INFORMED CONSENT FORM
Greetings! We are students from St. Anthony of St. Paul University Manila, and we are conducting a study in partial fulfillment of our subject Practical Research 1. This is to invite you to participate in this survey about The Analysis of the Academic Consequences of Social Isolation During the COVID-19 Pandemic on Senior High School Students. It is important that you read this form before you answer the survey. Please know that we value your decision to join willingly in this study. You are being informed that you have the free will to decline if you are not comfortable participating. Also, please know that you are free to withdraw at any time during the survey without any consequence on your part. Should you decide not to participate, you do not need to ask permission from the researchers. Moreover, any questions related to the study can be addressed to Kharmela De Guzman (deguzmankharmela@gmail.com), Gillee Ann S. Valdez (gilleeannvaldez0604@gmail.com), Coleen A. Visita (visitacoleen@gmail.com), Julianne Andre R. Demeterio(djulianneandree@gmail.com) . In compliance with the data privacy law, your email address will only be required as part of the consent form but will not be identified among the responses you will give in this survey. You may decide not to give your name, for we will only require your age, sex, and grade level. Please be informed that all information will be treated with utmost confidentiality, that no names or any identifiable information will be part of the paper, and that all responses will be reported in its consolidated form to safeguard your identity. Moreover, all the information you will give will only be accessible to the researchers and/or our mentor/teacher, and will be secured through this ‘Jotform’. Lastly, all information you will give will only be used for this research purposes alone. Should you agree with these terms, please continue with the form by clicking Next.
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Email
*
example@example.com
Name
First Name
Last Name
Age
*
Sex
Female
Male
Grade level
*
Grade 11
Grade 12
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Social Isolation Assessment
The questions you will answer are adopted from the abbreviated Lubben Social Network Scale (LSNS-6). This scale was developed by Dr. Lubben and Gironda (2003). This part of the questionnaire will measure the number and frequency of your social contacts with friends and family members and the perceived social support that you receive from them. The answers are scored as: none = 0, one = 1, two = 2, three or four = 3, five to eight = 4, nine or more = 5. A total score of 12 and below indicates that you are socially isolated.
Family: Considering the people to whom you are related by birth, marriage, adoption, etc.
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None
One
Two
Three or Four
Five to Eight
Nine or More
Through chats, calls, video calls, and different kinds of online platforms, how many relatives do you happen to have communication with at least once a month?
1
2
3
4
5
6
When discussing something personal and private that involves you, how many relatives do you feel comfortable with talking about this matter?
7
8
9
10
11
12
When in need of help, how many relatives could you ask for a helping hand?
13
14
15
16
17
18
Friendships: Considering all of your friends including those who live in your neighborhood
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None
One
Two
Three or Four
Five to Eight
Nine or More
Through chats, calls, video calls, and different kinds of online platforms, how many friends do you happen to have communication with at least once a month?
19
20
21
22
23
24
When discussing something personal and private that involves you, how many friends do you feel comfortable with talking about this matter?
25
26
27
28
29
30
When in need of help, how many friends could you ask for a helping hand?
31
32
33
34
35
36
Score
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Analyzing the impacts of social isolation on the academic motivation and performance of students
In this part of the questionnaire, we are interested in finding out how social isolation during the COVID-19 pandemic has influenced your learning experiences and your academic motivation and performance.
How is the lack of interactions during the pandemic affecting your overall academic motivation ? (express your answer in 3-5 sentences)
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Has the lack of interactions during the pandemic made you feel lonely? Why? ((express your answer in 3-5 sentences)
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How do the feelings of loneliness affect your learning experience?(express your answer in 3-5 sentences)
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Since the school year 2020-2021 is nearing its end, briefly explain your overall academic motivation after transitioning to the new teaching and learning environment. (express your answer in 3-5 sentences)
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Given that you are experiencing social isolation, how has it made it difficult for you to attend and focus in classes? (express your answer in 3-5 sentences)
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Has your performance as a student worsened or improved after being isolated? Cite ways. (express your answer in 3-5 sentences)
Do you think that social interactions are essential for completing school? Cite ways. (express your answer in 3-5 sentences)
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Assessing COVID-19 and social isolation - associated mental health impacts on students
Two (Questions 2 and 3) out of the four questions you will answer are adopted from the Patient Health Questionnaire-4 (PHQ-4). This part of the questionnaire aims to detect the COVID-19 and isolation-associated mental health impacts (such as anxiety and depressive disorders) on students.
Are there times when being socially isolated has been difficult for you? Why? (express your answer in 3-5 sentences)
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Give instances where isolation has led you to feel nervous, anxious (on edge), not being able to stop or control worrying? (express your answer in 3-5 sentences)
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Give instances where isolation has led you to feel down, hopeless, depressed, or have little interest or pleasure in doing things? (express your answer in 3-5 sentences)
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In general, how has social isolation affected your overall psychological well-being?(express your answer in 3-5 sentences)
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