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AN ASSESSMENT OF THE HEALTH PROMOTION PRACTICES OF
THE RESIDENTS OF BRGY. BUKAL, CAVINTI, LAGUNA
A Thesis Proposal Presented to the
Faculty of the Graduate School
TRINITY UNIVERSITY OF ASIA
In Partial Fulfillment Of the Requirement for the Degree
MASTER OF ARTS IN NURSING
By
Vanessa M. Abalos, RN
August 7, 2010
CHAPTER ONE
INTRODUCTION
In this time of the 20th century, it is worthwhile to say that health
promotion has already reached its peak with the evolution of health promotion
from being just a concept to becoming a specialization and a profession in most of
the countries worldwide. Various organizations committed in the promotion of
health of the people such as World Health Organization, Australian Health
Promotion Association, and Canadian Public Health Association had made
significant contributions that catapulted the concept of Health Promotion into a
whole new level, making health the priority and the business of every human
being. Over the past two decades, explosion of interest and participation in health
promotion and wellness activities (Murray, 2009) became rampant as evidenced
by more people engaging in health-promoting activities such as exercise, proper
diet, and healthy lifestyle.
One of the most famous definitions of Health Promotion comes from the
World Health Organization which is the “process of enabling people to increase
control over, and to improve, their health (Ottawa Charter, 1986)”. Unknown to
the knowledge of many, health promotion is a concept distinct from the terms
health education and health maintenance in such a way that health promotion
conveys an umbrella effect on the other two terminologies and focuses on the
improvement of health, its goodness and wellness and enhancing the people’s
capacities for living (McKenzie, et al, 2005), regardless of any impairment on
their physical, mental, social, environmental, and spiritual condition. Health
promotion pushes a person forward towards the optimum goal of health. If health
maintenance refers to those activities that avoid illnesses, disabilities, etc.
(Murray, 2009), health promotion pertains to activities that aims to empower the
individuals to seek for better health. These actual behaviors that individuals
perform in seeking better health refer to Health Promotion Practices.
Health Promotion refers to the efforts to promote positive health (Naidoo,
2005). Whatever a person does to improve their health refers to health promotion
practices. However, these practices differ from one person to another depending
on how they define and understand health as influenced by their culture, religion,
spiritual beliefs. It also differs based on the geographical location of the area and
its socioeconomic status. Therefore, health promotion practices in one location
may not be necessarily the same in another location. Furthermore, certain health
promotion programs may need specific tailoring based on the current practices of
the target population. This scenario warrants a closer look in the health promotion
practices before arriving at a conclusion that would describe the health promotion
practices of the residents of Brgy. Bukal, Cavinti, Laguna.
This study aims to describe the Health Promotion Practices commonly
done by the residents of Brgy. Bukal, Cavinti, Laguna. Output of this study would
serve as a tool to document areas for improvement to enhance the health status of
the individuals in Brgy. Bukal.
Health Promotion Practices plays a big role in continuously enhancing
positive health. As a nurse, it is one of our major responsibilities to ensure that the
health promotion practices known to people are correct and makes a significant,
positive contribution to the optimum well-being of the community. As a
professional, it is expected that one has the knowledge and skills to meet the
needs of an individual or group. This puts the clients in the position to trust that
the “professional will keep the given entity’s best interest as the primary goal and
will strive to meet their needs (Endelman, et al., 2006)”.
Just as all nursing interventions begin with assessment, this study reflects
the first phase of the nursing process as it identifies the overall health status of
Brgy. Bukal. This acquisition of information will serve as the beginning of an on-
going process that can lead to the development of future nursing interventions.
BACKGROUND OF THE STUDY
This study will be conducted in Brgy. Bukal, Cavinti, Laguna, where the
researcher is currently assigned as a Clinical Instructor to supervise students in
their Community Immersion.
Brgy. Bukal is one of the 19 barangays of the Municipality of Cavinti,
Laguna with a total population of 1,200 and approximately 350 households. It has
a total land area of 543 hectares with 9 puroks namely Masigla, Maligaya 1,
Maligaya 2,Manigning, Magiliw, Marikit, Mahinhin, Marilag, and Isla.
Being the third adopted community chosen to be the recipient of the
Community Organizing Participatory Action Research (COPAR) program,
Makati Medical Center – College of Nursing (MMC-CN) is currently
implementing the first two phases of the COPAR Process which are the Pre-entry
and Entry Phase where the focus of nursing activities are purely integration and
desensitization of the community people to the presence of the students from
MMC-CN (Jimenez, 2005).
This is the second time that the said barangay has accommodated nursing
students having their community immersion, the first encounter being
approximately 10 years ago as mentioned by the community people. Since then,
no other studies have been conducted in and about the said barangay and most of
the records, if not destroyed by time, are not anymore applicable today. Due to the
lack of appropriate records of the barangay that can supposedly be used to further
describe the community specifically on their health promotion practices, this
raised a question in the mind of the researcher, “Are the health promotion
practices of the residents of Brgy. Bukal 10 years ago still applicable up to this
day?”
This scenario prompts the researcher to conduct a study on the current
health promotion practices of the residents of Brgy. Bukal. With the advent of
modern technology and the rise of new health-related breakthroughs and
discoveries, an assessment of their health promotion practices is needed to
determine the timeliness and effectiveness of these practices. At the same time,
the researcher is also motivated to improve the health status of the said rural
community, following the human perspective in health promotion as stated by
Lucas (2005) in his book Health Promotion Evidence and Experience that the
starting point in health promotion is the “desire to improve the quality of people’s
lives without necessarily adopting disease prevention as a primary aim”.
“An assessment should produce both needed change and increased
empowerment (Homan, 2008)”. For that reason, this study will find out the
common methods done by the residents of the community in promoting health
and the results of which will serve as a basis for designing and developing an
appropriate health education programs that will address the current need of the
community.
THEORETICAL FRAMEWORK
This research study works under the model of Dr. Nola J. Pender which is
the Health Promotion Model. This model works on the premise that individual
characteristics, including prior related behavior, personal factors, and
biopsychosocial factors have a direct effect on the desired health-promoting
behavior. At the same time, these individual characteristics also affect the feelings
and perception of the individual. All these combined affect an individual’s
commitment to a plan of action and the performance of the health-promoting
behavior (Murray, 2009). The researcher believes that the individual
characteristics of the residents of Brgy. Bukal such as the age, gender, civil status,
educational attainment, occupation, and spiritual beliefs affect their health-
promoting practices. Although the researcher will not give much attention on the
feelings and perception of the individual, the totality of this study under the
Health Promotion Model will serve as a reference in determining the compliance
of the residents of Brgy. Bukal to the Health Promotion Program that will be
implemented later on as the outcome of this study.
RESEARCH PARADIGM
Figure 1
Figure 1 explains the interrelationship of the variables of the study which
focuses on the research on the common health promotion practices of the
residents of Brgy, Bukal.
It begins with the profile of the residents of Brgy. Bukal in terms of their
age, gender, civil status, educational attainment, occupation, and spiritual beliefs
as it relates with their health promotion practices in terms of Health
Responsibility, Interpersonal relations, Nutrition, Physical Activity, Spiritual
Growth, and Stress Management. These two set of variables would lead to the
RESIDENTS OF BRGY. BUKAL
Age Gender Civil Status Educational
attainment Occupation Spiritual
Beliefs
Health Promotion Practices in terms
of:
Health Responsibility
Interpersonal Relations
Nutrition Physical Activity Spiritual Growth
Stress Management
Health Promotion Program
development of a health promotion program that would address the issues and
concerns of the community. This would require an analytic interpretation and
implication of findings.
STATEMENT OF THE PROBLEM
The study aims to design a health promotion program through the
identification of the common health promotion practices done by the residents of
Brgy. Bukal.
Specifically, this study seeks to find answers on the following questions:
1. What is the demographic profile of the residents of Brgy. Bukal in terms
of:
1.1. Age
1.2. Gender
1.3. Civil Status
1.4. Educational Attainment
1.5. Occupation
1.6. Spiritual beliefs
2. What are the health promotion practices of the residents of Brgy. Bukal in
terms of:
2.1. Health Responsibility
2.2. Interpersonal Relations
2.3. Nutrition
2.4. Physical Activity
2.5. Spiritual Growth
2.6. Stress Management
3. What are the common situations/scenarios that prompts the residents to
perform health promotion practices in terms of:
3.1. Health Responsibility
3.2. Interpersonal Relations
3.3. Nutrition
3.4. Physical Activity
3.5. Spiritual Growth
3.6. Stress Management
4. Is there a significant relationship between the profile of the residents and
their health promotion practices;
5. Based on the results of the study, what program can be designed to address
and enhance the health promotion practices of the residents of Brgy. Bkal?
SIGNIFICANCE OF THE STUDY
To the residents of Brgy. Bukal
The outcome of this study can benefit the residents of
Barangay Bukal by raising their consciousness on how to
promote positive health and their unique behavior as residents
of Brgy. Bukal. This will provide a solid and scientific
description of the health promotion practices they perform
thereby strengthening their exclusive identity. This can also
provide an opportunity to re-evaluate their own practices in
enhancing health and identifying their weaknesses thus the
creation of programs that can address the needs of Brgy. Bukal.
Results of this study can also lead to the development of
policies that will guide and control the behavior of the residents
towards a better health.
To the Community Health Workers of Brgy. Bukal and in Cavinti, Laguna
This study will benefit the Community Health Workers of
Brgy. Bukal by providing a concrete and scientific description
of the common practices done by the residents in the said
barangay thereby increasing their personal knowledge. This
description will provide an accurate knowledge of the client
and serve as the foundation where programs designed to
improve the health of the community can be built upon.
To Nursing Practice
The scientific result of this study can serve as a basis and
framework in developing and implementing programs
pertaining to health promotion especially to those living in
Southern Tagalog region. With the current knowledge on
health promotion produced by this study, future nursing
interventions in maintaining and managing health will have a
rational basis, thus contributing to the evidence-based practice
in the nursing field. The intended output of this study, which is
the Health Promotion Program can be implemented in other
areas where similar problems or concerns manifest.
To Nursing Education
This study can enrich the health promotion literature by
providing a documentation of the health promotion practices of
the habitants in one of the areas in Southern Tagalog region,
thus advancing the theoretical knowledge in health promotion.
Findings in this study can be used as a reference material in
teaching Health Promotion in the Colleges of Nursing and
Public Health.
To Nursing Research
This study can provide a scientific and statistical reference on
the current health promotion practices done in a rural
community which can be used as a document, reference
material, and a guide to future researchers who wish to conduct
a similar study. This study can be used as a building block for
subsequent research that can raise questions that would entail a
more complex, experimental research.
SCOPE AND DELIMITATION
The focus of this study is the heath promotion practices commonly done
by the residents of Barangay Bukal in terms of Health Responsibility,
Interpersonal Relations, Nutrition, Physical Activity, Spiritual Growth, Stress
Management.
.The researcher chose Brgy. Bukal as a convenient place to conduct the
study since the researcher will stay in the area 6 days in a week for the next 8
weeks to follow-up students undergoing Community Immersion. Therefore, the
data to be utilized in this study is readily available and accessible to the
researcher. Moreover, the researcher believes that a rural community like Brgy.
Bukal would yield more significant results that can contribute to the substance of
the study.
The subject of the study will be the long-time residents of Brgy. Bukal.
Five representatives from each of the eight puroks of the said barangay together
with the ten Brgy. Officials will be selected as respondents of this study. Data
gathering techniques will be limited to observation and distribution of survey
questionnaires.
DEFINITION OF TERMS:
1. Health – refers to a state of complete physical, social, and mental well-
being, and not merely the absence of disease of infirmity (WHO)
2. Health Education – refers to “any planned combination of learning
experiences designed to predispose, enable, and reinforce voluntary
behavior conducive to health in individuals, groups, or communities
(Green and Kreutuer, 2005)”.
3. Health Promotion – refers to efforts to improve the health status of an
individual and enhance his capacity to achieve health.
4. Health Promotion Practices – also known as Health Promotion
Behaviors; refers to
the actual behaviors performed by anindividual in order to improve health.
5. Health Maintenance – refers to the desire of an individual to actively
avoid the occurrence of illness or disease.
6. Health Protection – refers to behaviors that protect a person from
acquiring an illness or disease.
7. Health Responsibility – refers to
8. Interpersonal Relations – refers to social relationship of an individual. It
includes the kind of communication done by an individual to fulfill his
personal and intimate needs.
9. Nutrition – refers to the selection and consumption of food of an
individual
10. Physical Activity – refers to an individual’s participation in light,
moderate, or vigorous activity (Walker, S., 1996).
11. Spiritual Growth – refers to the ability of an individual maximize human
potential through searching for meaning, finding a sense of purpose, and
working towards goals in life (Walker, S., 1996). It also refers to the belief
of an individual to a higher form of being.
12. Stress Management – refers to the coping mechanisms done by an
individual to reduce tension or manage stress.
CHAPTER TWO
Review of Related Literature
A collection of extensive related literature is an essential part of a research
paper in a way that it serves as the framework of the study to make it substantial,
credible, and reliable. It serves as the feet of a research study so it can stand on its
own and make it strong enough for future researches to build upon.
The researcher gathered all literatures, both foreign and local, that are
deemed important to the topic at hand. Each literature was read and scrutinized,
and significant statements were selected and paraphrased by the researcher to
come up with this compilation of literature.
Foreign Literature and Journals
Health Promotion dates back up to the time when religion and superstition
influenced people’s belief on health and illness. The Babylonians, the Greeks,
Egyptians, Palestinians, Romans, and the Chinese have laid down the foundation
of most of the health promotion practices that we enjoy today. Concepts on
hygiene and sanitation were introduced to civilization by the Greeks whose belief
in health and illness was mandated by their gods and goddesses; the quarantine
practices that benefit people of today especially in communicable diseases can be
traced back during the Palestinian times under the Mosaic Code which
emphasized the importance of segregation by separating what is clean from the
unclean. The public health sanitation like street cleaning, building construction,
ventilation, heating, and water sanitation that we enjoy today are some of the
accomplishments of the Romans and Egyptians (Murray, 2009). Even during that
time, health was already considered of prime importance and its enhancement was
necessary, some for the purpose of achieving balance of the mind, body and spirit
and some as a form of luxury and personal indulgence. Whatever the purpose may
be, these ancient practices bear the underlying fact that an individual, even in the
earliest times, is always in search of activities that can prolong life and improve
the quality of life (Marks, et al, 2005).
As Health Promotion gains popularity, myriad of definitions rose and
overlap with one another. Oftentimes, the term health promotion is used
interchangeably with health education, health maintenance, and health
protection. The leading organization in managing health, the World Health
Organization (WHO) defined Health Promotion as “the process of enabling
people to increase control over, and to improve their health.(WHO, 1986)”.
During this definition’s inception, five key strategies were also identified namely
Building healthy public policy, Creating physical and social environments
supportive of individual change, Strengthening community action, Developing
personal skills such as increased self-efficacy, and Reorienting health services to
the population and partnership with patients (Ottawa Charter, 1986). This
definition coincides with the definition of Marks, et al (2005) which is “any event,
process, or activity that facilitates the protection or improvement of the health
status of individuals, groups, communities, or populations.” It targets a wider
range of population as it intends to focus on the community level which includes
environmental interventions such as “targeting the built environment (e.g. fencing
around dangerous sites) and involve legislation to safeguard the natural
environment (Marks, et al, 2005)”. It encompasses a broader scope as it
“represents a comprehensive social and political process” and with actions
“directed towards changing social, environmental, and economic conditions so as
to alleviate their impact on public and individual health (Health Promotion
Glossary, WHO, 1998).
A more individualistic approach on Health Promotion is reflected on the
definition of Pender, et al. (2006) which states that “Health Promotion is the
behavior motivated by the desire to increase well-being and actualize human
health potential”. This definition, on the other hand, includes the behavioral
approach of health promotion, which “focuses on secondary and primary
prevention to improve health status through lifestyle and behavior changes of
individuals (Leddy, 2006)”. These behavioral interventions are “primarily
concerned with the consequences of individual’s actions whose focus is on the
concept of empowerment (Marks, et al., 2005)”. The objective of this approach is
to generate changes in the behavior of an individual towards health, so that
independence and self-reliance can be fostered. This can be achieved by
increasing the awareness and knowledge of an individual on health and ways on
how to improve it through health education. Health Education is defined as “any
planned combination of learning experiences designed to predispose, enable, and
reinforce voluntary behavior conducive to health in individuals, groups, or
communities (Green and Kreutuer, 2005). Using Travis’s Illness-wellness
Continuum, movement in the direction of wellness state must begin with
awareness, followed by education, then growth (Kozier, 2008). Therefore, health
Education capitalizes on awareness and knowledge in initiating behavioral change
in an individual. This insight reflects the difference between health promotion and
health education, where health education serves as a tool in implementing health
promotion. To further operationalize the definition of health promotion, Breslow
stated on his commentary on health promotion in JAMA, 1999 “that each person
has a certain degree of health that may be expressed as a place in a spectrum.
From that perspective, promoting health must focus on enhancing the people’s
capacities for living. That means moving them toward the health end of the
spectrum, just as prevention is aimed at avoiding disease that can move people
toward the opposite end of the spectrum”. For this reason, Health promoting
behaviors must be geared towards the High-Level Wellness of Travis’s Illness-
Wellness Continuum.
Another definition of Health Promotion deals with the actions done to
promote health. Health behavior refers to the actual actions performed by an
individual to improve health. Health behavior alone is defined as “any activity
undertaken by an individual regardless of actual or perceived health status, for the
purpose of promoting, protecting, or maintaining health, whether or not such
behavior is objectively effective toward that end (WHO, 1998)”.
This definition introduces the other two terminologies that are frequently
confused with the promotion of health. There is a mention of the word protection
of health, which, according to Sharma (2008), are actions leading to protection of
health are those behaviors that protect a person from developing ill-health or
specific disease, example of which is immunization against Tetanus. Another is
the word maintenance of health where actions under health maintenance “are
those that seek to maintain health – avoid illness, disability, and so forth. Example
would be wearing of seatbelts, eating a balanced diet, and quitting smoking
(Murray, 2009)”. This kind of behavior is “motivated by a desire to actively avoid
illness, detect it early, or maintain functioning within the constraints of illness
(Pender, et al., 2006, p. 7)”. These two terminologies bear the two significant
words “prevent” and “avoid”, both conveying a negative connotation and focus
on the presence of disease. Using Travis’s Illness-Wellness Continuum, Health
Protection and Health Maintenance behaviors do not encourage movement of an
individual toward the High level of Wellness but maintain health on a status quo,
preventing health from moving towards the other end of the continuum which is
the Premature Death (Kozier, 2008), whereas Health promotion encourage
movements to the positive side of the continuum. To clearly delineate the
difference between the two, let’s take the example of a man jogging around the
village every morning. The man jogs everyday because he believes that this will
improve his stamina and increase his energy (Health Promotion) and at the same
time he is doing this to prevent burn fats and avoid cardiovascular diseases
(Health Protection or Disease Prevention) (Pender, et al., 2006).
These three foci of health behavior: promotion, protection, and
maintenance of health can now be summed up as “all actions with a potentially
measurable frequency, intensity, and duration performed at the individual,
interpersonal, organizational, community, or public policy level for primary,
secondary, and tertiary prevention (Sharma, 2008)”.
Health Promotion Behavior, or Health Promotion Practices are used
interchangeably in this study, although the term Health-promoting behavior is
now being used more often in health literature and bears a renewed interest as
behavior is motivated by a desire to promote personal health and well-being
(Pender, et al., 2006).
Health Promoting Practices or Behaviors of an individual differ from one
person to another. Pender (2006) stated it best that “each person has unique
personal characteristics and experiences that affect subsequent actions”. There are
five levels that affect a person’s behavior (Sharma, 2008). First, are the individual
factors, like the attitude of a person. If a person believes that a healthy body will
permit him to perform more challenging tasks, then engaging in health promotion
activities would come naturally. According to Fawcett (2005), “Environment,
culture, family background, work ethic, educational level, social standing, and
gender may contribute to the individual’s perception of heath and illness”. Then
personal view and understanding on the concept of health and illness also falls on
this level. In the earlier times, if a disease is believed to be caused by an entry of
an evil spirit, holes are bored into the skull of the patient to release these spirits. In
the Philippines, if illness or disability is caused by nunu sa punso or aswang,
people immediately visit an “arbolaryo” and submit the patient to a “tawas” to
detect the spirit believed to cause the disease. In addition to this, an individual’s
environment also play a crucial role in his health promotion practices as stated in
an article from the Global Health Promotion (Jul, 2010) entitled “How does socio
economic position link to health behaviour? Sociological pathways and
perspectives for health promotion” by Weyers S., et al. The study showed that the
“characteristics of the neighbourhood environment influence health behaviour of
its residents above and beyond their individual background”. Therefore, the
physical environment also determines the health promotion practices of an
individual. Also included in the individual factors are the age, civil status,
spiritual beliefs, occupation, and educational attainment of the individual.
Second level is the Interpersonal factors where an external factor affects
the behavior, example of which is a spouse requesting for a healthy breakfast.
Third level refers to organizational factors which include policies that contribute
to a better health like a company that allots 1 hour of exercise for employees
every morning. Fourth level is community factors, such as the physical
environment an individual is surrounded with. For example, if the person needs to
fetch water every day from the communal faucet that is 1 kilometer away from his
house, then that activity can be considered as a vigorous form of exercise. Last is
the role of public policy factors. For example, if a memorandum coming from the
Mayor mandates the cleaning of suspected breeding and resting sites for Dengue
mosquitoes three times a week, then that memorandum compels the residents to
do such (Sharma, 2008).
In this study, the factors that are taken into consideration are the 6
dimensions of health-promoting lifestyle identified in the Health Promotion
Lifestyle Profile II (Walker, et al., 1996). These are the Spiritual Growth,
Interpersonal Relations, Nutrition, Physical Activity, Health Responsibility, and
Stress Management. Health Promotion Lifestyle Profile II is used to measure the
health promoting behavior of an individual. Lifestyle, according to Pender (2006),
is defined as “discretionary activities that are regular and part of one’s daily
pattern of living and significantly influence health status”. In this study, the term
lifestyle is synonymous with Health Promoting Behaviors.
Spiritual growth or health is defined as the “ability to develop one’s inner
nature to its fullest potential which includes the ability to discover and articulate
one’s basic purpose; to learn how to experience love, joy, peace, and fulfillment
(Pender, et al., 2006, p. 104)”. Spiritual health is essential in assessing the heath-
promoting practices because this “affects the client’s interpretations of life events
and health (Chuengsatiansup, 2003 as cited in Pender, et al. 2006)”. Numerous
studies have been done supporting this significant correlation of spirituality and
health experiences. One of these is a study entitled “Spiritual health, clinical
practice stress, depressive tendency and health promoting behaviours among
nursing students by Hsiao Y. et al. (2010) wherein Spirituality was positively
associated with health-promoting behaviors. This relationship will contribute to
the holistic approach in assessing the health promotion practices of an individual.
Interpersonal Relations, likewise, is also vital in assessing health promotion
practices as this reflects the social relationship an individual posses. According to
Lucas (2005), positive social relationships “stimulate the production of a health-
promoting hormone and block the production of hormones usually related to
stress”. Positive social relationships offer a venue for verbalization of feelings of
the individual which is necessary for the individual to get in touch with their
feelings and emotions and enables the individual to select the most appropriate
strategy in dealing with stress through feedbacks from others. This dimension is
related to the third dimension of the HPLP II which is Stress Management as
“high levels of social support have also been linked to positive affect, and may
thus protect against distress from life events associated with high stress (Lucas, et
al., 2005 p. 130)”. Stress is defined as anything that may threaten the physical and
psychological well-being of a client. Assessment of how an individual handles
these stresses may serve as a better predictor of his health promoting practices.
Fourth and fifth dimensions of the HPLP II are the Nutrition and Physical
Activity, respectively. Nutrition involves the way an individual selects and
consumes foods that are essential in promoting a health well-being. Their
selection of food must be consistent with the guidelines provided by the Food
guide Pyramid. Physical Activity, on the other hand, “involves regular
participation in light, moderate, and/or vigorous activity (Walker, et al., 1996).
Assessment of physical activity is important since “sedentary lifestyle, for many
individuals, begin with childhood and continues until adulthood (Pender, et al.,
2006, p. 102)” and lack of physical exercise has been directly related with the
occurrence of cardiovascular diseases.
Last, but not the least, is the dimension on Health Responsibility, which
involves “an active sense of accountability for one’ own well-being (Walker, et
al., 1996)”. This includes paying attention to one’s health through education and
exercise of informed consumerism. As Pender, et al., (2006) mentioned,
“individuals play a significant role in the determination of their own health status
because self-care represents the dominant mode of health care in our society”.
Like breathing, no one else can take care of one’s health than the person owning
that health. The desire to enhance health and well-being must come from within.
One must bear in mind that human health promotion is a moral endeavor.
In the individual level, health promotion provides services that will assist humans
in their functioning taking into consideration their particular circumstance.
Therefore, a need to include the factors that influence a person’s health status like
mental, physical, spiritual, and environmental factors in the assessment of an
individual is a must (Edelman, et al., 2006). This will only be possible if thorough
assessment will be done on the health promotion practices of the respondents.
Prolonging life and improving its quality is the objective of Health
Promotion (Marks, et al., 2005). In order to achieve this goals, health promotion
must concentrate more on enhancing the physical, psychological, and emotional
well-being of an individual instead of focusing on reducing the risk of acquiring
diseases. A more positive approach to promote health is needed to stimulate in
individuals the desire to enhance the quality of life.
Local Literature
The need for health promotion in the Philippines goes back to the time of
the Ramos Administration, when the Administrative Order No. 341 entitled
Implementing Philippine Health Promotion Program through Healthy Places was
created. It was written along with the belief that there is a “need to undertake
more health promotion and disease prevention measures as a result of the reported
increase in the incidence of preventable diseases in Asia and in the country (AO
No. 341, 1997)”. The PHPP gives priority to women, and children, adolescent
youth, workers, elders, disabled and chronically ill persons, ethnic minorities,
rural people, and urban poor (Palaganas, 2003). Time went on and health
promotion was given a renewed interest as a result of the association of
degenerative diseases with the lifestyle of an individual. In 2002, Mortality
statistics showed that 7 of the 10 leading causes of deaths in the country are
associated with the unhealthy lifestyle of the client: tobacco smoking, physical
inactivity, and an unhealthy diet (Cuevas, et al., 2007). This rise in the occurrence
of degenerative and lifestyle diseases called for a need to take on a new approach
to health promotion that will go beyond the interaction between the client and a
physician. Hence, the creation of the National Policy on Health Promotion
(Administrative Order No. 58 s. 2001). This Administrative Order promotes the
utilization of a “socio-ecological approach” to health promotion that would
include the environment and other sectors that affect the over-all well-being of a
person. The vision for Health Promotion, “By the year 2010, Filipinos are
managing their own health” serve as the framework for health promotion. This
study will contribute to the attainment of the said goal through the creation of
appropriate health promotion programs/strategies that can change the lifestyle of
the target population by starting with proper assessment of their current health
promotion practices. This fulfills a fraction of the health sector’s responsibility to
“build capacity for policy development, leadership, health promotion practice,
knowledge transfer and research, and health literacy (Anden, 2010)”.
“Without sincere efforts directed towards achieving socio-economic
transformation no lasting improvements are expected in the field of health
(Palaganas, 2003, p. 90)”. Health Promotion may sound easy to say but it is very
much harder to do, especially if the community is underdeveloped. Brgy. Bukal is
a rural community situated in Cavinti, Laguna. As a rural community, it is
expected that progress in terms of the eight subsystems of a community
particularly in health is far behind from those living in the urban community. The
basic source of living of the residents in Brgy. Bukal is pag-lalala or weaving of
hats, which they sell for Php 12.00 per piece. The average income of a family
household ranges from Php700.00 to 1,000.00 a month. This amount of income
can hardly provide them enough funds to take appropriate measures in promoting
health. This situation reflects the description of Palaganas (2003) of those living
in the rural area – people hardly eats three times a day, lack of proper education,
belief in superstition and evil spirits when it comes to health, lack of funds to
support health, etc. As Palaganas (2003) puts it, “many mistaken practices result
from ignorance and superstition”. Since Brgy. Bukal is a rural community,
conclusion can be drawn that the health promotion practices of the community
may still be possibly linked with the practices and beliefs of the past, which are no
longer applicable today. At the same time, there is also a lack of medical
professionals that would correct their current practice and provide them with the
correct ones. Among all Filipinos, only a small portion are physician, nurses,
dentists, medical technologists, physical therapists, public health workers, or other
health workers (Policarpio, 2006). Therefore, the lack of health workers in a rural
community specifically in Brgy. Bukal does not come as a surprise since this
small amount “good samaritans” are maldistributed in areas where the richer
sectors of society are concentrated (Palaganas, 2003, p. 73).
In this kind of situation, nurses are an “indispensable human resource to
take care of people’s health (Palaganas, 2003, p. 153). Especially in this time
where there is a shift from hospital-based to community-based nursing will
consequently affect the nursing role in the health care delivery system (Mallari,
2005). Focus will now be geared towards the health of the community, and the
key to a healthy community is the promotion of health.
Specifially, the Community Health Nurse serves 1. As an advocate as they
seek to promote and enhance the quality health; 2. As an Epidemiologist as she
uses the epidemiological approach in studying their health and dealing with
community wide problems; and 3. As a Health Planner as the nurse creates health
programs for the community (Jimenez, 2006). In order to fulfill this function, the
nurse must take the first step in creating a program which can be used to meet the
needs of the people and that is the assessment of health promotion practices of the
residents of Brgy. Bukal.
Relevance of the Literature to the Study
After reading and compiling the relevant literatures above, one idea
remains – that for a nurse to come up with a program that will meet the needs of
the community in terms of health promotion, a thorough, accurate assessment of
their health promotion practices is of supreme importance. It is the responsibility
of the nurse to gather all the information that she can get in order to come up with
a program/plan that is specifically designed according to the specific needs of
Brgy. Bukal, Cavinti, Laguna. This includes the consideration of all the factors
that may influence the health promotion practices of the individual such as the
individual characteristics as these may affect the way a person takes care of his
health as reflected in the 6 dimensions stated in the Health Promotion Lifestyle
Profile II.
The readings in this chapter will help the researcher to further describe and
analyze the health promotion practices of the residents of Brgy. Bukal. These
literatures, both foreign and local will enlighten the researcher with the what, why
and how of the health promotion practices that the residents perform and will be
used as a stepping stone in the creation of the intended output of this study.
CHAPTER THREE
Methodology
RESEARCH DESIGN
This study is observational in nature which utilizes a cross-sectional
design which is commonly used in conducting a health promotion research
(Crosby, et al, 2006). According to John Creswell (2005), a cross sectional study
examines the current attitudes, beliefs, opinions or practices of a certain group or
community. To further examine the target population, a survey research was
utilized to understand the characteristics of the population and estimate the levels
of knowledge about any given health threat or health protective behavior; and
health-related attitudes, beliefs, opinions, and behaviors (Crosby, et al, 2006).
Therefore, this study will utilize a cross-sectional survey design as it
determines the common health promotion practices done in Brgy. Bukal, Cavinti,
Laguna.
POPULATION, SAMPLE, AND SAMPLING TECHNIQUES
The respondents of this study will be the Baranggay officials of Brgy.
Bukal and the top 3 officials of each of the eight puroks, mostly aged 20-40 years
old. This selection is based on the belief of the researcher that individuals in the
specified age group are mature enough to involve themselves in the improvement
of their health and capabilities. Moreover, people in this age group would
represent those who mostly engaged in activities that may negatively affect their
health situation such as alcohol abuse, smoking, and lack of physical exercise.
Therefore, their health promotion practices call for further investigation.
The respondents were selected using the purposive sampling technique
where the researcher selected those individuals who could provide richer and
more significant information about the study. Purposive sampling is a technique
where the “researcher intentionally select individuals and sites to learn and
understand the central phenomenon (Creswell, 2005)”.
RESEARCH INSTRUMENT
The researcher utilized the Health Promotion Lifestyle Profile II, an
instrument used to measure the health promoting behavior of an individual,
focusing on the six domains of health responsibility, physical activity, nutrition,
spiritual growth, interpersonal relations, and stress management. These
dimensions are reflected in the following items:
1. Health-Promoting Lifestyle 1 to 52
2. Health Responsibility 3, 9, 15, 21, 27, 33, 39, 45, 51
3. Physical Activity 4, 10, 16, 22, 28, 34, 40, 46
4. Nutrition 2, 8, 14, 20, 26, 32, 38, 44, 50
5. Spiritual Growth 6, 12, 18, 24, 30, 36, 42, 48, 52
6. Interpersonal Relations 1, 7, 13, 19, 25, 31, 37, 43, 49
7. Stress Management 5, 11, 17, 23, 29, 35, 41, 47
This instrument, based on the Health Promotion Model of Nola J. Pender,
was originally produced in 1987 by Susan Walker, Professor Emeritus of
University of Nebraska, College of Nursing. This 52-item examination used a 4-
point Likert Scale to determine the behavior of the individual with a format of
“Never”, “Sometimes”, “Often”, and Routinely”.
In order to accommodate the level of education of the residents of Brgy.
Bukal, the instrument was translated into the Filipino language. Considering the
translation made, this study will also serve as mean in measuring the
appropriateness of the HPLP II tool in the Philippine setting.
No pilot study is needed since the instrument to be used has been tested
and validated as evidence by the number of studies that utilized the said survey
tool.
DATA GATHERING PROCEDURE
In order to obtain the much-needed data, the researcher followed a series
of steps. First of which will be to distribute the necessary communication letters
written by the researcher and approved and noted by the researcher’s adviser and
the Dean of the Graduate School, respectively, to the Municipal mayor of Cavinti,
Hon. Florceli Esguerra and the Brgy. Captain of Brgy. Bukal, Mr. Aben
Calinagan. Once permission is granted, the researcher will begin the data
gathering.
To select the respondents, the researcher will obtain a list of names of the
Brgy. Officials of Bukal and the different officers per purok, together with their
addresses. The researcher will personally visit the selected respondents and
provide them with the questionnaire. Beforehand, a letter asking for their
participation will be given to the participant. They participants have the right to
refuse involvement in the said study.
Collection of the questionnaire will follow afterwards for the collation and
analysis of data. Necessary statistical treatment will be applied in order to come
up with the results needed for the study
STATISICAL TREATMENT OF DATA
The data that will be obtained in this study will be statistically treated with
the necessary formulas to facilitate the analysis and interpretation of findings. The
Health Promotion Lifestyle Profile II, the instrument used by the researcher,
already has a proposed method of scoring the results.
The score for the over-all health promoting lifestyle will be obtained by
computing the Mean of the individual’s responses. Likewise, the scores for each
subscale will be obtained using the same computation. The mean, denoted by an
x, is the most sensitive measure of center since it takes into account all scores in a
distribution when it is calculated (Bordens, 2007). The formula for the mean is:
Where: Ex is the summation of scores
n is the number of scores in the distribution.
To answer question number 4, PEARSON PRODUCT-MOMENT ‘
CORRELATION COEFFICIENT will be utilized. This is a measure of
association that provides an index of the direction and magnitude of the
relationship between two sets of scores (Bordens, 2007).
where:N no. of casesXY sum of the products of x and yX sum of the x’sY sum of the y’sX2 sum of the squares of x’s
Y2 sum of the squares of the y’s
To test the significance of the computed r
Where
n the number of respondents
r the computed coefficient of correlation
HEALTH PROMOTION LIFESTYLE PROFILE II
(Tagalog Version)
DIREKSYON:
Ang papel na ito ay naglalaman ng mga katanungan patungkol sa inyong
kasalukuyang pamamaraan ng pangangalaga sa inyong kalusugan. Bawat
katanungan at maaring sagutin sa pamamagitan ng PAGBILOG sa letra na
naaayon sa inyong kasagutan:
P para sa PALAGING GINAGAWA;
M para sa MADALAS GINAGAWA;
Mi para sa MINSAN GINAGAWA, at
H para sa HINDI GINAGAWA.
Pangalan: ____________________________________ Edad: ________
Kasarian: _________
Estado sa buhay: ___________ Pinakamataas na naabot sa pag-aaral:
_________________
Trabaho: ________________ Relihiyon: _______________
KATANUNGAN H Mi M P
1. Pinag-uusapan ang aking mga suliranin at
alalahanin sa mga taong malapit sa akin.
2. Pumipili ako ng mga pagkaing mababa sa taba at
kolesterol.
3. Dumadaing sa tuwing may hindi pangkaraniwang
senyales o sintomas sa isang doctor o iba pang
propesyonal sa pangkalusugan.
4. Sumusunod sa mga programang pang-ehersisyo.
5. Natutulog ako ng sapat na oras.
6. Ako ay lumalaki at nagbabago tungo sa
pamamaraang positibo.
7. Pinupuri ko ang ibang tao sa kanilang mga
tagumpay.
8. Limitado ang aking pagkain ng matatamis na
pagkain at paggamit ng asukal sa pagkain.
9. Ako ay nagbabasa o nanonood ng mga programa
patungkol sa kalusugan.
10. Ako ay nag-e-ehersisyo na tumatagal ng 20
minuto tatlong beses sa isang lingo (gaya ng
paglalakad, pagbibisikleta, pagsayaw, o pag-akyat
ng hagdan).
11. Ako ay naglalaan ng oras upang magpahinga sa
loob ng isang araw.
12. Ako ay naniniwala na ako ay mayroong misyon
sa buhay.
13. Napapanatili kong maganda at mkahulugan ang
aking mga relasyon sa ibang tao.
14. Kumakain ako 6 hanggang 11 na hain ng tinapay,
kanin, at noodles sa loob ng isang araw.
15. Nagtatanong ako sa doctor o nurse sa tuwing
hindi ko naiintindihan ang kanilang mga
instruksyon.
16. Sumasali ako sa mga gawaing nakakapag-
ehersisyo ng aking katawan gaya ng matagalang
paglalakad (30-40 minuto) limang beses o higit pa
sa isang lingo.
17. Tinatanggap ko ang mga bagay sa aking buhay na
hindi ko na mababago.
18. Umaasa ako sa isang magandang hinaharap.
19. Ako ay naglalaan ng oras para makasama ko ang
malalapit kong mga kaibigan.
20. Kumakain ako ng 2 hanggang 4 na hain ng prutas
sa loob ng isang araw.
21. Ako ay kumukuha ng pangalawang opinion (2nd
opinion) kapag nanghihingi payo tungkol sa aking
kalusugan.
22. Ako ay lumalahok sa mga gawaing pisikal na
nagbibigay kasiyahan sa akin katulad ng
paglangot o pagsasayaw).
23. Nag-iisip ako ng mga magagandang bagay bago
matulog.
24. Ako ay kuntento sa aking sarili at sa aking buhay.
25. Madali sa akin ang magbigay ng pagkabahala,
pagmamahal, at init sa aking kapwa.
26. Kumakain ako ng 3 hanggang 5 na hain ng gulay
sa loob ng isang araw.
27. Kumukonsulta ako sa mga propesyonal sa
kalusugan tungkol sa aking kalusugan.
28. Ako ay nag-iinat 3 beses sa isang lingo.
29. Gumagamit ako ng mga paraan para ma-kontrol
ang aking pagod.
30. Pinagtatrabahuan ko ang aking mga pangarap sa
buhay.
31. Ako ay natitinag ng mga taong malalapit sa akin
at ganoon din ako sa kanila.
32. Ako ay umiinom ng 2 hanggang 3 timpla/hain ng
gatas, o ng mga pagkaing may gatas sa loob ng
isang araw.
33. Sinusuri ko ang aking katawan sa anumang
pagbabago o senyales isang beses sa isang buwan.
34. Ako ay nage-ehersisyo sa pang-araw-araw na
gawaing bahay gaya ng pag-iigib o paglilinis ng
bahay.
35. Binabalanse ko ang trabaho at paglalaro o
pagsasaya.
36. Interesado ako sa mga mangyayari sa aking buhay
araw-araw.
37. Naghahanap ako ng mga paraan upang
matugunan ang aking pangangailangang personal.
38. Kumakain ako ng 2 hanggang 3 hain ng manok,
baboy, isda, at itlog sa loob ng isang araw.
39. Ako ang humihingi ng impormasyon sa mga
propesyonal tungkol sa tamang pangangalaga sa
aking kalusugan.
40. Dinadama at binibilang ko ang aking pulso
tuwing nag-e-ehersisyo.
41. Ako ay nagpapahinga at nagmumuni-muni sa
loob ng 15-20 minuto araw-araw.
42. Alam ko ang mga bagay na mahahalaga at
importante sa aking buhay.
43. Ako ay nakakakuha ng suporta sa mga taong
mahal ko.
44. Binabasa ko ang mga sustansiya na nasa likod ng
pakete ng mga pagkain.
45. Dumadalo ako sa mga pagtitipon na may
kinalaman sa aking kalusugan.
46. Naaabot ko ang tamang bilang ng tibok ng aking
puso sa tuwing ak ay nag-e-ehersisyo.
47. Ako ay nagdadahan-dahan sa pagtatrabaho upang
maiwasan ang pagkapagod.
48. Ako naniniwala na ako ay konektado sa isang
nilalang na may higit na kakayahan sa akin.
49. Naayos ko ang aking mga di-pagkakaunawaan sa
ibang tao sa pamamagitan ng pagkukumpromiso.
50. Kumakain ako ng agahan araw-araw.
51. Humihingi ako ng gabay o payo kung
kinakailangan.
52. Ihinaharap ko ang aking sarili sa mga bago at
kakaibang pagsubok sa aking buhay.
BIBLIOGRAPHY
Foreign Literature
Bordens, S. Research Design and Methods. A Process Approach.
McGraw-Hill, International © 2007
Cosby, R., et al., Research Methods in Health Promotion. John
Wiley and Sons, Inc. © 2006
Creswell, J., Educational Research. Planning, Conducting, and
Evaluating Quantitative and Qualitative Research. Pearson Education, Inc.
© 2005
Endelman, C. et al., Health Promotion Throughout the Life Span
6 th Edition. Mosby, Inc. © 2006
Homan, M. Promoting Community Change. Making It Happen in
the Real World. 4 th Edition. Thomson Brooks/Cole. © 2008
Houser, J., Nursing Research. Reading, Using, and Creating
Evidence. Jones and Barlett Publishers. © 2008
Leddy, S., Integrative Health Promotion: Conceptual Basis for
Nursing Practice. Jones and Barlett Publishers, Inc. © 2006
Lucas, K. et al., Health Promotion. Evidence and Experience.
SAGE Publications, Ltd. © 2005
Marks, et al., Health Psychology: Theory, Research, and Practice.
SAGE Publications, Ltd. © 2005
McKenzie, J., et al., Planning, Implementing, and Evaluating
Health Promotion Programs, 4 th Edition. Pearson Education, Inc., © 2005
Miller, C., Nurses’ Toolbook for Promoting Wellness. McGraw-
Hill, Inc. © 2008
Murray, R., Health Promotion Strategies through the Life Span.
Pearson Education, Inc. ©2009
Naidoo, J., Public Health and Health Promotion: Developing
Practice. Bailliere Tindall© 2005
Pender, N. et al., Health Promotion in Nursing Practice 5 th Edition.
Pearson Education Inc., © 2006.
Scriven, A., Health Promoting Practice: The Contribution of
Nurses and Allied Health Professionals. © 2008
Sharma, M., Theoretical Foundations of Health Education and
Promotion. Jones and Barlett Publishers, © 2008
Local Literature
Cuevas et al.. Public Health Nursing in the Philippines. National
League of Philippine Government Nurses, Inc. © 2009
Dayrit, M., National Policy on Health Promotion. Sta. Cruz,
Manila © 2001
Jimenez, C., Community Organizaing Participatory Action
Research (CO-PAR) for Community Health Development. SynerAide
Research and Publications. © 2006.
Palaganas, E., Health Care Practice in the Community. First
Ediction. Educational Publishing House © 2003.
Policarpio, J., Economics in Health for the Allied Health Sciences.
C&E Publishing, Inc. © 2006
Ramos, F., Implementing Health Promotion Program through
Healthy Places. Malacañang, Manila © 1997
Journals
Hsiao, Y., et al., Spiritual health, clinical practice stress, depressive
tendency and health promoting behaviours among nursing students.
Journal of Advanced Nursing, © 2010 Jul; 66(7): 1612-22.
Weyers S., et al., How does socio economic position link to health
behaviour? Sociological pathways and perspectives for health promotion.
Global Health Promotion © 2010 Jun; 17(2): 25-33
Unpublished Literatures
Anden, A., Basic Course on Health Promotion and Education for
Health Promotion and Education Officers (HEPOs) and Information
Officers (IOs). National Center for Health Promotion, DOH, © 2010
Walker, S., Psychometric evaluation of the Health-Promoting
Lifestyle Profile II. University of Nebraska Medical Center, © 1996
Local Studies
Lorena. J., Designing Parenting Skills Program Through Temper
Tantrum Management of Toddlers. © 2008.
Mallari, G. Competencies of Graduating Nursing Students in
Implementing Primary Health Care: Basis for Enhancing Community
Otiented BSN Curriculum. © 2005
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