Chapter 1 INTRODUCTION
Background of the Study According to Pimpas (1998) “All human being needs to be and feel safe, both physically and psychologically because one of the most basic human needs is safety” (Pimpas, 1998). Most of us protect ourselves within the changing environment by functioning as healthy individuals who make decisions in a reasonable manner. Disease prevention covers measures not only to prevent the occurrence of disease, such as risk factor reduction, but also to arrest its progress and reduce its consequences once established. Disease prevention is sometimes used as a complementary term alongside health promotion. Although there is frequent overlap between the content and strategies, disease prevention is defined separately. Disease prevention in this context is considered to be action which usually emanates from the health sector, dealing with individuals and populations identified as exhibiting identifiable risk factors, often associated with different risk behaviors (adapted from Glossary of Terms used in Health for All series. WHO, Geneva, 1984). Health Promotion is the provision of information and/or education to individuals, families, and communities that-encourage family unity, community commitment, and traditional spirituality that make positive contributions to their health status. Health Promotion is also the promotion of healthy ideas and concepts to motivate individuals to adopt healthy behaviors. Health promotion represents a comprehensive social and
2 political process, it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. Participation is essential to sustain health promotion action. According to Pender’s Theory (1982), health promotion and disease prevention should be the primary focus in health care, and when health promotion and prevention fail to prevent problems, and then care in illness becomes the next priority. Health promotion and disease prevention can more easily be carried out in the community, as compared to programs that aim to cure disease conditions. This is because the people in the rural area tend to go away from modern medical methods. Most of them, due to financial reasons, choose to avail of the services offered by “herbolarios” and other folk healers. In the local setting, promoting health to our fellow Filipinos is very crucial. Though, there are campaigns provided by the government’s health agency, which is the Department of Health (DOH), there’s still a big percentage in the population who live unhealthily and many are suffering from different type of diseases. The researchers chose this topic to be the center of their research study because they want to know the level of disease prevention and health promotion and compare the results to determine if there is a significant difference in the two community. This study also aims to make a substantial contribution to the body of human knowledge and may even help in determining the primary reason why illnesses are mainly prevalent in the rural areas.
3
Theoretical Framework This study was anchored in the Betty Neuman’s System Model (1989). In this model nurses goal is to keep the client stable in systems terms, the maintenance of stability requires that interventions are directed towards counteracting movement to entropy or illness. Neuman (1989) describes nursing interventions by using the term prevention. As defined by Neuman's model, prevention is the primary nursing intervention. Prevention focuses on keeping stressors and the stress response from having a detrimental effect on the body. Primary -Primary prevention occurs before the system reacts to a stressor. On the one hand, it strengthens the person (primarily the flexible line of defense) to enable him to better deal with stressors, and on the other hand manipulates the environment to reduce or weaken stressors. Primary prevention includes health promotion and maintenance of wellness. Secondary-Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing systems. Secondary prevention focuses on preventing damage to the central core by strengthening the internal lines of resistance and/or removing the stressor. Tertiary -Tertiary prevention occurs after the system has been treated through secondary prevention strategies. Tertiary prevention offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution (K. Reed, 1993)
4 In the early 1980’s, the initial version of Pender’s Health Promotion (HPM) appeared in nursing literature (Pender, 1982). The HPM proposed a framework for integrating nursing and behavioral science perspective on factors influencing health behaviors. The framework offered a guide for exploration of the complex biopsychosocial processes that motivate individual to engage in behaviors directed toward the enhancement of health. Pender’s Health Promotion Model is based on the following assumptions, which reflect both nursing and behavioral science perspectives. First, persons seek to create conditions of living through which they can express their unique human health potential. This is inherent in every person. Second, persons have the capacity for reflective selfawareness, including assessment of their own competencies. Third, persons value growth in directions viewed as positive and attempts to achieve a personally acceptable balance between change and stability. Fourth, individuals seek to actively regulate their own behavior. Fifth, individuals in all their biopsychosocial complexity interact with the environment, progressively transforming the environment and being transformed over time. Sixth, health professionals constitute a part of the interpersonal environment, which exerts
influence
on
persons
throughout
their
lifespan.
Lastly,
self-initiated
reconfiguration of person-environment interactive patterns is essential to behavior change (Pender, Murdaugh & Parsons, 2002).
5
Conceptual Framework of the Study
Catalunan Pequeño Residents
Disease Prevention and Health Promotion
Sto. Niño Residents
Age Gender Family Income Educational Attainment Figure 1. Conceptual Paradigm of the Study The above paradigm describes the comparison between the two communities, namely Catalunan Pequeño and Sto. Niño in response to their level of disease prevention and health promotion in terms of their age, gender, family income, and educational attainment.
Statement of the Problem This study aimed to determine the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño. Specifically, this study answered the following questions: 1. What is the profile of the respondents in terms of:
6 a. Age b. Gender c. Family income d. Educational attainment 2. What is the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño? 3. Is there a significant difference between disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño as grouped according to profile. 4. Is there a significant difference between disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño?
Hypotheses Problems number one and two are hypotheses free. For problems three and four the following hypotheses have been derived: Ho1: There is no significant difference between the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño as grouped according to profile. Ho2: There is no significant difference between the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño.
Scope and Limitations
7 The study focused on the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño. This level of disease prevention gleaned from the views and experiences of the people residing in Catalunan Pequeño and Sto. Niño. Moreover, the study will also look into the practices towards health promotion by the residents of Catalunan Pequeño and Sto. Niño. The researchers conducted the study on August 2009. Furthermore, the study included respondents whose age is above 18 years old and will be purposely chosen. This method of selecting the respondent poses limitations on the generalizability of the findings.
Significance of the Study This research is believed to be significant to the following: To the Medical Practitioner. As soon as the level of disease prevention and lifestyle of people living among the selected residents of Catalunan Pequeño and Sto. Niño have been determined, medical practitioners can now identify the susceptibility of these individuals to certain illness. Appropriate interventions and health teachings then may be given to prevent them from acquiring diseases. To the Society of Catalunan Pequeño and Sto. Niño. Now in this contemporary time compared to the generation of the grandparents have a shorter life expectancy because most of people today are living with unhealthy lifestyle such as smoking, alcoholism and poor diet. Although they might have the advantage because of the modern technology and drugs that can easily get rid of certain diseases but still prevention is the best way for
8 them to be safe from these diseases. And this study is conducted to help individuals increase their level of disease prevention and to get rid of their unhealthy lifestyle. To the DOH. The results of this study can help the department of health update their information as regards to the level of disease prevention and health promotion in the selected residents of Catalunan Pequeño and Sto. Niño. Moreover, this study can help empower the DOH to further improve their health promotion programs to communities that needs assistance like the residents at Catalunan Pequeño and Sto. Niño. To the District III of Davao city. This research study can help promote awareness to the people living at Davao City specifically people from Catalunan Pequeño and Sto. Niño concerning the level of disease prevention and health promotion. So that in the future everyone can better prevent the susceptibility to certain diseases. In addition this study can educate respondents on how to prevent acquiring diseases by means of health promotions. To the Ateneo de Davao University. The results of this study can further help the school in giving references to future researcher that is related to this study. Moreover this study can further increase school’s knowledge about disease prevention and health promotion. To the Researcher. The results of this study gives the researcher more information about the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño. And hopefully in the future the researcher can apply the knowledge about disease prevention and health promotion not only in the community but to the world.
9 To the Future Researcher. Results of the study may serve as a basis of information for future similar researches to be conducted in the future.
Definition of terms To guide and for easy understanding of this study, the following conceptual and operational definitions of terms were presented: Community. According to Blackwell’s Dictionary of Nursing (2002) it refers to a group of people living in the same geographic area and under the same government. In this study, it refers to the selected residents of Catalunan Pequeño and Sto. Niño in which they will conduct this research study. Disease. According to Blackwell’s Dictionary of Nursing (2002) it refers to an illness or a departure from a state of health caused by an interruption or modification of any of the vital functions, and characterized by a definite train of symptoms. In this study, it refers to the primary symptoms that the people living at Catalunan Pequeño and Sto. Niño experiences like colds, fever, cough or stomach ache. Health Promotion. According to Blackwell’s Dictionary of Nursing (2002) it refers to the field of medicine concerned with safeguarding and improving the health of the community as a whole. In this study, it refers to the interventions or health teachings that they will provide to the people living at Catalunan Pequeño and Sto. Niño to prevent them from acquiring certain diseases.
10 Level of Disease Prevention. According to Blackwell’s Dictionary of Nursing (2002) (2002) it refers to activities designed to protect patients or other members of the public from actual or potential health threats and their harmful consequences. In this study, it refers to the primary prevention and health promotion of the residents of Catalunan Pequeño and Sto. Niño. Prevention. According to Maglaya (2004) it refers to identification of potential problems so that the nurse can minimize or probably even eradicate possible disability or deformity in a population-at-risk to a negative exposure factor. In this study, it refers to primary prevention of the residents of Catalunan Pequeño and Sto. Niño. Primary Prevention. According to Maglaya (2004) it refers to focusing on prevention of emergence of risk factors and removal of the risk factors or reduction of their levels. In this study, it refers to the activity that is concerned in preventing the specific illness or disease to the people living at Catalunan Pequeño and Sto. Niño. Residents. According to Blackwell’s Dictionary of Nursing (2002) it refers to an occupier, occupant, and inhabitant. In this study, it refers to the people residing at Catalunan Pequeño and Sto. Niño.
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Chapter 2 REVIEW OF RELATED LITERATURE AND STUDIES
Through the review of related literature and related studies, researcher was provided the knowledge and background on the topic or subject being studied. Reading these literatures and studies will help the researchers determine what has been done in the past and will give the researchers pointers on how to develop or make some progress on the status of its study.
Related Literature Disease Prevention Humans have been struggling with disease for thousands of years, and the problem only became more pronounced when people began living in closely crowded areas. As cities grew, so did the diversity of disease, along with a variety of colorful attempts at disease prevention. Not until the 1800s did people really begin to understand the process of disease, and start to take steps to prevent the spread of disease and to promote healthy communities, ranging from washing hands between patients to pasteurizing dairy.
12 Different nations have reached different levels in their disease prevention strategies. In developed countries, for example, basic steps like sanitizing drinking water, providing clean living conditions, and using widespread vaccination programs have proved to be very effective at preventing disease in community at large, and doctors can focus on individual patients. In the developing world, however, medical professionals are still struggling with the basic rudiments of disease prevention, ranging from encouraging the modification of cultural values to reduce the spread of disease to attempting to provide basic medical care. In communities, disease prevention is usually focused on providing clean living conditions and promoting education so that people understand the mechanisms of disease. Sewer systems, water purification plants, health codes, and the establishment of sterile hospital facilities are all examples of infrastructure which is designed to prevent disease. Many nations also have community education programs such as HIV/AIDS education which tell citizens about how diseases spread. This two-pronged approach reduces the risk of disease by eliminating conditions in which it can thrive. For individuals, disease prevention can include the use of vaccination and prophylactic medications, and the identification of risk factors which could make someone more prone to disease. General wellness may also be promoted, as healthy individuals with strong bodies are less likely to contract a disease. Based on Maglaya (2004), “promoting health make up most of the nurse’s activities in the community”. Disease prevention refers to identification of potential problems so that the nurse can minimize or probably even eradicate possible disability or deformity in a population-at-risk to a negative exposure factor. Disease prevention activities include
13 provision of proper nutrition, safe water supply and waste disposal system, vector control, promotion of a healthy lifestyle and good personal habits (Maglaya, 2004). Disease prevention in a narrow sense, means averting the development of disease that will manifest in the future. In a broad sense prevention consists of all measures, including definitive therapy, that limit disease progression. Leavell and Clark (1965) defined levels of prevention; primary and secondary. Although levels of prevention are related to the natural history of disease, they can be used to prevent disease and provide nurses with starting points in making effective, positive changes in health status of their clients. Within the levels of prevention, there are five steps. These steps include: Health promotion (primary prevention), Specific protection (primary prevention), early diagnosis and prompt treatment (secondary prevention), disability limitation (secondary prevention). Some confusion exists in interpretation of these concepts; therefore, a consistent understanding of primary and secondary prevention is essential. The levels of prevention operate on a continuum but may overlap in practice. The nurse must clearly understand the goals of each level to intervene effectively in keeping people healthy (Leavell & Clark, 1965). On the other hand disease prevention is sometimes used as a complementary term alongside health promotion. Although there is frequent overlap between the content and strategies, disease prevention is defined separately. Disease prevention in this context is considered to be action which usually emanates from the health sector, dealing with individuals and populations identified as exhibiting identifiable risk factors, often associated with different risk behaviors (Green & Kreuter, 1990).
14 WHO also stated that disease prevention covers measures not only to prevent the occurrence of disease, such as risk factor reduction, but also to arrest its progress and reduce its consequences once established (Glossary of Terms used in Health for All series, WHO, Geneva, 1984). More over disease prevention is an approach to the effective provision of essential health services that are accessible, acceptable, sustainable and affordable. Although promotive health measures are emphasized in the availability an accessibility of curative and rehabilitative services also affect peoples' health (Reyala, 2000). Disease prevention is an activity designed to protect patients or other members of the public from actual or potential health threats and their harmful consequences (Mosby's Medical Dictionary, 2009).
Health Health is defined in the WHO constitution of 1948 as: A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity. Within the context of health promotion, health has been considered less as an abstract state and more as a means to an end which can be expressed in functional terms as are source which permits people to lead an individually, socially and economically productive life. Health is a resource for everyday life, not the object of living. It is a positive concept emphasizing social and personal resources as well as physical capabilities (Ottawa Charter for Health Promotion, WHO, Geneva, 1986). Health is also a state characterized by anatomical, physiological, and psychological integrity; ability to perform personally valued family, work, and community roles; ability
15 to deal with physical, biological, psychological, and social stress; a feeling of well-being; and freedom from the risk of disease and untimely death (Stokes, Noren, & Shindell, 1982). Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources as well as physical capabilities (Last, 2000). Health Promotion Health promotion is the combination of educational and environmental supports for actions and conditions of living conducive to health (Green & Kreuter, 1990). Health promotion is the process of enabling people to increase control over, and to improve their health (Ottawa Charter for Health Promotion. WHO, Geneva, 1986). "Health Promotion is the art and science of helping people discovers the synergies between their core passions and optimal health, and become motivated to strive for optimal health. Optimal health is a dynamic balance of physical, emotional, social, spiritual and intellectual health.
Lifestyle change can be facilitated through a
combination of learning experiences that enhance awareness, increase motivation, and build skills and most importantly, through creating supportive environments that provide opportunities for positive health practices"(O'Donnell, American Journal of Health Promotion, 2009). Health promotion is “the science and art of helping people change their lifestyle to move toward a state of optimal health” (O’Donnell, 1987). Kreuter and Devore propose a more complex definition in a paper commissioned by the U.S. Public Health Service. The state that health promotion is “the process of
16 advocating health in order to enhance the probability that personal (individual, family, and community), private (professional and business), and public (federal, state, and local government) support of positive health practices will become a societal norm” (Kreuter and Devore, 1980).
Health Promotion Approaches Historically health promotion has tended to focus on specific disease, illness and injury prevention. Contemporary health promotion identifies and acknowledges the significance of underlying social determinants of health and uses a range of approaches to address the many factors that determine the health of individuals and populations. In the Socio-Environmental Approaches Health is often determined by factors outside the immediate health system and the control of the individual. The socioenvironmental approach promotes health by addressing the broader or social determinants of health (e.g. access to food, housing, income, employment, social isolation, early life, transport, addiction and education) as well as creating healthy environments. Health promotion actions commonly used in the socio-environmental approach include creating environments that support health, working with communities to strengthen community development and advocating for public policy. Examples of health promotion programs that work within this model include health promoting schools, health promoting workplace activities and school nutrition policy development. In the Preventive Medicine Approach is the traditional approach where in health sector understood health as the absence of illness and disease. This approach is directed
17 at improving physiological risk factors, such as high blood pressure and lack of immunization. This approach also focuses on the treatment and prevention of disease. Health promoting action in this approach is commonly referred to in a series of stages: primary, secondary and tertiary prevention. Action usually comes from the health sector, dealing with individuals and populations identified as having identifiable illnesses, risk factors and risk behaviours. The preventative approach promotes health through the following actions such as preventing the initial occurrence of an illness (primary prevention); e.g. childhood immunization programs, stopping or slowing existing illness (secondary prevention); e.g. cervical screening and reducing the re-occurrence and establishment of chronic illnesses (tertiary prevention), e.g. effective rehabilitation. The Lifestyle Behavioral Approach is generally based on the belief that giving people knowledge and skills to adopt a healthy lifestyle will improve their health. This approach is directed at improving behavioral risk factors, such as smoking, poor nutrition, physical inactivity and substance abuse. It focuses at the individual or population level and commonly uses health education, social marketing, self-help, selfcare and public policies to support healthy lifestyles. Examples of health promotion programs that work within this model include walking groups for adults with health concerns, oral health programs targeting primary school aged children and quit smoking campaigns and strategies (http://www.healthpromotion.act.gov.au/c/hp? a=da&did=1003708&pid=1150780477).
Primary Prevention
18 Primary prevention is the stage of prevention covers all activities such as immunizations, environmental sanitation, good personal hygiene etc. 5designed to ‘reduce’ the instances of an illness in a population and thus to reduce, as far as possible, the risk of new cases appearing; in speech and language therapy this mainly covers information and health education of a population, as well as training all those who have a role to play with the population in question (Murray, Zentner, & Pangman, 2006). On the other hand primary prevention also is directed to the healthy population, focusing on prevention of emergence of risk factors (primordial prevention) and removal of the risk factors or reduction of their levels. In communicable disease prevention, activities on primary prevention are targeted at intervening before the agent enters the host resistance, inactivate the agent (source of infection) or interrupt the chain of infection through environmental manipulation/modification and prevention of spread to human reservoirs and other susceptible human hosts. This can be done through personal surveillance, quarantine, segregation or isolation (Spradley, 1990). Kaufman stated that primary prevention targets generally health individuals to decrease the probability that they will develop a disease or disability. A classic example of a primary prevention strategy is fluoridation of public water supplies to prevent dental caries. For chronic diseases, primary prevention strategies are those that influence the entire population to adopt healthier life styles (Kaufman, 1990). Pender also stated that primary prevention refers to providing specific protection against disease to prevent its occurrence is the most desirable form of prevention. Primary preventive efforts spare the client the cost, discomfort and the threat to the quality of life that illness poses or at least delay the onset of illness. Preventive measures
19 consist of counseling, education and adoption of specific health practices or changes in lifestyle (Pender, Murdaugh, & Parsons, 2006). The primary prevention focuses mainly on health education and primary health promotion. This activity is concerned in preventing the specific illness or disease. The definition of primary prevention is to prevent the individuals in the onset of a targeted condition. Examples of primary prevention we have, giving active and passive immunization, teaching the client, maintaining normal body weight, maintaining the daily diet, eating healthy foods, regular exercise and many others. Primary prevention also is the most cost effective form of health care. Its target is the community as a whole (The U.S. Preventative Services Task Forces’ Guide to Clinical Preventive Services 2nd edition, 1996). Health promotion/disease prevention objectives relating to nutrition for the adult population will largely be achieved by primary prevention strategies. Information must be widely disseminated to encourage consumers to follow the Dietary Guidelines for Americans. Food markets, schools, houses of worship, libraries, and the media reach consumers in their daily activities. Exercise, fitness, and smoking cessation programs must be more broadly accessible. Incentives for food processors, restaurant chefs, and school and work site cafeteria managers should encourage them to prepare and serve foods lower in fat, calories, and sodium. Legislation and regulations can be enacted to ensure more complete nutrition labeling (Kaufman, 1990).
Public Health
20 The science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society and the government such as health care programmes designed and implemented to aid in the needs of the people in the community(adapted from the “Acheson Report”, London, 1988). Public health is a social and political concept aimed at the improving health, prolonging life and improving the quality of life among whole populations through health promotion, disease prevention and other forms of health intervention. A distinction has been made in the health promotion literature between public health and a new public health for the purposes of emphasizing significantly different approaches to the description and analysis of the determinants of health, and the methods of solving public health problems. This new public health is distinguished by its basis in a comprehensive understanding of the ways in which lifestyles and living conditions determine health status, and recognition of the need to mobilize resources and make sound investments in policies, programs and services which create, maintain and protect health by supporting healthy lifestyles and creating supportive environments for health. Such a distinction between the “old” and the “new” may not be necessary in the future as the mainstream concept of public health develops and expands. Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" (Winslow, 1920). Public Health is what we as a society collectively do to assure the conditions in which people can be healthy” (U.S. Institute of Medicine, 1988).
21 In conclusion, the general strategy of disease prevention and health promotions is to promote the factors that prevent the occurrence or impede the progression of such a disease and remove or diminish the factors that cause or contribute to the occurrence of a disease.
Related Studies International The first International Conference on Health Promotion, meeting in Ottawa this 21st day of November 1986, hereby presents this CHARTER for action to achieve Health for All by the year 2000 and beyond. This conference was primarily a response to growing expectations for a new public health movement around the world. Discussions focused on the needs in industrialized countries, but took into account similar concerns in all other regions. It built on the progress made through the Declaration on Primary Health Care at Alma-Ata, the World Health Organization's Targets for Health for All document, and the recent debate at the World Health Assembly on inter-sectoral action for health. Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept
22 emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being. Good health is a major resource for social, economic and personal development and an important dimension of quality of life. Political, economic, social, cultural, environmental, behavioral and biological factors can all favor health or be harmful to it. Health promotion action aims at making these conditions favorable through advocacy for health. Health promotion focuses on achieving equity in health. Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. This includes a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices. People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to women and men. The prerequisites and prospects for health cannot be ensured by the health sector alone. More importantly, health promotion demands coordinated action by all concerned: by governments, by health and other social and economic sectors, by nongovernmental and voluntary organization, by local authorities, by industry and by the media. People in all walks of life are involved as individuals, families and communities. Professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health. Health promotion strategies and
23 programmes should be adapted to the local needs and possibilities of individual countries and regions to take into account differing social, cultural and economic systems. Health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health. Health promotion policy combines diverse but complementary approaches including legislation, fiscal measures, taxation and organizational change. It is coordinated action that leads to health, income and social policies that foster greater equity. Joint action contributes to ensuring safer and healthier goods and services, healthier public services, and cleaner, more enjoyable environments. Health promotion policy requires the identification of obstacles to the adoption of healthy public policies in non-health sectors, and ways of removing them. The aim must be to make the healthier choice the easier choice for policy makers as well. Our societies are complex and interrelated. Health cannot be separated from other goals. The inextricable links between people and their environment constitutes the basis for a socioecological approach to health. The overall guiding principle for the world, nations, regions and communities alike, is the need to encourage reciprocal maintenance to take care of each other, our communities and our natural environment. The conservation of natural resources throughout the world should be emphasized as a global responsibility. Changing patterns of life, work and leisure have a significant impact on health. Work and leisure should be a source of health for people. The way society organizes work should help create a healthy society. Health promotion generates living and working
24 conditions that are safe, stimulating, satisfying and enjoyable. Systematic assessment of the health impact of a rapidly changing environment – particularly in areas of technology, work, energy production and urbanization - is essential and must be followed by action to ensure positive benefit to the health of the public. The protection of the natural and built environments and the conservation of natural resources must be addressed in any health promotion strategy. Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities - their ownership and control of their own endeavours and destinies. Community development draws on existing human and material resources in the community to enhance self-help and social support, and to develop flexible systems for strengthening public participation in and direction of health matters. This requires full and continuous access to information, learning opportunities for health, as well as funding support. Health promotion supports personal and social development through providing information, education for health, and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health. Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential. This has to be facilitated in school, home, work and community settings. Action is required through educational, professional, commercial and voluntary bodies, and within the institutions themselves.
25 The responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health service institutions and governments. They must work together towards a health care system which contributes to the pursuit of health. The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services. Health services need to embrace an expanded mandate which is sensitive and respects cultural needs. This mandate should support the needs of individuals and communities for a healthier life, and open channels between the health sector and broader social, political, economic and physical environmental components. Reorienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organization of health services which refocuses on the total needs of the individual as a whole person. Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love. Health is created by caring for oneself and others, by being able to take decisions and have control over one's life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members. Caring, holism and ecology are essential issues in developing strategies for health promotion. Therefore, those involved should take as a guiding principle that, in each phase of planning, implementation and evaluation of health promotion
activities,
women
and
men
should
(http://www.crrps.org/download/OttawaCharter.pdf).
National
become
equal
partners
26 The Department of health released seven steps toward a healthier life to be a guide in disease prevention and health promotion practices of the Filipino families. The 7 steps toward a healthier life are inter-related, easy-to-remember steps that can help patients achieve consistent improvements in health regardless of their age. Because behavioral changes are broken into components, the patient and the APN have the flexibility to choose 1 or more steps. It is important for health care providers to stress to patients that it is never too late to implement lifestyle changes and that no matter how small the change may seem, it is important. Remind patients that while the damage from some lifestyle choices (eg, smoking) seems to be greater than others, the body has an amazing ability to heal itself. (A recent article in Time magazine supported these ideas and is written in a tone that patients usually find reassuring and informative.) Providers can have these 7 steps printed and given to their patients on wallet-sized laminated cards with their office phone numbers and addresses on the back. Posters with the 7 steps can be placed on examination room doors, waiting rooms, and elevators. Many health-related organizations strive to promote good health and offer posters and brochures and other teaching materials for patient and provider use. Step 1: Eat Well But Not Too Much of the Wrong Foods. Nutrition counts. Population surveys indicate that the age-adjusted prevalence of overweight adults in the United States has increased from about 25% in the 1970s to 33% during the period from 1988-1991. The increase is evident for all race and sex groups. More patients eat out now than in previous years, and relatively few patients participate in regular exercise. People tend to gain weight as they age, particularly as their activity levels decrease. Permanent
27 lifestyle changes that combine nutritional strategies and increased physical activity are the most effective for weight management. The APN can ask questions about patients' dietary practices; even a 24-hour recall is helpful to understand how a patient manages nutritional intake. For some patients, a review of the food pyramid is helpful. For others, a consultation with a nutritionist may be required. Obesity is a difficult disease to treat and should be viewed by the APN as a complicated medical problem, just as coronary artery disease and diabetes are. Therefore, I believe that all patients who are obese and/or have a chronic disease should consult with a nutritionist in addition to working with their primary care provider. Children at risk for obesity should be identified early, and weight gain prevention practices such as nutritional guidance and emotional support should be put into place by the family. Patients who have lost weight are always at risk for weight regain. Exercise is the most effective method for weight maintenance. Individuals who burn about 2700 calories weekly through exercising above their daily activity achieve better weight control results than individuals who exercise less.(Standard exercise programs recommend burning 1500 calories per week, a substantial difference.) Many people cannot find the time to complete 30 to 60 minutes of daily exercise. However, patients should be informed about the level of exercise that will be required to maintain their weight loss. Step 2: Quit Smoking. Nearly 50 million Americans smoke while long-term studies now indicate that damage to the lungs from smoking is harder to undo than other damage, patients still reduce their risk for lung cancer and other diseases if they quit. Patients may experience benefits to the circulatory system immediately upon quitting. For details on
28 how to help a patient quit smoking, an article by Schaffer says that, "Clearing the Air: Brief Strategies for Smoking Cessation". Health care providers should ask patients who are smoking if they have ever tried to quit and, if so, what strategies they tried. Just because one strategy did not work does not mean that others will not work. Patients should be encouraged to remain open-minded about strategies. Even strategies that have been successful in the past may need to be altered the second time around. Step 3: Exercise Regularly. Exercise can make a person feel better immediately. It also helps patients cope with chronic disease and stress by increasing the body's release of endorphins and other hormones. Patients should be encouraged to avoid exercising too much too soon, which can result in soreness and motivate the patient to quit exercising. Any form of exercise that a patient is willing to undertake and is within his or her physical abilities should be encouraged. For specific guidelines on exercise, see the article by Padden, "The Role of the Advanced Practice Nurse in the Promotion of Exercise and Physical Activity," published in this issue. The benefits of exercise also are detailed in an online report from the National Center for Chronic Disease Prevention and Health Promotion; Health care providers who want specific information to share with their patients can print out this report, which is available on the CDC Web site at http://www.cdc.gov/health/physact.htm. The APN should ask patients what forms of exercise they like to participate in, feel comfortable doing, or have an interest in learning. Encourage patients to be as active as possible. If they cannot participate in a sport, encourage them to do small bits of activity such as sweeping the floor, parking further away from the entrance to a building than
29 they normally would, or perhaps moving around while talking on the cell phone. Sometimes crossing and uncrossing one's leg is better than no activity at all. Step 4: Maintain or Reduce Your Weight. Even a modest weight loss will have positive health effects. A 10% to 15% reduction in body weight in obese patients lowers blood pressure, decreases joint stress, and improves exercise tolerance. Patients were once told that they needed to achieve a normal weight to experience the benefits of weight loss. Although the full benefits of weight loss might be better realized if a normal weight can be achieved, many patients are not able to reach their goal weight These patients tend to become discouraged and depressed, which increases a sense of defeat and may even result in more weight gain. Step 5: Avoid Excessive Use of Alcohol and/or Other Drugs. Excessive use of alcohol and other drugs is associated with a decline in patients' health status and a lack of motivation for self-care practices in general. Patients who abuse alcohol and other drugs are at risk for accidents and often don't sleep or eat well. Frequently, they use these substances to self-medicate for anxiety disorders and depressive symptoms. The risks for dental caries, sexually transmitted diseases, and unplanned pregnancy are known to be higher in substance-abusing patients than in others. Unfortunately, adequate mental healthcare has become a luxury in our society; most insurance plans do not cover adequate treatment. Patients are stigmatized and fear asking for help because of rejection from providers, family members, and employers. There is a strong genetic basis for alcohol and drug abuse, and patients often experience many relapses before treatment is effective. Again, prevention seems to be key. Children and adolescents should be asked about substance abuse in their families. If
30 there is a positive family history, they should be encouraged to consider choosing not to consume alcohol or experiment with drugs. Anxiety and depressive symptoms should be identified early and treated before adolescents and adults decide to self-medicate. All patients should be asked about the use of alcohol and other drugs when they experience an event, such as an accident or unplanned pregnancy, associated with substance abuse. At routine visits, the provider should ask about the use of alcohol and other drugs and any risk factors for substance abuse. Step 6: Get Enough Sleep. The National Sleep Foundation reports that more than one half of adults surveyed (58%) experienced insomnia at least a few nights per week within the past year. It is believed that serious health effects may be at least in part caused by inadequate sleep. For example, a study reported at the American Diabetes Association's 61st Annual Scientific Sessions revealed that the incidence of insulin resistance was higher in persons who received 5 or fewer hours of sleep each day. Other sleep disorders, such as sleep apnea, have been reported to be associated with hypertension and Alzheimer disease. Health care providers can suggest various educational and behavioral strategies to reduce insomnia. It is important to teach patients about the kinds of behavior that disrupt sleep. For example, the bedroom should be reserved only for sleeping and sexual activities rather than more general activities such as watching television or reading. Strategies such as going to bed only when sleepy and getting out of bed after 15-20 minutes if unable to sleep and returning to bed later have been shown to re-establish the psychological connection between the bedroom and sleeping. Pharmacotherapeutic
31 management can be effective with patients who don't respond to relaxation techniques and sleep hygiene practices. Cognitive behavioral therapy has been shown to be superior to relaxation therapy or placebo for chronic primary insomnia.Patients will find that if they concentrate on some of the other steps for healthy living, their insomnia may also improve. Step 7: Practice Some Method of Relaxation on a Daily Basis. Stress-related hormones such as cortisol and epinephrine help people adapt to their environments, but if they are secreted in excess, body systems can be damaged. People today do not contend with the same threats as their ancestors did. Today's threats -- loss of self-esteem, socioeconomic losses, interpersonal conflicts -- often involve ill-defined, diffuse situations that are not resolved by a "flight or fight" response. However, today's threats are usually chronic and over time can cause the adaptive physiologic response to become maladaptive. Stress has been implicated in the pathophysiology of atherosclerotic processes, heart disease, hypertension, and stroke. While direct evidence that stress causes cardiovascular dysfunction or disease is not always conclusive, there is enough evidence for Health care providers to be concerned about stress levels in patients and to make recommendations for stress reduction. Patients frequently use nontraditional methods such as yoga, biofeedback, and acupuncture with success. Psychotherapy can help patients modulate the effects of chronic stress by teaching them how to recognize when they are stressed, what particular stressors seem to provoke physiologic responses, and how to cope in other, more healthy ways. Several of the other steps, such as exercising regularly and getting
32 adequate sleep, will also help mitigate the effects of stressful life situations (Department of Health, Retrieved on August 14, 2009).
Chapter 3 RESEARCH METHODOLOGY
This chapter presents the research design, research locale, respondents of the study, sampling technique, research instrument, research procedure, and statistical treatment of the data.
Research Design In this study, descriptive comparative design was used. This type of research is utilized since it would determine the difference between the disease prevention and health promotion among the residents in Catalunan Pequeño and Sto. Niño. Descriptive research is designed to summarize the status of phenomenon of interest as they currently exist.
Research Locale This study was conducted among the residents of the two communities in Davao City; Catalunan Pequeño, with a household of 792 and Sto. Niño with a household of
33 1178 (National Statistics Office, 2000). The site is selected due to its accessibility and to achieve a more comprehensive study.
Respondents of the Study The respondent of the study consisted of the selected residents of Catalunan Pequeño and Sto. Niño above 18 years of age. The researchers chose them because they came from a community who rarely seeks for medical assistance when not feeling well. Through these respondents they aimed to determine the level of disease prevention and health promotion of the two communities. The researchers also believe that these respondents will be honest and truthful upon answering the questionnaires. Table 1 Distribution of the Respondents Community
Actual No. of Household
n (Sample Size)
Catalunan Pequeño
792
133
Sto. Niño
1178
199
Total
1970
332
Table 1 shows the actual number of household in Catalunan Pequeño which is 792 while in Sto. Niño is 1178 (National Statistics Office, 2000). Thus, the total number of households in the 2 areas is 1970. The number of households that will be the respondents of this study in Catalunan Pequeño is 133 while in Sto. Niño is 199 and the total sample size of the two areas is 332. Proportion and allocation is use to distribute the respondents.
Sampling Technique
34 Multi-stage random sampling is the method used in this study. The researchers use this method because the respondents in this research study involves the whole household and that researchers just chose randomly one representative each household. The researchers use the Slovin’s formula to determine the sample size of the two communities that was the respondents of this study as shown below: n=
N (1 + Ne2)
_
Where: 1 - constant N- population size n- sample size e- margin of error n=_____1970_____ 1+1970 (0.05)2 n=_____1970_____ 1+1970 (0.0025) n=_____1970_____ 1+4.925 n=____1970______ 5.925 n= 332.4894515 The total sample size of this study is 332.
Research Instrument
35 The researchers utilized a survey questionnaire in determining the respondents’ level of disease prevention and health promotion. After a set of instructions and reminders, the researchers had set down the questions for the survey proper. The instrument aimed to measure the level of disease prevention and health promotion practiced by the community of Catalunan Pequeño and Sto. Niño. The survey questionnaires will be prepared according to the level of understanding of the respondents. Pretesting and revision of the questionnaire was done to improve the choice of words and sentence construction, check the validity and reliability of the questions, eliminate unnecessary questions, and therefore, eliminate errors and perfect the data collection instrument (Arboleda, 1998). The researchers hope that people who are interested in the disease prevention and health promotion among the residents of Catalunan Pequeño and Sto. Niño wascome more aware and active in the policy-making process. They want the residents of the said baranggays to pay attention to not only the questionnaires they have to answer but also the importance of the study in their day to day living. The researchers chose 10 respondents to participate in the pilot study that is not included in the actual respondents of this research. Through them the researchers hope that there would be an improvement in the content of the questionnaire. The scale below is found in the survey questionnaire and was use as the basis in determining the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño. Rank
Interval
Interpretation
4
3.27 - 4.0
Excellent
36 3
2.52 – 3.26
Very Good
2
1.36 – 2.51
Good
1
1.0 – 1.35
Poor
Research Procedure Permission to conduct the study was obtained from the baranggay officials of Catalunan Pequeño and Sto. Niño through a communication signed by all the researchers and noted by the adviser and the dean. Once permission to conduct the study was granted, the questionnaire was administered by the researchers and it was also retrieved after the respondents had finished answering it. After, the data collected were then be tallied and statistically treated.
Statistical Treatment Data were collected, collated and tabulated. Both parametric and non-parametric statistical tools were utilized. Data were encoded and treated through the SPSS 17.0 program using 0.05 level of significance. Statement problem number one was answered using frequency and percentage. Statement problem number two was answered using weighted mean. Statement problem number three was answered using 0.05 as its level of significance, is the t – test and ANOVA. Statement problem number four was answered using t - test.
37
Chapter 4 PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA
This chapter deals with the presentation, analysis and interpretation of statistical data on the Level of Disease Prevention and Health Promotion among the Selected Residents of Catalunan Pequeño and Sto. Niño, Davao City.
Profile of the Respondents Table 2 presents the demographic profile of the respondents in terms of age, gender, family income and educational attainment per baranggay. According to age, the data gathered shows that most of the respondents in Baranggay Catalunan Pequeño and Baranggay Sto. Niño were in the range of 30 yrs old and below earning 44.4 % and 48.7%. In terms of gender, the data gathered shows that most of the respondents were females garnering 57.1% and 56.3%. According to family income, the data gathered shows that most of the respondent’s highest monthly income appeared in the range of 4000 – 5000 pesos with 35.3% and 28.6%. Lastly, according to educational attainment
38 the data gathered shows that the majority of the respondents are high school graduates with 51.1% and 45.7%. In accordance to age, this implies that majority of the respondents belong to the age group that is particular with health promotion and disease preventive measures since this is a crucial time where in people tend to be cautious because of death causing illnesses experienced by their older relatives. In accordance to gender, one lifestyle factor accounting for the gender gap in mortality is that men are more likely prone when compared with women to engage in potentially risky behaviors such as smoking and drinking. Another gender difference in health habits is that women make greater use of preventive health services and are more likely to seek medical treatment when they are ill. Women’s greater tendency to visit the doctor’s office suggests that they are more health conscious than men. In accordance to family income, 4, 000-5, 000 pesos being the highest monthly income by both baranggays might not be enough for a family to supply their daily needs such as food because if you would divide presuming the highest income with P5000 to 30 days the result would be approximately P167 per day. Their income would basically be used up only for their daily needs and they cannot afford to buy other necessities for health such as vitamins and food supplements. Lastly, in accordance to educational attainment, Hill, Hoffman and Rex (2005) state that acquiring higher education is a form of human capital investment, and it generally leads to higher worker productivity, greater output, and enhanced economic prosperity. Lack of education can greatly affect the chances of finding a good job with good pay which may cause future problems in the community.
39
Table 2 Profile of the Respondents Category Age
Catalunan Pequeño Frequency Percentage (n) (%) 59 44.4 30 22.6 26 19.5 13 9.8 5 3.8 133 100
Sto. Niño Frequency Percentage (n) (%) 97 48.7 49 24.6 32 16.1 18 9.0 3 1.5 199 100
Gender
Frequency (n) 56 77 133
Percentage (%) 42.1 57.9 100
Frequency (n) 87 112 199
Percentage (%) 43.7 56.3 100
Family Income
Frequency (n) 11 16 36 47 23 133
Percentage (%) 8.3 12.0 27.1 35.3 17.3 100
Frequency (n) 31 36 43 57 32 199
Percentage (%) 15.6 18.1 21.6 28.6 16.1 100
Frequency (n) 8 68
Percentage (%) 6.0 51.1
Frequency (n) 18 91
Percentage (%) 9.0 45.7
30 yrs old and below 31 - 40 yrs old 41 - 50 yrs old 51 - 60 yrs old 61 yrs old and above Total
Male Female Total
1,000-2,000 2,000-3,000 3,000-4,000 4,000-5,000 5,000 and above Total Educational Attainment Elementary Graduate High School Graduate
40 College Graduate Others Total
48 9 133
36.1 6.8 100
69 21 199
34.7 10.6 100
Level of Disease Prevention and Health Promotion among the Selected Respondents of Catalunan Pequeño and Sto. Niño In the 40-item questionnaire given out, the researchers ranked the mean score in both baranggays into highest and lowest and compared the difference between the two baranggays. The highest mean score in Catalunan Pequeno is 3.58 which means that most of their respondents always takes a bath every day, while in Sto. Niño has a highest mean score of 3.53 which means that their respondents also do the same thing. This implies that most of the respondents of both the community knows the importance of proper hygiene and applies it to themselves not only as a means of preventing diseases but also as a means of promoting health and well being. The lowest mean score in Catalunan Pequeno is 1.90 which means that their respondents sometimes drink alcoholic beverages, while in Sto. Niño has a lowest mean score of 1.94 which means that their respondents also do the same thing. This implies that most of the respondents of both the community have a good reputation in taking alcoholic beverages occasionally. The rest of the items are not interpreted as poor but rather good, very good and excellent, this implies that both the communities has developed in keeping self-care
41 practices by doing proper hygiene in order to prevent diseases and promote healthy lifestyle for the benefit of their children.
Table 3 Level of Disease Prevention and Health Promotion Among the Selected Respondents of Catalunan Pequeño and Sto. Niño Items 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31.
Exercises regularly. Sleeps eight hours a day. Regularly intake of vitamin and mineral supplements. Avoids drinking alcohol. Avoids smoking. Takes a bath daily. Brushes teeth 3x a day. Cleans ear once/twice a week. Regularly keeps the nails trimmed nail short. Changes clothes everyday or as needed. Prefers eating vegetables every meal/day. Regularly eats fruits every meal/day. Limits intake of fatty foods such as meat. Eats three times a day. Regularly drinks milk. Washes hands before and after eating meals. Washes raw food before eating. Properly stores food. Cleans the kitchen daily/weekly. Sterilizes kitchen utensils weekly/once a month. Washes hands every after using the toilet. Uses toilet bowls when defecating. Flushes toilet bowl every after use. Keeps toilet clean and odor free. Disinfects toilet daily/weekly. Disposes garbage properly. Segregates biodegradable from nonbiodegradable wastes. Recycles non-biodegradable wastes. Composting the biodegradable wastes. Avoids burning garbage. Keeps the yard and its surroundings clean.
Catalunan Pequeño Mean Interpretation 2.26 Good 2.67 Very Good 2.30 Good
Mean 2.49 2.66 2.41
Sto. Niño Interpretation Good Very Good Good
1.90 2.01 3.58 3.56 3.40 3.11 3.40 3.29 2.99 2.88 3.38 2.98 3.30 3.24 3.24 3.35 3.10 3.25 3.32 3.34 3.32 2.92 3.20 2.92
Good Good Excellent Excellent Excellent Very Good Excellent Excellent Very Good Very Good Excellent Very Good Excellent Very Good Very Good Excellent Very Good Very Good Excellent Excellent Excellent Very Good Very Good Very Good
1.94 2.00 3.53 3.25 3.03 3.00 3.33 3.02 2.79 2.68 3.23 2.67 3.31 3.16 3.43 3.17 3.04 3.27 3.34 3.32 3.26 3.09 3.21 2.83
Good Good Excellent Very Good Very Good Very Good Excellent Very Good Very Good Very Good Very Good Very Good Excellent Very Good Excellent Very Good Very Good Excellent Excellent Excellent Very Good Very Good Very Good Very Good
2.76 2.86 3.41 3.29
Very Good Very Good Excellent Excellent
2.73 2.54 2.58 2.84
Very Good Very Good Very Good Very Good
42 32. 33. 34. 35. 36. 37.
Avoids having stagnant waters at the yard. Cleans drainage every week. Practices fogging weekly/once a month. Trims grasses around the backyard. Appreciates the importance of immunizations. Emphasizes the need to complete the required immunizations in the family. 38. Always aware of exisiting DOH programs related to immunizations. 39. Avails the free immunizations given by the baranggay health centers. 40. Knows the significance of completing the immunizations.
3.22 3.15 2.86 3.04 3.22 3.35
Very Good Very Good Very Good Very Good Very Good Excellent
2.87 2.82 2.85 2.91 3.17 3.25
Very Good Very Good Very Good Very Good Very Good Very Good
3.10
Very Good
3.17
Very Good
3.19
Very Good
3.20
Very Good
3.08
Very Good
3.20
Very Good
Difference Between Disease Prevention and Health Promotion Among the Selected Residents of Catalunan Pequeño and Sto. Niño as Grouped According to Profile. Table 4 shows the significant difference between level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño as grouped according to profile. According to age in Catalunan Pequeño the computed f value is 1.064 while the p value is 0.377 at 0.05 level of significance indicates that there is no significant difference between the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño in terms of age therefore the null hypothesis is accepted. In Sto. Niño the computed f value is 2.340 while the p value is 0.57 at 0.05 level of significance indicates that there is no significant difference between the level of disease prevention and health promotion among the selected residents of Sto. Niño in terms of age therefore the null hypothesis is accepted. According to gender in Catalunan Pequeño the computed t value is 0.100 while the p value is .921 at 0.05 level of significance shows that there is no significant difference between the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño in terms of gender therefore the null hypothesis is
43 accepted. In Sto. Niño the computed t value -.950 while the p value is 0.343 at 0.05 level of significance shows that there is no significant difference between the level of disease prevention and health promotion among the selected residents of and Sto. Niño in terms of gender therefore the null hypothesis is accepted. According to family income in Catalunan Pequeño the computed f value is .926 while the p value is .450 at 0.05 level of significance shows that there is no significant difference between the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño in terms of family income therefore the null hypothesis is accepted. In Sto. Niño the computed f value 1.452 while the p value is 0.221 at 0.05 level of significance shows that there is no significant difference between the level of disease prevention and health promotion among the selected residents of Sto. Niño in terms of family income therefore the null hypothesis is accepted. According to educational attainment in Catalunan Pequeño the computed f value 0.773 while the p value is 0.551 at 0.05 level of significance shows that there is no significant difference between the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño in terms of educational attainment therefore the null hypothesis is accepted. In Sto. Niño the computed f value 1.078 while the p value is .359 at 0.05 level of significance shows that there is no significant difference between the level of disease prevention and health promotion among the selected residents of Sto. Niño in terms of educational attainment therefore the null hypothesis is accepted. Table 4 Difference Between Disease Prevention and Health Promotion Among the Selected Residents of Catalunan Pequeño as Grouped According to Profile Catalunan Pequeño
f or t value
p value
Remarks
44 Disease Prevention and Health Promotion according to Age Disease Prevention and Health Promotion according to Gender Disease Prevention and Health Promotion according to Family Income Disease Prevention and Health Promotion according to Educational Attainment Sto. Niño Disease Prevention and Health Promotion according to Age Disease Prevention and Health Promotion according to Gender Disease Prevention and Health Promotion according to Family Income Disease Prevention and Health Promotion according to Educational Attainment
1.064 0.100 0.926
0.377 0.921 0.450
Accept Ho Accept Ho Accept Ho
0.773
0.551
Accept Ho
f or t value 2.340 -.950 1.452
p value 0.57 0.343 0.221
Remarks Accept Ho Accept Ho Accept Ho
1.078
0.359
Accept Ho
Difference Between Disease Prevention and Health Promotion Among the Selected Residents of Catalunan Pequeño and Sto. Niño Table 5 shows the significant difference between the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño. According to data gathered the computed t value is 2.215 while the p value is 0.028 at 0.05 level of significance indicates that there is a significant difference between the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño therefore the null hypothesis is rejected. Table 5 Difference Between Disease Prevention and Health Promotion Among the Selected Residents of Catalunan Pequeño and Sto. Niño Baranggay Disease Prevention and Health Promotion Among the Selected Residents of Catalunan Pequeño and Sto. Niño
t value 2.215
P value 0.028
Remarks Reject Ho
The two communities have a significant difference in their level of disease prevention and health promotion. Even though the two communities are both rural areas, the data that the researchers have gathered shows that there is a difference in both the communities’ health practices. This implies that a health promotion and disease prevention practice varies in every person regardless of their age, gender, family income and educational attainment.
45
Chapter 5 SUMMARY, CONCLUSION AND RECOMMENDATION
This chapter presents the summary of the study, the findings, conclusions based on the findings of the study and recommendations for future studies.
Summary This study aimed to prove if there was a significant difference between the level of disease prevention and health promotion among the selected residents of Catalunan Pequeño and Sto. Niño. The variables are the residents of Catalunan Pequeño and Sto. Niño, being the independent variable and the level of disease prevention and health promotion, being the dependent variable. This study used a descriptive comparative research design. Survey questionnaires were prepared having the level of disease prevention and health promotion of the two communities. The respondents were the selected residents in Catalunan Pequeño and Sto. Niño. The researchers used multi-stage sampling technique because the respondents in this research study involves the whole household and that the researchers just chose randomly one representative each household.
46 On August 2009, the researchers had their thesis title proposal. After which, revisions were made and the survey questionnaires were handed out to the said respondents. After all survey questionnaires were handed out, tallying began, the data was collated carefully using the SPSS 17.0 program to determine the percentage distribution of the respondents’ profile, measure the Level of Disease Prevention and Health Promotion, to determine if there is a significant difference in the Level of Disease Prevention and Health Promotion among the Selected Residents of Catalunan Pequeño and Sto. Niño, Davao City according to profile and if there is a significant difference in the Level of Disease Prevention and Health Promotion among the Selected Residents of Catalunan Pequeño and Sto. Niño, Davao City. Findings: 1. The profile of the respondents in terms of age, majority are 30 yrs old and below. 2. The family income mostly appeared is P4000 – 5000. 3. Most of the respondents are female. 4. In terms of educational attainment the results showed majority of the residents are high school graduates. 5. The overall level of disease prevention and health promotion of the respondents are very good. 6. There is no significant difference in the level of disease prevention and health promotion among the Selected Residents of Catalunan Pequeño and Sto. Niño, Davao City as grouped according to profile and 7. There is a significant difference between the Level of Disease Prevention and Health Promotion among the two community.
47
Conclusion Based on the findings of the study, the researchers concluded that there is a significant difference between the Level of Disease Prevention and Health Promotion among the Selected Residents of Catalunan Pequeño and Sto. Niño, Davao City. Recommendation Based on the results of this study, the researchers recommend that the local government would further extend their efforts in helping the rural communities to improve their health practices by developing and implementing effective health programs and services such as “Free Medical Check-ups”, “Medical Mission”, “Free Animal Vaccinations” etc. For the residents of the rural communities the researchers recommend that they should also take the initiative to avail and participate in the programs that are being implemented by the government and not be apathetic. Lastly, the researchers would like to recommend to the school especially to the nursing division to continue their efforts in imparting the skills and knowledge of their students about health during the community exposures.
