• Factors Contributing to Acceptance on COVID-19 Vaccines Among High School Teachers in San Juan, Batangas

  • CONSENT FORM

    We are level IV nursing students from De La Salle Lipa. We are conducting a research study on the Acceptance and Contributing Factors on COVID-19 Vaccines among High School Teachers in San Juan, Batangas. In line with this, we, the researchers, would like to invite you to take part in this research study because we believe that your insights will be vital.

    This consent form may contain words that may be unfamiliar to you, but rest assured that we are willing to explain it to you, and if you have questions or clarifications, please feel free to ask us.

     

    Purpose of the research

    This study is designed to determine the factors which affect the decision of a high school teacher in accepting COVID-19 vaccines which can also be of help with the proposed plans of the Department of Education (DepEd) pertinent to the possibility of reopening classes in a limited face to face set up. This will also help in formulating solutions on how to combat vaccine hesitancy possibly among colleagues and/or community members.

     

    Participant Selection 

    You are invited to participate in this research study because we believe that your perceptions as a teacher who is currently teaching this Academic Year 2021-2022, a person who belong to the A3 vaccination category set by the Interagency Task Force (IATF), and who is in the field of the academe, can contribute much to determine the factors contributing to acceptance of COVID-19 vaccines.

     

    Voluntary Participation

    Your participation in this research is entirely voluntary. It is your choice whether to participate or not, and if you choose not to participate, we will wholeheartedly respect your decision. However, we are hoping that you will accept our simple request to participate. Rest assured that it is guaranteed that it will be handled with dignity and care.

     

    Procedures

     If you accept, you will be asked to answer a 10-minute survey questionnaire in Google Forms which is consisted of four (4) sections. In the first part, we would be asking for your sociodemographic profile (e.g., name, age, gender, etc.), followed by eight (8) questions regarding your health status, knowledge on COVID-19, adherence to preventive measures, and your level of fear or worry of being infected with COVID-19. The third section is consisted of two screening tests for psychological examination followed by a tool which measures your belief on several matters pertinent to COVID-19. 

    The main type of the survey questionnaire will only require you to type and tick items and the information recorded is confidential. Your name will not be included in the form, only a designated number will identify you, and no one else except Mr. Castillo and Mr. Escalona will have access to your survey to ensure anonymity and confidentiality.

     

    Duration

    The research data gathering takes place on September 2021 and will end on October 2021. We will be sending the questionnaire through your respective email accounts and will be collected after 2 weeks.

     

    Risks

     The risk associated with participating in this research study is minimal; however, if you feel like that you are uncomfortable on some of the items and you wish to withdraw your participation in this study, you may do it anytime and inform us, the researchers.

     

    Benefits

     Participants of this study will be able to assess their intentions to be vaccinated and be able to realize their internal determinants on their willingness to be accept the COVID-19 vaccines. This will also let the Department of Education – San Juan, Batangas obtain a copy of the study and possibly come up a solution to influence some teachers who are hesitant, as well as their community members. Moreover, volunteering and participating in this study will benefit not just us, the researchers and the people and organization aforementioned, but also those who will use this as a basis or guide.

     

    For further clarifications pertinent to the research, please contact us at 09398627687 or email us at dale_fernan_castillo@dlsl.edu.ph and/or jose_ed_karlo_escalona@dlsl.edu.ph.

  • I have read the provided information, or it has been read to me. I have had the opportunity to ask questions about it and any questions I have been asked have been answered to my satisfaction. I understand that I will be given a copy of this form, and the researcher will keep another copy on file. I consent voluntarily to be a participant in this study.*
  • Clear
  • Date*
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    2 digit month, 2 digit day, 4 digit year

  • Profile of Respondents

  • Sex*
  • School Division*
  • Highest Educational Level*
  • Which source of COCID-19 information/advice do you trust the most?*
  • Prior to your vaccination schedule, how often have you been bothered by each of the following symptoms?*
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  • HEALTH BELIEF MODEL

    Five-point likert scale: (1) Strongly disagree; (2) Disagree; (3) Neither agree nor disagree; (4) Agree; (5) Strongly agree. Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Maecenas porttitor congue massa. Fusce posuere, magna sed pulvinar ultricies, purus lectus malesuada libero, sit amet commodo magna eros quis urna. Nunc viverra imperdiet enim. Fusce est. Vivamus a tellus.Pellentesque habitant morbi tristique senectus et netus et malesuada fames ac turpis egestas. Proin pharetra nonummy pede. Mauris et orci. Aenean nec lorem. In porttitor. Donec laoreet nonummy augue.Suspendisse dui purus, scelerisque at, vulputate vitae, pretium mattis, nunc. Mauris eget neque at sem venenatis eleifend. Ut nonummy. Fusce aliquet pede non pede. Suspendisse dapibus lorem pellentesque magna. Integer nulla.Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Maecenas porttitor congue massa. Fusce posuere, magna sed pulvinar ultricies, purus lectus malesuada libero, sit amet commodo magna eros quis urna. Nunc viverra imperdiet enim. Fusce est. Vivamus a tellus.Pellentesque habitant morbi tristique senectus et netus et malesuada fames ac turpis egestas. Proin pharetra nonummy pede. Mauris et orci. Aenean nec lorem. In porttitor. Donec laoreet nonummy augue.Suspendisse dui purus, scelerisque at, vulputate vitae, pretium mattis, nunc. Mauris eget neque at sem venenatis eleifend. Ut nonummy. Fusce aliquet pede non pede. Suspendisse dapibus lorem pellentesque magna. Integer nulla.
  • Perceived Susceptibility*
    Rows
  • Perceived Severity*
    Rows
  • Health Motivation*
    Rows
  • Perceived Benefits*
    Rows
  • Perceived Barriers*
    Rows
  • Perceived Barriers*
    Rows
  • Cues to Action*
    Rows
  • Should be Empty: