneumonia d) Influenza e) Heart Disorders(TOF,RHD) f) Accidents g) Malignant Neoplasm h) Enteritis- Diarrheal Disease(AGE) i) TB Respiratory j) Measles k) Dengue Fever l) Typhoid Fever m) Malaria n) Infectious Hepatitis(A,B,C) o) Others_________________ 3. Common Illness in the Family Treatment applied Diarrhea Upper Respiratory Infection Diabetes Mellitus Malaria Diseases of the Heart Chicken Pox Anemia (Pallor/Weakness) Parasitism Malnutrition Measles Others

4. Family Planning Acceptor Yes No Methods Used Pills Condom IUD Injection Natural Method Others:

5. Health Resources Government Hospital Private Hospital Main Health Center Private Medical Station Barangay Health Workers Hilot Halbolario Others:

5. Children Immunization(0-5y/o) Name Age BCG OPV DPT Measles HepaB FIC

_____________________________ Printed Name of Student/Interviewer

Appendix B Matrix for Scoring Community Health Problems/Health Needs from University of the Philippines College of Nursing Community Health Nursing Specialty Criteria Nature of the problem Health status Health resources Health-related Magnitude of the problem 75% - 100% are affected 50% - 74% are affected 25% - 49% are affected <25% are affected Modifiability of the problem High Moderate Low Not modifiable Preventive Potential High Moderate Low Social concern Urgent Recognized as a problem but not needing urgent attention Not a community concern Weight 3 2 1 4 3 2 1 3 2 1 0 3 2 1 2 1 0 1

Appendix C Organizational Structure of Barangay Mamalingling Local Officials

Sonny Tuates
Barangay Captain

Camilo Olesco

Secretary

Orlando Castaeda

Treasurer

Henry Cordero
Barangay Kagawad

Estrelia Jimenez
Barangay Kagawad

Lito Gabison
Barangay Kagawad

Federico Paras
Barangay Kagawad

Hemigildo Gamboa
Barangay Kagawad

Randy Ballesteros
Barangay Kagawad

Chris Tabora
Barangay Kagawad

Heidi Martin
SK Chairperson

Appendix D Photographs

Satellite image of Brgy. Mamalingling (By estimate of Land Area) using Google Earth

Barangay Hall of Mamalingling

Mamalingling Day Care Center

Mamalingling Elementary School

Basketball Court, West of the Barangay Hall

One of the many fish ponds in the barangay (Fishing as one of the main sources of livelihood)

A heap of garbage (Open Dumping)

A pumped underground well

Concrete streets

Appendix E Action Plan for Nursing Students in the Implementation of Community Organizing and Participatory Action Research Work Group: Dr. Brando Solis, Jan Patrick Arrieta, Dexter Corrales, Joseph Michael Gascon Area of Concern 1. Pre-Entry Phase/ Orientation Phase Objectives 1. Select a Site for Implementation of COPAR Approaches/Strategies 1. List adopted communities for COPAR implementation 2. Records review to satisfy DOPE (Depressed, Oppressed, Poor, Exploited) criteria 3. Preliminary investigation of Sites Locus of Responsibility RHU personnel Clinical Instructor Time Frame Results/Outcome Budget Activity fund College

June- August Site has been of First selected Semester

2. Identify key community officials

1. Set a courtesy call to Clinical concerned public officials Instructor 2. Introduce yourself and your agency 3. List community officials 1. Initiate contact through home or official visits to the community leaders or attending meeting of community leaders 2. Communicate interest in the communitys welfare 3. Maintain a two-way communication with the community leader 1. Arrange first meeting with identified key community leaders (Sophomore) Students with supervision Clinical Instructor Barangay officials

List of current Barangay Officials

3. Establish a good working relationship with the community

4. Conduct a community

Clinical Instructor

Minutes of the meeting Committee

organization meeting

a. Record attendance b. Prepare an agenda 2. Hold election for Health Action Committee 3. Write a report on the events transpired

Barangay officials

Officers as elected

2. Entry Phase a. Working Phase

1. Conduct community assessment a. Prepare a community spot map

1. Conduct an ocular survey. 2. Draw a spot map with legends 3. Take photographs of imperative landmarks 1. Interview reliable community officials and residents 2. Review pertinent records 1. Outline and detail the: a. Barangay Profile i. Barangay boundaries ii. Land Area iii. Total population iv. Total number of households v. Number of business establishment vi. Location of Barangay Hall/Health Center vii. Name and location of school and church, etc. b. Economic Features

(Junior and Senior) Students with supervision BHWs Midwives Sanitary Inspector

September to February of current Academic Year

b. Relate history of barangay

Community Diagnosis Compiled Community Survey forms Photographs Teaching Plan Project Plan Records of attendance during meetings, seminars, trainings, etc.

Activity fund College fund

c. Construct/ consolidate community profile

i.

Major source of livelihood ii. Industry iii. Housing iv. Sectoral Strategies v. Protective services vi. Sports and recreation vii. Barangay-owned facilities viii. Government support and organizations 1. Conduct home visits and interview head of household

d. Gather community demographic profile e. Present vital statistics and epidemiology data 2. Identify community health problems

1. Employ graphical/tabular presentation of statistics

1. List down the recognized problems as to: a. Health Status problems b. Health Resources problems c. Health-related problems

(Junior and Senior) Students with supervision Residents BHWs Midwives Barangay officials (Junior and Senior)

3. Analyze problems and determine

1. Enumerate the necessities for problem resolution

resources needed

a. Manpower b. Money c. Material 1. Compute for the prioritization of problems as suggested by Araceli Maglaya (1997)

Students with supervision

4. Identify priority community health problems a. List community problems according to priority 5. Prepare a community health care plan a. Work out details of the plan together with the Community Action Group

(Junior and Senior) Students with supervision

(Junior and 1. Brainstorm with Senior) Committee on the activities Students and programs to be taken with or carried out for the supervision resolution of the identified Barangay problems officials 2. Make a project plan BHWs reflecting the results of Midwives brainstorming 1. Creation of Teaching Plan on knowledge deficit 2. Make instructional materials 3. Conduct group classes/ seminars and trainings for the residents of the community 1. Identify the support agencies within the community

6. Implement community health care plan a. Conduct Health Education and Information Campaign b. Coordinate with Intra and Inter

(Junior and Senior) Students with supervision Barangay Officials BHWs Midwives NGOs

Agency/Sector

2. Help existing projects being implemented by support agencies

3. OrganizationBuilding Phase

1. Work together with the Committee members, LGUs, and residents in the execution of the project plan based on the identified needs of the community. 1. Formation of Core 1. Assess the sought-after Group persons in the community a. Identify key and list their names persons/ 2. Hold an election for the opinion committee heads and makers members b. Election of 3. Conduct a committee Project Heads meeting with the 2. Proposing community members to projects according suggest and discuss to community potential projects needs 4. Brainstorm on the details 3. Plan for the on how to carry out requisites of decided project as to the project proposal necessary manpower, a. Manpower manpower, money b. Material 5. Create a Gantt Chart on the c. Money time frame for project 4. Plot time frame completion and emphasize for project on meeting objectives set completion for each time frame 5. Carry out project 6. Complete project proposal proposal with the help of the a. Modify as Barangay Officials and needed and community members

c. Mobilize the community

Barangay Officials Key persons BHWs and Midwives Students with supervision

List of Sponsorships committee Fund-raising heads and ventures members Project proposal Project plan with Gantt Chart and Requirements for project completion

4. Sustenance Phase

replan 1. Conduct follow-up 1. Perform an ongoing visits and assessment of the project evaluation of projects progress 2. Monitor project until completion

Students with supervision

Gantt Chart

Activity Fund

Curriculum Vitae