Republic of the Philippines

BATANGAS STATE UNIVERSITY

College of Nursing and Allied Health Sciences
Gov. Pablo Borbon Main Campus I, Rizal Avenue, Batangas City, Batangas, Philippines
Tel No: (043) 300-2202 loc. 120, (043) 300-2273 loc. 1127 Email:
[email protected]

Title: “Health Culture on Complementary and Alternative Medicine

of Selected Barangays in Cuenca, Batangas”

QUESTIONNAIRE

I. DEMOGRAPHIC DATA

Instruction: Put a check (/) on the line as your answer in the given

questions.

1.1 Age:

__18-25 year old __42-49 year old

__26-33 year old __50-57 year old

__34-41 year old __58 and up year old

1.2 Sex: __Female __Male

1.3 Relihiyon

__Iglesia ni Cristo

__Born Again Christian

__Adventist

__Roman Catholic

__Islam
1.4 Educational Attainment:

__Level in Elementary __Graduated in Elementary

__Level in High School __Graduated in College

__Graduated in High School __Vocational

__Level in College Others_____

II. HEALTH CULTURE

Instruction: Put a check (/) on the line as your answer in the given

questions.

2.1 LIFESTYLE

a. Eating habits

Types of How often Kung hindi. Piliin

Food kung anong dahilan

Everyday Sometimes Never Don’t Prohibited

Rice I don’t Base on

like the my beliefs

taste Base on

I don’t my religion

have Base on

enough the advice

money of doctor
Pig Meat I don’t Base on

like the my beliefs

taste Base on

I don’t my religion

have Base on

enough the advice

money of doctor

Chicken I don’t Base on

like the my beliefs

taste Base on

I don’t my religion

have Base on

enough the advice

money of doctor

Fish I don’t Base on

like the my beliefs

taste Base on

I don’t my religion

have Base on

enough the advice

money of doctor

Sweet I don’t Base on

foods like the my beliefs

 taste Base on

I don’t my religion

have Base on

enough the advice

money of doctor

Salty I don’t Base on

Foods like the my beliefs

taste Base on

I don’t my religion

have Base on

enough the advice

money of doctor

Vegetables I don’t Base on

like the my beliefs
taste Base on
I don’t my religion
have Base on
enough the advice
money of doctor
Coffee I don’t Base on

like the my beliefs

taste Base on

I don’t my religion

have Base on

enough the advice

 money of doctor

Milk I don’t Base on

like the my beliefs

taste Base on

I don’t my religion

have Base on

enough the advice

money of doctor

Alcohol I don’t Base on

like the my beliefs

taste Base on

I don’t my religion

have Base on

enough the advice

money of doctor

Soft drinks I don’t Base on

like the my beliefs
taste Base on
I don’t my religion
have Base on
enough the advice
money of doctor

(Source MDAP Diet Manual, 2010)

b. hygiene

4- Everyday (always)
 3- Often (two to four a week)

2- Sometimes (one in a week)

1-Never

4 3 2 1
Bathing
Washing hands before and after using the
toilet
Cleaning wounds
Washing private part of the body
Drinking water from the faucet

2.2 HEALTH PERCEPTION

a. View on health

Instruction: Put a check (/) on the line as your answer in the given

questions.

4-Strongly Agree

3-Agree

2-slightly agree

1-disagree

4 3 2 1
Base on your view, are you healthy?

Base on your view, when you are sick, do

you think it’s a challenge by God?

Base on your view, when you are sick

because of wrong diet?

Base on your view, when you are sick or

have a condition is because of heredity?

Base on your view, when you are sick or

have a condition is because of lack of

exercise?

Base on your view, when you are sick or

have a condition is because of addiction

(drugs, smoking, etc.,)?

Base on your view, when you are sick or

have a condition is because of unhealthy

environment?

Base on your view, when you are sick or

have a condition is because of witch craft?

Base on your view, when you are sick or

have a condition is because of dwarf-like
creature?
Base on your view, when you are sick or

have a condition is because of karma?

b. Health seeking
 Write down the 1-4 numbers that rely on where do you seek to treat

your disease or illness, first to last (1 is the first and 4 is the last).

___Doctor

___Albularyo

___Massage Therapist

___Self-medication

Instruction: Put a check (/) on the line as your answer in the given

questions.

When you go to consult or to treat of your illness? Put

on check (/) as your answer on the given question.

____4 severe ailments

____3 moderate ailments

____2 mild ailments

____1 I Don’t feel ailments

How many times did you go to consult or to seek help to

treat your disease or condition as the following:

4- Everyday (always)

3- Often (two to four a week)

2- Sometimes (one in a week)

1-Never

4 3 2 1
Hospital/Clinic

Rural Health Unit

Massage Therapist

Herb Doctor

Others_________________

III. COMPLEMENTARY AND ALTERNATIVE MEDICINE

PRACTICES

Complementary and Alternative Medicine is a natural way to

treat or alleviate your disease or illness, meaning without any use

of conventional or standard medicine that prescribed by the

doctor. For instance, herbals, ointments, supplements,

acupuncture, massage therapy and so on.

III.1 Types of Complementary and Alternative Medicine

Instruction: Put a check (/) on the line as your answer in the given

questions.

Types of How often do you use?

Complementary and Everyday Often Sometimes Never

Alternative Medicine

Herbal medicine_____

Traditional Healers

(Herb doctor,

spiritualist, etc.,)

Massage therapy

“supplements”

(vitamins, minerals)

“ointments” (white

flower, eficacent oil

etc..)

Others__________

III.2 Accessibility

Where do you get or know about Complementary and

Alternative Medicine that you use in the following sources:

OO HINDI
Internet
Recommended by doctor
Recommended by neighbors or friends
Have plants
Television
Herb Doctor
Recommended by relatives
Others_____________

I.1 COMMUNICABLE OR NON-COMMUNICABLE

Types of Ailments Yes Sometimes Never

Pain like:__________

COMMUNICABLE DISEASE

Colds

Cough

Flu

Chicken Pox

Measles

Animal bite (dogs, cats,

etc.,)

Diarrhea

Mumps

Others_________

NON-COMMUNICABLE DISEASE

Hypertension
Allergies

Heart Disease

Stroke

Canser

Diabetis

Asthma

Renal Disease

Others_________

Instruction: Put a check (/) on the line as your answer in the given

questions.

What are you using to help you to treat yourself from sickness?

___ I use only Complementary and Alternative Medicine

___ I use Complementary and Alternative Medicine together

with conventional medicine.

 II. BELIEFS ON COMPLEMENTARY AND ALTERNATIVE

MEDICINE IN TERMS OF PERCEIVED EFFICACY

Instruction: Put a check (/) on the line as your answer in the given

questions.

4- Everyday (always)

3- Often (two to four a week)

2- Sometimes (one in a week)

1-Never

4 3 2 1
Efficacy on having ailments
Efficacy on everyday supplements
Efficacy on increasing immunity
Efficacy on the treatments of herb
doctors”
Efficacy on finasncial
Tradition/Culture
Natural, less side-effects
Efficacy as “maintenance”
Don’t have trust on conventional
medicine

Seconds Minutes Hour Day Weeks Month Year

How long
the
effects of
CAM that
you use?