UNIVERSITY OF NUEVA CACERESCITY OF NAGA

DETERMINANTS AFFECTING THE LEVEL OF COMPLIANCE OF THE BENEFICIARIES OF

PANTAWID PAMILYANG PILIPINO PROGRAM IN BRGY. CALAUAG, NAGA CITY: AN

ASSESSMENT

CHAPTER 1 INTRODUCTION

CHAPTER 2 REVIEW OF RELATED LITERATURE AND STUDIES

CHAPTER 3 RESEARCH METHODOLOGY AND DESIGN

CHAPTER 4 ANALYSIS AND INTERPRETATION

CHAPTER 5 SUMMARY, FINDINGS, CONCLUSION AND RECOMMENDATIONS

DETERMINANTS AFFECTING THE LEVEL OF COMPLIANCE OF THE BENEFICIARIES OF PANTAWID PAMILYANG PILIPINO

PROGRAM IN BRGY. CALAUAG, NAGA CITY: AN ASSESSMENT

7. Theoretical Framework

CHAPTER 1

3. Assumptions

4. Hypothesis5. Significance of Study

2. Scope and Delimitation

6. Definition of Terms

1. Statement of the Problem

8. Theoretical Paradigm9. Conceptual Framework10. Conceptual Paradigm

This study aimed to know the determinants affecting the level of compliance of the household beneficiaries of Pantawid Pamilyang Pilipino Program (4P’s) in Barangay Calauag, Naga City from March 2011- August 2012.

Specifically, this study sought to find answers to the following questions:What is the demographic profile of the respondents in terms of:1.1 Age1.2 Civil Status1.3 Educational Attainment

STATEMENT OF THE PROBLEM

1.4 Monthly Income1.5 Maternal Status1.6 Number of children 2. What are the determinants that affect the level of compliance of household beneficiaries to services of 4Ps as to:2.1 Time Allocation2.2 Accessibility of Barangay Health Center2.3 4Ps’ Household Beneficiaries – Parent Leader Relationship2.4 Motivation of the 4Ps’ Household Beneficiaries

3. What are the areas of assessment in determining the level of compliance?

3.1 Health3.2 Nutrition3.3 Education3.4 Family Development Sessions

4. Is there any significant relationship between the level of compliance and the demographic profile?

This study focused mainly on the level of compliance of the 4Ps’ household beneficiaries to the conditions of 4Ps concerning health, nutrition, education and family development sessions. It also specified the determinants affecting the level of compliance in terms of time allocation, the accessibility of Barangay Health Center, the 4Ps household beneficiary’s relationship with their respective parent leaders and their motivation to comply.

SCOPE AND DELIMITATION

The respondents of this study included the 4Ps household beneficiaries living in Barangay Calauag, Naga City with duration of membership from the month of March 2011 – August 2012.

Male beneficiaries were not included.

ASSUMPTIONSThis study was guided by the following assumptions:

1. 4Ps household beneficiaries are the indigent citizens needing health and educational services.

2. The demographic profile of the respondents affects the health perception and health needs of the respondents.

3. The level of compliance to conditions of 4Ps is assessed for health, nutrition, education and family development session.

4. The conditions of 4Ps are health related.5. The determinants affecting the level of compliance of the 4Ps household beneficiaries is directly influenced by the demographic profile of the respondents.

HYPOTHESIS

There is no significant

relationship between the level of compliance of the 4Ps’ household beneficiaries and their demographic data.

SIGNIFICANCE OF THE STUDY

4Ps’ Household Beneficiaries. As subjects of our study, it may supply them additional information regarding the objectives, conditions or policies as stated in the program. It may help to increase their probability of complying with the conditions of 4Ps that promotes health and prevent diseases. Their encountered problems regarding 4Ps will also be realized.

Barangay Health Officials. Findings of this study will enable them to know the level of compliance of the 4Ps household beneficiaries in their Barangay and will enable them to determine the specific reasons of non - compliance of some 4Ps household beneficiaries. Thus, create some necessary changes in the system of implementation and effectively motivate the beneficiaries to comply.

Local Government Unit. The findings of this research will provide them information on the extent of compliance of the household beneficiaries on the selected barangay and their feedback regarding the services of the program. This can help them to design strategies intended for a more effective governance and implementation of the program’s advocacy.

Department of Social Welfare and Development in Naga City. Being the implementing agency, the results of this study may help them assess the level of effectiveness of the program in Barangay Calauag.

Data collected will provide them a clear picture of the present status of the said program that will enable them to give emphasis in supervising and monitoring the 4Ps household beneficiaries.

Department of Health. As one of the implementing agency, this study may help them to know whether the 4Ps beneficiaries are availing the health and nutritional services provided by the government to prevent diseases and promote health. Furthermore, they will be able to ensure their compliance and better health- practices.

Department of Education. The result of the study will show the level of compliance of the 4Ps beneficiaries on the educational services given by the program, assess the factors that affect their compliance and ensure attainment of primary education of the 4Ps beneficiaries in Barangay Calauag, Naga City.

Future Researchers. The final conclusions attained in this study may be useful for them as their basis for their present study. It will also serve as one of their sources as a related study.

Definition of Terms

Assessment. The initial step in gathering data and solving problem. In the study, it refers to the process of describing the level of compliance and the determinants affecting it.

Barangay Calauag. It is an Urban Area, with a total land area of 0.5 square kilometer or .65 % of the total land area of Naga City. It is one of the affiliating barangay of UNC – College of Nursing. Operationally, this area is selected to be the location of the study where the respondents are obtained.

Compliance. Refers to either a state of being in accordance with established guidelines, specifications, or legislation or the process of becoming so. In the study, it refers to the participation of the 4Ps’ household beneficiaries to conditions of 4Ps.

Determinants. An element that identifies or determines the nature of reward or conditions an outcome. As used in the study, it refers to the factors that affect the level of compliance of the 4Ps’ household beneficiaries to conditions of 4Ps.

Level of Compliance. Degree of participation to a condition, guidelines or agreement. In the study, it refers to the rate of participation of each 4P’s household beneficiaries to services and conditions of 4P’s.

4P’s Household Beneficiaries. Group of people who qualified as the target beneficiaries. As used in the study, they are the residents in Calauag, Naga City who are covered by the program and are benefited by its services in health and nutrition, education and family development session. They are rewarded through cash grants upon compliance to the conditions.

Pantawid Pampamilyang Pilipino Program (4P’s).Refers to conditional cash transfer. It is a government program implemented to reduce poverty and hunger, achieve universal primary education, promote gender equality and empowering women, reduce child mortality and improve maternal health. In the study, it is viewed as a health promoting program that delivers primary health care services and prevents diseases of the mother and children aged 0 - 14.

THEORETICAL FRAMEWORKThe study was guided by Imogene King’s Theory of

Goal Attainment and Theory of Motivation by Ken and Param Shah. Goal Attainment Theory

Imogene King, the theorist of the commonly used Goal Attainment Theory of several researches, defines man as a dynamic human being whose perception of objects, person, and events influences his behavior, social

interaction and health. He/she has the ability to perceive, think, feel, choose, set goals, select means to achieve goals and make decisions. Man has three basic health needs according to King, these are the information on health that can be accessed and utilized when needed, care that aims to prevent illness and care in times of illness.

King’s model is composed of three interacting systems; these are personal, interpersonal, and social system. These are used to establish a foundation for a dynamic and interactive environment.

She states that the concepts for the personal system are: perception, self, growth and development, body image, space and time. These are fundamentals in understanding human being because it refers on how the one views and integrates self, based from personal goals and beliefs. Among all these concepts, the most important is perception, because it influences behavior. King summarized the connection among these concepts as an “individual perception of self, body image, time, and space which influences the way he/she complies to events in his/her life”.

The concepts associated for interpersonal system are: interaction, communication, transaction, role and stress. This shows how the person interrelates with others. Collaboration between the client and the health provider is very important for the attainment of the goal. In these concepts, king emphasizes communication which encompasses intrapersonal, interpersonal, verbal and nonverbal communication which human relations are developed and maintained.

The final interacting system is the social system which shows the person interacts with others and his/her environment. These are group of people within the community that share a common goals, values and interests. And it provides a framework for social interaction and relationships and establishes rules of behavior and courses of actions.

It is viewed to describe the behavior of the individual, particularly the poor, in setting and attaining their goals. The goals they set for their family and for themselves resembles with the goals of 4Ps, a government program towards development of Filipino people.

Those goals are to have proper nutrition, to prevent illnesses, to have safe perinatal experiences, to have education for their children and to have another financial source that reduces poverty. Thus, the individual and the Pantawid Pamilyang Pilipino Program must interact to agree on means of achieving those goals together.

Theory of MotivationThis theory was postulated by Ken and Param Shah,

theorist in the field of management, which emphasizes motivation as a powerful tool to achieve both, the individual and organizational objectives.

Motivation is described as a personal trait of an individual to willingly exert high levels of effort towards organizational goals, conditioned by the efforts and ability to satisfy their own individual needs. It was once assumed that motivation had to be taught, but it is now understand that everyone is motivated by several differing forces.

Different types of motivation were named from individuals’ basic motivational drives and interest. These are the achievement motivation, affiliation motivation, competence motivation, power motivation, attitude motivation, incentive motivation and fear motivation. Every individual possesses several type of motivation that must be met to effectively act on the organizational and individual objectives.

The process of motivation was then described by this theory. It states that the process was initiated by a person’s feeling of lacknesses. There is an urgent arousal of need, which the bearer has to prioritize and venture in search to satisfy it.

This tension also creates drives and attitudes regarding the type of satisfaction that is desired. Information is then gathered by the person related to his query, which ultimately leads to evaluation of alternatives where the best alternative is chosen. After choosing the alternative an action is taken. Because of the performance of the activity, satisfaction is achieved which then relieves the tension of the individual.

This theory explains the compliance of the 4Ps household beneficiaries to conditions of 4Ps. The beneficiaries are motivated to attain their goals and needs for themselves and for their family and they perceive the deve-

lopmental program of the government as an alternative to achieve their goals. The implementing agencies of 4Ps must be able to meet the beneficiaries’ motivations to in able to expect a good compliance from them. Thus, achieving the organizational goals they have set.

The motivation in compliance of the beneficiaries to 4Ps is composed generally by three types of motivation namely the achievement motivation, attitude and incentive motivation. Achievement motivation is the drive to pursue and attain goals towards success; their accomplishment is important for their self – fulfillment rather than the rewards that accompany it.

Attitude motivation is the person’s perception of themselves and of the organization. It is their confidence with the program that might be the way to resolve their needs. And, the incentive motivation is anchored by the rewards and prizes that drive people to work a little harder in an organization. It is the “you do this and you get that” attitude. These three motivations serve as the “pushing forces” for the beneficiaries to comply.

In the theoretical paradigm of this study, a pictorial presentation of relationship between Goal Attainment theory and Theory of Motivation was made.

While the topmost part of the plant which is the flower resembles the priority of the program, its beneficiaries, who also have several distinguished parts. From the petal, which is the center, is the personal, interpersonal and social system that comprises an individual. It affects his goal setting and decision making, the goals that where set and aimed to be achieved by the beneficiaries and by 4Ps are represented by the petals of the flower. As the beneficiary complies with the services of 4Ps their goals will be met just like how flower blooms when it receives nutrients from the roots.

THEORETICAL PARADIGM

CONCEPTUAL FRAMEWORKThe study on the determinants affecting the level of compliance of 4Ps household beneficiaries in Barangay Calauag, Naga City, includes the discussion of the services and conditions offered by Pantawid Pamilyang Pilipino Program, the level of compliance of the 4Ps’ household beneficiaries and the determinants that affects their compliance.

In order to clearly show the relationship between the dependent and independent variables of the study, a conceptual framework in a form of a proposed original model was made.

The demographic profile of the 4Ps’ household beneficiaries particularly their age, civil status, educational status, monthly income, maternal status and number of children serves as the independent variables in the study. It is viewed to affect the dependent variables which are the level of compliance of the 4Ps household beneficiaries to 4Ps and the determinants that are commonly seen to affect it. Age and gender are two personal characteristic of the respondent that might affect their level of compliance and interest in the services rendered by Pantawid Pamilyang Pilipino Program.

While educational status determines their literacy level and may implicate their understanding about the importance of the services of 4Ps regarding health, nutrition, education and family development session thus, affecting their level of compliance to 4Ps. Furthermore, occupation and monthly income suggest the respondent’s need for support from the services of the program particularly the cash grant to sustain daily needs such as food and shelter.

This study will seek to know the determinants that affect the level of compliance of 4Ps household beneficiaries. There are four possible determinants viewed to affect their level of compliance; the time – allocation of the respondents, the accessibility of the Barangay Health Center, the relationship of the 4Ps household beneficiary and their parent leaders as well as their motivation in complying to t Determinant on time – allocation will specifically tackle on the different time difficulties of the respondents in relation to the scheduled services of 4Ps. he conditionalities of the said program.

Determinant on time – allocation will specifically tackle on the different time difficulties of the respondents in relation to the scheduled services of 4Ps. While the determinant on the accessibility of Barangay Health Center will focus on the respondent’s difficulty on attending and complying with services of 4Ps due to its venue and distance from their houses. However, the determinant which regards to the relationship of the 4Ps household beneficiary and their parent leaders will determine how effectively information regarding 4Ps and its services were communicated with the respondents.

Lastly, the determinant that pertains to the motivation of the 4Ps household beneficiaries will briefly explain their willingness and eagerness to comply on conditionalities of 4Ps to avail their services.

There are different areas of assessment based on the 4Ps services namely health, nutrition, education and family development session. Those areas of assessment will be the four corners of this study because the level of compliance

and the determinants that affect it will focus on those areas with their corresponding conditionalities as specified by Pantawid Pamilyang Pilipino Program.

After gathering and analyzing data, an interpretation will be made to know if there is any relationship between the level of compliance of 4Ps household beneficiaries and their demographic profile.

CONCEPTUAL PARADIGM

Determinants Affecting the Level of Compliance of the Beneficiaries of Pantawid Pamilyang Pilipino Program in Barangay Calauag Naga, City:

An Assessment

I. Profile of household beneficiaries of 4Ps in terms of:

Age Civil Status Educational

Attainment Monthly

Income Maternal

Status Number of

children

II. Determinants affecting the level of compliance of 4Ps’ household beneficiaries as to:

-Time Allocation-Accessibility to BarangayHealthCenter-Household beneficiaries – -Parent Leader relationshipMotivation of the Household Beneficiaries

Areas of AssessmentHealth NutritionEducation

Family Development Session

LevelOf

Compliance

Significant relationship between the level of compliance of household beneficiaries and their demographic profile

CHAPTER 2

1. Review of Related Literature

2. Review of Related Studies

3. State of the Art

RELATED LITERATURE

Alajar (2009) stated that prevalence of infant and maternal mortality in Bicol has turned from bad to worse because of grinding poverty. He reported that in the provinces of Bicol, Camarines Sur, which is the biggest in terms of population and number of municipalities, has the lowest number of birth rate at 19.91%. While for highly urbanized cities in Bicol, Naga City has the lowest birth rate of 20.18%.

Counselor Ranulfo Ludovica (2012), president of the city’s Liga stated that providing education is one of the primordial duties and obligations of parents to their children. He said that parents, even the unemployed have no reason not to send their children to school. Ludovica also included that parents who fail to send their children in schools does not only contribute to out of school youths but exposes them to child abuse, exploitation, discrimination and other conditions prejudicial to their development as well.

Santiago (2009) proposed Senate Bill No. 3412 known as the Pantawid Pamilyang Pilipino Program Act of 2009 proposes to formally institutionalize the program by formally making it the National Conditional Fund Transfer Program.

National Anti-Poverty Commission (NAPC) chair Joel Rocamora cited that in the CCT program dubbed as Pantawid Pamilyang Pilipino Program (4Ps), they have already enlisted 2.3 million households out of the targeted 4.7 million by 2016. They also intend to enlist 5.2 million for the subsidized health insurance project.In Bicol, the 4Ps program is also implemented in Camarines Sur with 13 towns and a city: Pasacao, Siruma, Tinambac, Caramoan, Ragay, Del Gallego, Sagñay, Presentacion, Minalabac, Libmanan, Lupi, Bula, Pamplona, San Jose and Naga City with some 20,000 household beneficiaries. (Bicol Mail 2010)

Taradji (2011) stated that one of the major priorities of the Pantawid Pamilyang Pilipino Program in 2011 was the completion of the 2.3 million household beneficiaries from the 936 municipalities, 74 cities in 79 provinces nationwide with a total geographical target of 1,010 municipalities and cities covering 62% out of the 1,634 nationwide.

Valte (2012) said the Aquino administration would continue “to aggressively pursue programs meant to address the needs of vulnerable sectors” by expanding the coverage of the conditional cash transfer (CTT) program with a budget of P39.5 billion. The proper use of money being given to beneficiaries is crucial.

RELATED STUDIESQuality Improvement Demonstration Study (2008) reported that there is an additional evidence of intergenerational transmission of poverty on children under 5 years old residing in the 10 provinces in the Visayas and one province in Northern Mindanao. The study further implicated that the parents who are poor may transmit poverty and disadvantage to their children during their earliest years of life. If a parent is too unhealthy and unskilled to be productive enough to support their family, the children may have to work, which means they will not get the education they need.

The study by Orbeta (2005) entitled “Poverty, vulnerability and family size: evidence from the Philippines” had a potential impact of the 4Ps on school attendance. Said study focuses on the impact of family size on the various aspects of family welfare specifically on education. Study shows that each additional child reduces the proportion of school-age children attending school.

Human Development Network (2000) revealed that about 28%-34% of the total population does not complete the sixth grade.

The study conducted by Singh et al (2009) focusing on the Socio-Economic Inequalities in the Use of Postnatal Care stated that the highest risk of death for both the mother and her newborn occurs at the time of childbirth or immediately in the period after birth.

Dr. Alejo Alajar (2009), the primary cause of rising infant mortality prevalence in Bicol is pneumonia and malnutrition due to poverty where majority of the families could not afford to buy medicines.

According to 2006 Annual Poverty Statistics of the National Statistical Coordination Board 27.9 Million Filipinos or 1/3 of the entire population are poor. To address this problem the Department of Social Welfare and Development (DSWD) together with its other programs and services implemented a Conditional Cash Transfer Program known as Pantawid Pamilyang Pilipino Program (4Ps) inspired by the successes of similar programs in Latin American countries such as Bolsa Familia in Brazil, Familias en Accionin Colombia and OPORTUNIDADES in Mexico.

Schady and Araujo’s Study (2006) on the CCT experience in Ecuador, many, but not all, CCT programs have a positive effect on education and health outcomes. Favorable education outcomes were drawn mostly from the experience of Progresa as evaluated by the International Food and Policy Research Institute.

Pilot Spot Check (2010) by Social Weather Stations (SWS) in the Municipalities of Palapag, Mondragon, and Pambujan in Northern Samar in February - March 2010 with a sample of 760 household beneficiaries, reported that on average, each pregnant woman received 4.7 visits (antenatal care services) during the duration of the pregnancy.

The study conducted by Ateneo de Manila entitled “Qualitative Impact Evaluation by Institute of the Philippine Culture” (2010) conducted to 6 municipalities located in the Provinces of Nueva Ecija, Northern Samar, and Agusan del Sur last February-March 2010. They have concluded that 4Ps has a lot of potential in improving people’s lives and changes in beneficiary behaviors (related to health and education). But they also had found out that there’s a lack of knowledge and low compliance on conditions of household beneficiaries specifically on pregnant mothers.

The studies cited offered the researcher a deeper understanding and insights on the determinants affecting the level of compliance to 4Ps that helped the researchers formulate the variable needed for the study. Complementary to the present study are ideas and concepts presented by the different reviewed literature and studies with emphasis on the determinants affecting the level of compliance to 4Ps.

STATE OF THE ART

The point of relatedness of the related studies with the present study lie on the worsening poverty and increasing health and education needs in the Philippine as well as in Bicol Region Asia Development Bank (2009), National Statistical Coordination Board (2008), Population Commission Regional Director Magdalena Abellera and from the study of Quality Improvement Demonstration Study (2008) Orbeta (2005), Human Development Network (2000) and Annual Poverty Statistics (2006).

The point of similarities with the present study lie on the study conducted by Ateneo de Manila (2010) entitled “Qualitative Impact Evaluation by Institute of the Philippine Culture” conducted to 6 municipalities located in the Provinces of Nueva Ecija, Northern Samar, and Agusan del Sur last February - March 2010. It was aimed on determining the effects of 4Ps to lives of indigent population of Filipinos in the selected Regions as well as knowing their compliance with conditionalities of the program. They have concluded that 4Ps has a lot of potential in improving people’s lives and changes in behaviors of the beneficiaries (related to health and education).

But they also had found out that there’s a lack of knowledge and low compliance on conditions of household beneficiaries specifically on pregnant mothers. This study is found to be similar with the present study in such a way that both studies have the objective of knowing the compliance of the 4Ps beneficiaries in an area. However, the present study is more focused on the level and determinants affecting the compliance of beneficiaries of Pantawid Pamilyang Pilipino Program in Barangay Calauag Naga, City.

Thus, the present study will be able to know the specific degree of accordance to health, nutrition, and education as well as family development session conditionalities of the 4Ps household beneficiaries which will further be explained by the determinants that are viewed to affect their compliance. Better assessment and understanding of the beneficiaries’ compliance to 4Ps will lead to an effective implementation of the developmental program.

CHAPTER 3

1. Research Design

2. Respondents of Study

3. Research Instrument

4. Data Gathering Procedure

5. Statistical Treatment

RESEARCH DESIGNThe researchers decided to use qualitative research design. Specifically the study used the descriptive – correlational method.

The descriptive method was used to describe the demographic profile of the respondents as to age, civil status, educational attainment, monthly income, maternal status and number of children. It was also used to assess their level of compliance to conditions of Pantawid Pamilyang Pilipino Program (4Ps).

The correlational method was used to know the significant relationship between the level of compliance of the respondents as to their age, civil status, educational attainment, monthly income, maternal status and number of children.

RESPONDENTS OF THE STUDY

The researchers have chosen the 4Ps’ household beneficiaries in Barangay Calauag, Naga City as subjects of the study. The selected barangay was the largest barangay in Naga City but had been noted with problems in compliance to 4Ps as shown by their records at the DSWD. The total population of four hundred (400) 4Ps’ household beneficiaries in Barangay Calauag are officially listed by the DSWD.

The National Household Targeting System for Poverty Reduction (NHTS - PR) is the management who identifies these 4Ps’ household beneficiaries by estimating and ranking their annual per capita income to determine if they are one of the poorest families in their community.

Using the 20% acceptable size of a descriptive research (Gay, 1976); eighty - three (83) 4Ps’ household beneficiaries out of 400 served as the sample and source of data in the study.Purposive sampling was used in identifying the respondents. The eighty – three (83) household beneficiaries of 4Ps from Barangay Calauag, Naga City were the respondents of the study.

Purposive sampling was used in identifying the respondents. The eighty – three (83) household beneficiaries of 4Ps from Barangay Calauag, Naga City were the respondents of the study.

RESEARCH INSTRUMENT

A semi – structured interview was done to gather data from the respondents. An interview guide was used and some additional questions related to the study were also asked to thoroughly assess their compliance.

In the interview guide, Part I aimed to gather information on the demographic profile of the 4P’s household beneficiaries as to their age, civil status, educational attainment, monthly income, maternal status and number of children.

Part II identifies the determinants mostly affecting the level of compliance of 4Ps’ household beneficiaries. The factors presented are categorized as to their time allocation, accessibility of barangay health center, 4Ps’ household beneficiaries – parent leader relationship, and lastly is their motivation for compliance. Each category would have five (5) related questions in a situational form. Each question was assessed by the respondents as to whether they always, sometimes or never experience the situation presented.

Another set of questions were made for Part III. Part III would be used to assess the level of compliance of each 4Ps’ household beneficiaries to conditions of 4Ps regarding health, nutrition, education and family development sessions. There were twenty (20) questions prepared for Part III.

DATA GATHERING PROCEDURE

After finalizing the instruments, the researchers prepared a letter requesting permission from the Department of Social Welfare and Developments – City Link to conduct the study in Barangay Calauag with 4P’s beneficiaries. After the request was approved, the researchers started to conduct the interview the mother of each selected household covered by 4Ps. The interview was scheduled on the third week of August 2012.

The end result of the interview was one hundred percent (100%) since the entire respondent were available during the interview. After all the data gathered, the researchers collated and tabulated the data. The data gathered were recorded in the master tally sheet and then quantified data was processed for the scientific analysis and interpretation.

STATISTICAL TREATMENT

To come up with the desired number of sample for the study, the researchers made use of the 20% acceptable size of a descriptive research (Gay, 1976).

Inferential statistical tools were employed to resolve adequately the problems presented. The demographic profile of the 4P’s household beneficiaries is summarized and counted using the frequency distribution and percentage.

A likert scale was used in describing the level of compliance of the 4P’s household beneficiaries as well as the determinants affecting it. The points for level of compliance is totalled and interpreted accordingly. While the points for determinants affecting the level of compliance is also totalled for each category and ranked from the most evident to least. Both of them were measured by using average weighted mean.

To determine the significant relationship between the levels of compliance of 4P’s household beneficiaries as to their demographic profile, Pearson Correlation was used.

CHAPTER 4

Figure 1.01.Demographic Profile of the Respondents

Figure 1.1Figure 1.2Figure 1.3Figure 1.4Figure 1.5

2. Determinants Affecting Level of ComplianceTable 1.0

Table 1.1

Table 1.2

Table 1.3

Table 1.4

3. Level of Compliance to 4P’s

Table 2.0

Table 2.1

Table 2.2

Table 2.3

Table 2.4

4. Relationship of Level of Compliance to the Health Conditions and the demographic profile of Household beneficiaries

Table 3.0

Table 3.1

Table 3.2

Table 3.3

Analysis and Interpretation

Demographic Profile of the Respondents

Figure 1.0 Percentage of Age of the Respondents

 

Age. Figure 1.0 shows the percentage of the ages of the respondents involved in the study. It can be noticed that the majority of the respondents fall under the age range of 28-38 years old with 40 respondents answered or 48.19 % , followed by 39-60 years old with 36 respondents or 43.37 % and there were 7 or 8.43% respondents under 17-27 years old.

This implies that older adults are more assertive in availment of benefits and services given by the government for the Filipino people.As proven by the theory of Erik Erikson on his theory “Erikson’s Stage of Psychosocial Development, he stated that person with the age of 12 to 18 are under the adolescence stage who tend to focus more on social relationships and building of self - identity , while person of age 19 to 40 (young adulthood) deals more on loving relationship with other people this is the stage in which the person start to build his/her own family; furthermore, person of age 40 to 65 (middle adulthood) are more work and parenthood oriented they focus on how to earn for their family and how to be good parents for their children.

Figure 1.1 Percentage of Civil Status of the Respondents

Civil Status. The pie chart shows that out of 83 respondents’ civil status, 71 or 85.54% respondents are married, 8 or 9.64% are separated, 3 or 3.61% are widow and the least with only 1 respondent or 1.20% is single. This shows that majority of the respondents of 4Ps are married, the father assumes the role of provider of family’s economic needs while the mother assumes the nurturing role.

This implies that majority of the respondents have higher probability of complying with 4Ps due to the assistance that their husband can offer.

(Cooper et al 2005) stated that marital status might influence patients’ compliance with medication positively. The help and support from a spouse could be the reason why married patients were more compliant to medication than single patients.

Figure 1.2 Percentage of Educational Attainment of the Respondents

Educational Attainment. The pie graph shows the percentage of educational attainment of the respondents for which 27 or 32.53% are high school undergraduate, 21 or 25.30% are high school graduates, 14 or 16.87% are elementary graduates, 10 or 12.05% are college undergraduates, 9 or 10.84% are elementary undergraduates, and the least are college graduates and respondents without formal education; both with one respondent that covers 1.20%. This shows that majority of the respondents reached high school level but most of them are under graduate.

This implies that respondents are educated and literate enough to understand the conditions explained to them regarding 4Ps.

Several studies found that patients with higher educational level might have higher compliance (Ghods and Nasrollahzadeh 2003; Yavuz et al 2004). A study conducted by (Yavuz et al 2004) stated that compliance increases with educational status of the patients. It is expected that patients with higher educational level should have better knowledge about the disease and therapy and therefore be more compliant. A study conducted by (Goldman-Smith 2002) in analysis of Health and Retirement Survey, noted that the relationship between socio-economic status and adherence to medical regimen may not be due to the resource’s availability but to individuals abilities in higher level of reasoning.

Figure 1.3 Percentage of Monthly Income of the Respondents

Monthly Income. The pie graph shows the percentage of approximated monthly income of the respondents for which 40 or 48.19% have monthly income of Php 3000 and above, 39 or 46.99% have monthly income ranging from Php 1000 to Php 3000 and only 4 or 4.82% respondents have monthly income of Php 500 and below. The data presented displays that majority of the respondents budget their monthly income, which ranges from Php. 1000 – 3000 and above, for their family expenses in the whole month.

Expenses and prices of commodities in our country uncontrollably inflate demanding for a greater source of income and support from the government.

A number of studies found that patients who had no insurance cover (Kaplan et al 2004; Choi-Kwon 2005), or who had low income (Ghods and Nasrollahzadeh 2003; Hernandez-Ronquillo et al 2003; Mishra et al 2005) were more likely to be non-compliant to treatment. In Singapore, a study on chronic hepatitis B surveillance found that monthly income was not related to patient’s compliance with regular surveillance (Wai et al 2005). This discrepancy might due to different healthcare systems in different countries. Healthcare personnel should be aware of patient’s economic situation and help them use medication more cost-effectively.

Figure 1.4 Percentage of the Maternal Status of the

Respondents

Maternal Status. The pie graph shows the percentage of the maternal status of the respondents for which 64 respondents or 77.11% are neither pregnant nor newly –delivered, 12 or 14.46% respondents are newly-delivered and the least number of respondents are the pregnant which accounts for 7 or 8.43%respondents.

It implicates that most of the respondents are neither pregnant nor newly – delivered which excluded them to benefit from the services offered specially for pregnant and newly – delivered 4Ps household beneficiaries.

Figure 1.5 Percentage of Children in the Family

Number of Children in the Family. The pie chart shows the percentage of children in the family, out of 83 respondents 47 or .56.63% have three to five children, whereas, 29 or 34.94% respondents have six and above children and only 7 respondents or 8.43% has an ideal number of 1 to 2 children.

All of the respondents are above the ideal number of child recommended by the Philippine Government under House Bill 4244 which states that “The State shall assist couples, parents and individuals to achieve their desired family size within the context of responsible parenthood for sustainable development and encourage them to have two children as the ideal family size.” (http://www.newphilrevolution.com/2011/05/house-bill-4244-mandates-ideal-family.html)

The household beneficiaries are responsible to attend to the needs and allot time for their children whether their needs concern financial, physical and emotional. It implies that the greater the number of children a household will have the greater time they need to devote for them and the lesser time they will be able to allocate for participating in the activities of 4Ps.

In the study conducted by Chakraborty et al 2003 entitled “Determinants of the use of maternal health services in rural Bangladesh,” it was cited that having more children may also cause resource constraints, which have a negative effect on health care utilization. Women with a large number of children underutilize available health services because too many demands on their time force them to forgo health care.

Table 1.0 Time Allocation as a determinant affecting the level of compliance to 4Ps.

 Table 1.0 presents the determinants affecting the level of

compliance to 4ps as Time Allocation, which shows “always” ratings from the respondents with a weighted mean of 2.87, 2.76, 2.54, 2.81 and 2.57 respectively. The responses show that the respondents always allocate their time to the 4Ps activities. The above situations under time allocation showed an interpretation of “always” rating which positively indicates that they are able to manage their time accordingly to the scheduled date of activities in 4Ps.

Mean Range Interpretation

2.35 - 3.00 Always

1.68 – 2.34 Sometimes

1.00 – 1.67 Never

This implies that the respondents’ time allocation is appropriate for them to effectively comply with the conditions of 4Ps. Majority of the respondents could “always” postpone their house chores whenever needed to attend in the scheduled activities of 4Ps. But some of them encounter problems in complying due to the need for time and attention of their other children. Some of the respondents would choose to prioritize the need of their children than attend to 4Ps.

Time allocation is considered as an important determinant that may affect the level of compliance of the 4Ps’ household beneficiaries. It describes their capability to manage their time effectively and to schedule their own personal activities in accordance to scheduled days for 4Ps.

Patients may not be able to take time off work for treatment; as a result, their rate of compliance could be threatened (Lawson et al 2005; Neal et al 2005). Therefore, a shorter traveling time between residence and healthcare facilities could enhance patient’s compliance (Gonzalez et al 2005)

Table 1.1 Accessibility of Barangay Health Center as a determinant affecting the level of compliance to 4Ps.

The responses shown at the table above presents that the distance of the Barangay Health Center(BHC) from the houses of 4Ps’ household beneficiaries is near (2.96), most of them has easy access when securing a transportation going to BHC (2.96), It is always open (2.67), they are well and in a good condition to walk and attend 4Ps activities in BHC (2.77) and they don’t have a physical disability, that makes it easy for them to go to BHC (2.67). All situations above showed an “always” rating from the respondents.

This implies that the majority of the respondents “always” found the Barangay Health Center near from their houses and do not encounter any problem in securing a mode of transportation in attending to activities of 4Ps held at Barangay Health Center. However some of the respondents are sometimes unable to comply due to their physical disabilities that make it hard for them to go to BHC and attend. It could be said that the location of Barangay Health Center is not a hindrance for the respondents to comply in 4Ps but their own health and physical capability to comply sometimes becomes their problem.

Accessibility is one of the factors when complying with the program. The accessibility of the Barangay Health Center is directly influencing the compliance of the 4P’s beneficiaries. The more that BHC is accessible to the beneficiaries, the more they tend to comply with the program.

A shorter traveling time between residence and healthcare facilities could enhance patient’s compliance (Gonzalez et al 2005). Lack of accessibility to healthcare (Ponnusankar et al 2004), long waiting time for clinic visits (Lawson et al 2005; Wai et al 2005), difficulty in getting prescriptions filled (Vlasnik et al 2005), and unhappy or unsatisfied clinic visits (Spikmans et al 2003; Gascon et al 2004; Lawson et al 2005) all contributed to poor compliance.

Table 1.2 4P’s Household Beneficiaries-Parent Leader Relationship as Determinant affecting

the Level of Compliance

Table 1.2 presents the determinants affecting the level of compliance to 4Ps as to 4Ps household beneficiaries – parent leader relationship, which shows “always” rating from the respondents with a weighted mean of 2.80, 2.86, 2.81 and 2.88 respectively.

This implies that a good relationship between the respondents with their parent leader exists. The parent leaders always understand the needs and situation of the respondents. But some of them are not friendly and approachable to some of the respondents. Problem in relationship between the parent leader and the 4Ps household beneficiaries may result to a conflict in their communication about necessary informations about 4Ps thus, affecting their compliance.

A Parent Group is composed of 25 to 30 household grantees per cluster. Each group chooses by consensus a parent leader who performs the following: (1) Acts as the point person between the MLs, LGU link, and the household grantees at the barangay level. (2) Leads a group of household grantees and facilitates the Family Development Session at the barangay level (3) Disseminates information and updates about 4Ps. Findings show that there is a good existing relationship between the 4P’s beneficiaries and parent leader in Barangay Calauag Naga, City. They believed that parent leaders are reliable enough when disseminating information and ensures their participation. Beneficiaries viewed that parent leaders are able to understand their needs. It further shows that there is good communication between them.

It could be concluded that patient -prescriber relationship is another strong factor which affects patients’ compliance (Moore et al 2004; Gonzalez et al 2005). Poor communication with healthcare providers was also likely to cause a negative effect on patient’s compliance. A healthy relationship is based on patients’ trust in prescribers and empathy from the prescribers. Studies have found that compliance is good when doctors are emotionally supportive, giving reassurance or respect, and treating patients as an equal partner (Moore et al 2004; Lawson et al 2005).

Table 1.3 Motivation to Comply as Determinant affecting the Level of Compliance

The table above shows the determinant affecting the level of compliance to 4Ps in terms of their motivation to comply. The respondents’ rate “always” to the situations related to the respondents motivation. Their respective weighted mean are as follows: 2.76, 2.77, 2.75, 2.74, 2.92.

The result implies that the respondents are well motivated in complying with 4Ps. Majority of the respondents are motivated because the program provides enough and useful information about taking good care of their family. But some of the respondents have less motivation in terms of the safety and assurance the program provides before, during and after their pregnancy.

This indicates that the respondents are satisfied with the information given by the program for the development of their family but they are not that satisfied with regards to the services it offers for their pregnancy. It might be due to the fact that most of the pregnant and newly – delivered respondents are more confident to acquire the services offered by fully equipped clinical facilities of other prenatal and postnatal clinics than the newly existing services of 4Ps at BHC.

The motivation of the 4Ps household beneficiaries is considered as the foundation of their compliance to the conditions of 4Ps. It is necessary to assess if their motivation is effectively met by the program to ensure their satisfactory compliance. This means that if their primary needs that urge them to work are well provided by the program a full compliance is expected.

Patients who had low motivation to change behaviours or take medication are believed to have poor compliance (Hernandez-Ronquillo et al 2003; Spikmans et al 2003). In a study done in Malaysia, 85% of hypertension patients cited lack of motivation as the reason for dropping out of treatment (Lim and Ngah 1991).

Table 1.4.Summary of the Determinants Affecting the Level of Compliance to 4Ps

Identified

DeterminantsAverage Mean Interpretation

Time Allocation 2.71 Always

Motivation to

comply2.79 Always

Relationship of

4Ps household

beneficiaries –

Parent Leader

2.84 Always

Accessibility of

BHC2.86 Always

The table above shows the major determinants affecting the level of compliance to 4Ps. They are organized chronologically from the most affecting to the least but all of them have an “always” rating from the respondents.

The most affecting determinant is Time Allocation, compared with the other identified determinants by the researcher, for it has an average mean of 2.71 while the least affecting determinant is the accessibility of Barangay Health Center with the highest average mean of 2.86. It implies that the respondents encounter some problems in time allocation than the other identified determinants. It might be due to the schedule days of activities in 4Ps that sometimes do not conform to their daily schedule and contradicts against their family members who demand much of their time. However, with regards to the accessibility of the barangay health center the respondents consider it the least problem they could have in relation with their compliance.

The Beneficiaries Level of Compliance to Pantawid Pamilyang Pilipino Program (4Ps)

Table 2.0 Level of compliance to conditions of 4Ps as to Health.

Health mean interpretation

1. I avail the pre – natal care such as pre – natal check-up, for the entire months of pregnancy 2.81 Fully Complied

2. My childbirth is/will be supervised by a health professional. 2.79

Fully Complied

3. I avail/will avail the post – natal care such as post – natal check – up a month after delivery. 2.63

Fully Complied

4. My 0 – 5 year old child/children availed/ will avail a complete immunization. 2.79

Fully Complied

5. My 0 – 5 year old child/children avails clinical check – up as needed or as required by 4Ps 2.61

Fully Complied

AVERAGE MEAN 2.73 Fully Complied

Mean range Interpretation

2.35 - 3.00 Fully Complied

1.68 –2.34 Partially Complied

1.00 – 1.67 Not Complied

The table above shows the beneficiaries’ level of compliance to Health – related conditions of 4Ps. The respondents rated “fully complied” on the health conditions of 4Ps which have a weighted mean of 2.81, 2.79, 2.63, 2.79 and 2.61 respectively.

The result implies that the pregnant women at pre – natal stage of pregnancy are more health conscious than at their post – natal stage of pregnancy. This may be due to the respondents perceive risk of health; they perceive pre – natal stage as more unsafe than at post – natal stage. On the other hand, the clinical check – up for 0 – 5 years old children is the least complied compared to other related conditionalities which may be due to the perceive severity of children’s condition by the respondents.

In summarizing the findings from the various studies, it would appear that compliance was better when the patient had the following beliefs; the patient feels susceptible to the illness or its complication (Spikmans et al 2003); the patient believes that the illness or its complications could pose severe consequences for his health (Loffler et al 2003);the patient believes that the therapy will be effective or perceives benefits from the therapy (Gonzalez et al 2005; Seo and Min 2005).

Table 2.1. 4Ps household beneficiaries level of compliance to conditions of 4Ps as

to Nutrition.

The table above shows that the respondents rated “fully complied” on the conditions of 4Ps on Nutrition which have the following computed weighted mean 2.83, 2.62, 2.60, 2.83 and 2.66.

Nutrition meaninterpreta

tion1. My 0 – 5 year old child/children avail weight monitoring as scheduled by 4Ps 2.83

Fully Complied

2. My child/ children maintain normal weight for their age. 2.62

Fully Complied

3. My child/children do not frequently acquire illnesses for the entire month. 2.60

Fully Complied

4. My child/children eat nutritional foods each meal a day. 2.83

Fully Complied

5. My 6 – 14 year old child/children avail de – worming pills twice a year. 2.66

Fully Complied

Average mean 2.73Fully

Complied

The result implies that the respondents are aware of maintaining and developing good nutrition for their children. They serve them nutritious foods each meal a day and they are also cooperative in monitoring their weight as scheduled by 4Ps. However, due to their children’s young age and susceptibility to illnesses they could easily acquire illnesses specially those seasonal ones. Children's growth and development are dynamic processes; they can be viewed at the molecular, cellular, organ, and whole - child levels. What determines the nature and severity of environmental factors' health effects is exposure occurrence within the different developmental stages [WHO 2006].

Table 2.2. Level of Compliance to

Education conditions of 4Ps

Education mean interpretation

1. My 3 – 5 year old child/children are enrolled in a Day Care Center. 2.46

Fully Complied

2. My 6 -14 year old child/children are enrolled in elementary or secondary school. 2.92

Fully Complied

3. My child/children’s absences in school are not more than three (3) days per month. 2.56

Fully Complied

4. My child/children know how to read and write according to their level of learning. 2.91

Fully Complied

5. I support my child/children’s activities in school using the cash grant from 4ps for education 2.88

Fully Complied

AVERAGE MEAN 2.75 Fully Complied

Table 2.2 presents the level of compliance to education conditions of 4Ps. The respondents rated “fully complied” on the specified conditions education which have a weighted mean of 2.46, 2.92, 2.56, 2.91 and 2.88 respectively.

This implies that the respondents are more compliant in sending their child to school in elementary and high school aged 6 – 14 years old than sending their 3 – 5 years old child to a Day Care Center. It reasons cited by the respondents during the interview, is the learning capacity and maturity of their child whose age is 3 – 5 years, they were not able to cooperate effectively in their class activities.

The maturation theory was advanced by the work of Arnold Gessell (1961). This believes that development is a biological process that occurs automatically in predictable, sequential stages over time. School readiness, according to maturation, is a state at which all healthy young children arrive when they can perform tasks such as reciting the alphabet and counting; these tasks are required for learning more complex tasks such as reading and arithmetic. It is believed that parents are to teach their young children to recite the alphabet and count while being patient and waiting for children to become ready for kindergarten.

The young child's underperformance is interpreted as the child needing more time to acquire the knowledge and skills needed to perform at the level of his or her peers. (http://www.ncrel.org/sdrs/areas/issues/students/earlycld/ea7lk18.htm)

Table 2.3 Level of Compliance to Family Development Session conditions of 4Ps.

Family Development Session mea

ninterpretatio

n

1. I attend family development sessions as scheduled by 4Ps. 2.77

Fully Complied

2. I attend seminars held at barangay health center as suggested by the barangay health workers. 2.81

Fully Complied

3. I help in disseminating information about the services and conditions of 4Ps 2.83

Fully Complied

4. I help in community development activities facilitated by the barangay health workers 2.86

Fully Complied

5. My husband and I practice our chosen family planning method as presented by the barangay health workers. 1.89

Partially Complied

AVERAGE MEAN 2.63 Fully Complied

The table shows the compliance to Family Development Session conditions of 4Ps. Respondents have a rating of “partially complied” to the condition related to family planning with a mean of 1.89 and “fully complied” in the other specific conditions under Family Development Session which have a computed weighted mean of 2.77, 2.81, 2.83 and 2.86 respectively.

The conditions under Family Development Sessions are designed to improve and develop good parenthood, family management and community involvement among families of 4Ps beneficiaries. As shown in the table above, it implies that the 4Ps beneficiaries are very cooperative in community services facilitated by 4Ps and they are also active in disseminating information regarding 4Ps. However, they are not fully compliant to family planning methods recommended by 4Ps, some of them practice only the natural method of family planning and most totally do not practice any of the suggested methods.

In the study conducted by the Social Science Research Institute, Central Philippines University (2012), stated that “Women found community activities relaxing, and said these activities allowed them to socialize and interact with their peers. Women reported that social participation gave them satisfaction and increased their sense of self-worth.”

According to the 2006 Family Planning Survey, only 50.6 per cent of women used family planning methods – unchanged in the past six years. In the Philippines, more than 80 per cent of the population is Catholic, and only natural family planning methods are sanctioned by the Church. Condoms, the Pill and other forms of modern contraception are equated with abortion, which is illegal. As a result, contraceptives are not available in most government and rural health clinics. (http://www.unfpa.org/public/News/pid/)

Summary of Average Mean of the Level of Compliance to conditions of 4Ps

Table 2.4 Level of Compliance to Conditions of 4Ps.

ConditionalitiesAverage

MeanInterpretation

Education 2.75 Fully Complied

Health 2.73 Fully Complied

Nutrition 2.73 Fully Complied

Family

Development

Session (FDS)

2.63 Fully Complied

The table above shows the beneficiaries Level of Compliance to conditions of 4Ps as to health, nutrition, education, and Family Development Session. These conditions were rated “fully complied” by the respondents which have an average weighted mean of 2.75, 2.73, and 2.63.

This implies that respondents have fully complied with the conditions of 4Ps. Education conditions are the most complied while the FDS is the least compared with the other conditions. It shows that the respondents prioritized the education of their children, rather than planning their family and participating in community development services. It might be due to the respondents’ higher perception of importance and benefits of education for their children.

Relationship between Level of Compliance and demographic profile of the 4Ps household beneficiaries

The Pantawid Pamilyang Pilipino Program is a government program which aims to promote maternal and child health, prevent illnesses through proper nutrition, facilitate primary education for children and eradicate poverty. A full compliance of beneficiaries to the set of conditions in Health, Nutrition, Education and Family Development Session is the key to attain the above mentioned developmental goals. The 4Ps’ household beneficiaries are individuals with personalities that affect their priority setting and attitudes toward achievement of their personal life goals.

Table 3 shows the relationship between the level of compliance to conditions of 4Ps and demographic profile of the 4Ps household beneficiaries. All these were compared at critical value of 0.217 and the null hypothesis was tested at 0.05 - level of significance.

Table 3.0 The relationship of level of compliance to Health conditions of and

the demographic profile of 4Ps household beneficiaries.

Health

Variables Correlation

Coefficient

Type of Relationshi

p

Null Hypothesis

Age -0.1301 No or negligible

Accepted

Civil Status

-0.1388 No or negligible

Accepted

Educational Attainment

0.0147 No or negligible

Accepted

Monthly Income

0.0278 No or negligible

Accepted

Maternal Status

-0.0947 No or negligible

Accepted

Number of Children

-0.1350 No or negligible

Accepted

Critical Value: 0.217 α=0.05

It can be seen from the table that there is a negligible or no existing relationship between the level of compliance to health conditions and the demographic profile of the 4Ps household beneficiaries as to age (-0.1301), civil status (-0.1388), educational attainment(0.0147), monthly income (0.0278), maternal status (-0.0947) and number of children (-0.1350). The values of correlation coefficient of the variables are less than the critical value of 0.217 which implies that the null hypothesis is to be accepted.

Health conditions of 4Ps include prenatal, postnatal and safe delivery during pregnancy, complete immunization and clinical check – up for children under 0 – 5 years old. According to health belief theory of Hochbaum, Rosenstock and Kegels (1950), demographic profile of a person is considered as a modifying factor that may affect his perception to susceptibility and seriousness of disease, perception on the threat of disease and likelihood of action towards health. However, demographic profile does not show significant relationship with the level of compliance of 4Ps household beneficiaries to health conditions of 4Ps. It indicates that the decision of the respondents to comply in health conditions of 4Ps is not affected by their health perceptions.

Table 3.1 Relationship of the level of compliance to Nutrition conditions

of 4Ps and demographic profile

Nutrition

Variables

Correlation

Coefficient

Type of Relationshi

p

Null Hypothesis

Age 0.1804No or

negligibleAccepted

Civil Status

-0.0705No or

negligibleAccepted

Educational Attainment

-0.0243No or

negligibleAccepted

Monthly Income

0.1509No or

negligibleAccepted

Maternal Status

0.1422No or

negligibleAccepted

Number of Children

0.1867No or

negligibleAccepted

Critical Value: 0.217 α=0.05

The table shows the relationship between level of compliance of 4Ps household beneficiaries to Nutrition conditions and demographic profile. With the value of correlation coefficient in age (0.1804), civil status (-0.0705), educational attainment (-0.0243), monthly income (0.1509), maternal status (0.1422) and number of children (0.1867) relationship could be said as negligible and the null hypothesis is therefore accepted.

Nutrition conditions of 4Ps are focus on the de – worming program, weight monitoring and nutritional diet of the children covered by 4Ps. The result suggests that the demographic profile of the respondents does not significantly affect the attitudes and behavior towards nutrition conditions of 4Ps. It could be said that the respondents’ level of compliance to health and nutrition conditions is not primarily affected by their health beliefs and capabilities to comply as individual. Their compliance and behavior could be driven by the reward system implemented in the program.

Based on the operant conditioning theory of Skinner, changes in behavior are the result of an individual's response to events (stimuli) that occur in the environment. When a particular Stimulus-Response (S-R) pattern is reinforced (rewarded), the individual is conditioned to respond. Reinforcement is the key element in Skinner's S-R theory. A reinforcer is anything that strengthens the desired response. It could be verbal praise, a good grade or a feeling of increased accomplishment or satisfaction.

The theory also covers negative reinforcers - any stimulus that results in the increased frequency of a response when it is withdrawn. In view of our study, the reinforcer used in 4Ps is the cash grants given to complying household beneficiaries as they comply effectively they will be given certain amount of money every two months. However, if they refuse to comply on the conditions deduction in cash grant or removal in the list of beneficiaries will be their punishment.

Table 3.2 Relationship of the 4Ps household beneficiaries’ level of

compliance to Education conditions of 4Ps and demographic profile

EducationVariables Correlatio

n Coefficien

t

Type of Relationsh

ip

Null Hypothesis

Age 0.4512 Strong positive

Rejected

Civil Status

0.1045 No or negligible

Accepted

Educational Attainment

-0.0388 No or negligible

Accepted

Monthly Income

0.0540 No or negligible

Accepted

Maternal Status

0.3551 Moderate positive

Rejected

Number of Children

0.4075 Strong positive

Rejected

Critical Value: 0.217 α=0.05

The table shows the relationship between level of compliance to education conditions of 4Ps and demographic profile of the 4Ps household beneficiaries. Age (0.4512) and number of their children (0.4075) of the respondents express strong positive relationship to their level of compliance with education conditions. And a moderate positive relationship existed between the maternal status (0.3551) of the respondents and their level of compliance to education conditions. While the civil status (0.1045), educational attainment (-0.0388) and monthly income (0.0540) shows negligible or no significant relationship with their level of compliance. Thus, the null hypothesis of the study for age, number of children and maternal status is rejected and accepted in the other identified demographic profile.

Educational conditions of 4Ps requires 3 - 5 years old children to attend school particularly at Day Care Centers and children aged 6 – 14 are required to attend elementary and high school with an attendance of not less than 85%. It also focuses on the literacy on the students appropriate for their age. The result suggest a positive relationship of the respondents age to their level of compliance to education conditions of 4Ps this implies that as the maternal age increases the probability for them to fully comply also increases. It is also evident with the maternal status, as the maternal status (whether respondents are pregnant, newly – delivered or neither of the two) of the respondents improves their level of compliance with education is also expected to improve.

As proven by the study of Holloway et. al (2008) on Determinants of Parental Involvement in Early Schooling: Evidence from Japan that focuses on how demographic and psychological factors shape the involvement of Japanese mothers in their children's education; five demographic variables studied were family income, maternal education, family size, mothers' employment status, and sex of the child. Survey data were obtained from 97 Japanese mothers with a second-grade child.

Multiple regression analyses indicated that a more highly educated and wealthier mothers with fewer children reported investing to a greater extent in supplementary lessons. Mothers' work status was not associated with any of the outcomes, nor was sex of the child.

The study by Orbeta (2005) entitled “Poverty, vulnerability and family size: evidence from the Philippines” had a potential impact of the 4Ps on school attendance. Said study focuses on the impact of family size on the various aspects of family welfare specifically on education. Study shows that each additional child reduces the proportion of school-age children attending school.

Table 3.3 Relationship of the 4Ps household beneficiaries’ level of

compliance to Family Development Session conditions of 4Ps and

demographic profileFDSVariables Correlatio

n Coefficien

t

Type of Relationshi

p

Null Hypothesis

Age -0.0508 No or negligible

Accepted

Civil Status

-0.0005 No or negligible

Accepted

Educational

Attainment

-0.0325 No or negligible

Accepted

Monthly Income

0.0404 No or negligible

Accepted

Maternal Status

0.1940 No or negligible

Accepted

Number of Children

-0.0052 No or negligible

Accepted

Critical Value: 0.217 α=0.05

The table shows the relationship between the level of compliance to Family Development Session and the demographic profile of the respondents. The result gave a negligible relationship of age (-0.0508), civil status (-0.0005), educational attainment (-0.0325), monthly income (0.0404), maternal status (0.1940) and number of children (-0.0052) to the level of compliance in education conditions of 4Ps; this accepts the null hypothesis of the study.

Family Development Session (FDS) condition of 4Ps includes giving relevant information about family planning, parenting style and community development activities. The result presented above could further be interpreted that the personal attributes of the respondents have nothing to do with their level of compliance to FDS conditions of 4Ps.

In the study entitled “Community involvement to increase utilization of maternal health services: Experiences from rural Bangladesh” by Tasnima et al 2011 sited that in Bangladesh there’s a high maternal mortality ratio: 290 deaths per 100,000 live births and only about 56% women seek antenatal care (ANC) and only 18% women receive postnatal care (PNC).Pregnant women in rural areas are less likely to seek maternity services from health centers and/or trained providers due to insufficient knowledge about the importance of pregnancy care and lack of motivation and financial support.

Community participation proved viable approach in reducing maternal morbidity and mortality in Ghana, Cambodia, and Tanzania by increasing knowledge, motivating and creating demand among pregnant women to utilize maternal health services. This study examined community participation to create demand among poor pregnant women for receiving ANC, delivery and PNC services from trained service providers along with financial assistance. Community participation was ensured through voluntary community support group (CSG). The findings of this study showed that financial support to poor pregnant women significantly increased the utilization of maternity care from the health facilities.

Furthermore, the conditional cash grant and other awards given by DSWD to most complying household beneficiaries motivate the respondents to comply effectively outweighing the health related benefits of the program. Due to increase rate of poverty in the Philippines the household beneficiaries found the Pantawid Pamilyang Pilipino Program as another way of earning money, this justify the primary purpose of the program which is to provide social assistance and development for the poor, reducing poverty in the country. It could be said that the 4Ps household beneficiaries are not merely focusing on their health needs but rather more concern on their financial stability.

CHAPTER 5

1. Summary

3. Conclusions

4. Recommendations

2. Findings FINDINGS 1

FINDINGS 2

FINDINGS 3FINDINGS 4

CONCLUSION 1

CONCLUSION 2

CONCLUSION 3CONCLUSION 4

RECOMMENDATION 2

RECOMMENDATION 3RECOMMENDATION 4

SUMMARYThis study aimed to know the determinants affecting the

level of compliance of the household beneficiaries of Pantawid Pamilyang Pilipino Program (4P’s) in Barangay Calauag, Naga City from March 2011- August 2012.

The study had 83 respondents composed of 4Ps beneficiaries of Pantawid Pamilyang Pilipino Program in barangay Calauag, Naga City. Related literature and studies were carefully selected to determine the similarities and differences of the past studies with the present study and to gain insights that would lead to new aspects to the present study.

An appropriate theory, from which this study was anchored, is illustrated in the theoretical framework. These theories were that of Imogene King’s Goal Attainment Theory and Ken and Param Shah’s Theory of Motivation.

A conceptual framework of the study was presented to further explain the relationship between variables.

The study used the descriptive – correlation research design with a prepared survey questionnaire as the research instrument, statistical tools used included, frequency distribution, percentage and average weighted mean and to determine the significant relationship Pearson Correlation was used.

Problem 1. What are the respondents’ demographic profiles?

Findings. 1. Most of the respondents are at the young and middle stage of adulthood, with 40 out of 83 or 48.19% of the respondents are within the range of 28 – 38 years of age, 36 respondents or 43.37% of the 83 respondents are within 39 – 60 years old, while only 7 or 8.43% of the respondents are within the age of 17 – 27 which is classified as late adolescence to young adulthood.

FINDINGS

2. Majority of the respondents is married with 71 or 85.54% of the 83 respondents are classified under this civil status, 8 or 9.64% are separated, 3 or 3.61% are widowed while only 1 respondent or 1.20% is a single mother.

3. For the educational attainment of the 83 respondents, 27 or 32.53% of the respondents are high school undergraduate, 21 or 25.30% are high school graduate, 14 or 16.87% are elementary graduate, 10 or 12.05% are college undergraduate, 9 or 10.84% of the respondents are elementary undergraduate and only 1 respondent or 1.20% accounts for a college graduate and a respondent with no formal education.

4. The approximate monthly income of the 83 selected 4Ps household beneficiaries is classified as follows; respondents with Php. 3,000 and above monthly income are 40 or 48.19% of the total population, 39 respondents or 46.99% have a monthly income of Php. 1,000 – 3,000 and only 4 respondents or 4.82% earn Php. 500 and below monthly.

5. In the maternal status, most of them are neither

pregnant nor newly – delivered represented by 64 or 77.11% of the respondents, it was followed by 12 respondents or 14.46% who are newly – delivered mothers and 7 pregnant or 8.43% respondents.

6. As for the number of their children, most of the respondents have 3 - 5 children with 47 respondents or 56.63%, followed by 29 respondents or 34.94% with 6 and above number of children, whereas, only 7 respondents or 8.43% have an ideal number of children, 1 -2 children.

The respondents are mostly at the age of young and middle adulthood, married, high school undergraduate, with a monthly income of Php 3,000 and above, neither pregnant nor newly–delivered with 3–5 number of children. The complete and accurate demographic profile of the 4Ps household beneficiaries must be obtained to understand their current situation and needs. It is also needed in making a complete data base of the beneficiaries to avoid errors such as misidentification of the beneficiaries.

CONCLUSION

2. What are the determinants that affect the level of compliance of household beneficiaries to services of 4Ps as to:

2.1 Time Allocation2.2 Accessibility of Barangay Health Center2.3 4Ps’ Household Beneficiaries – Parent

Leader Relationship 2.4 Motivation of the 4Ps’ Household

Beneficiaries

2.1 Time Allocation. It was found out that the 4Ps household beneficiaries who are respondents of the study “always” allot time for the activities of 4Ps. They are always willing to leave their house chores to participate in 4Ps, it has a weighted mean of 2.87; they have properly scheduled their time for their other family roles and responsibilities with a weighted mean of 2.81; they always find time for the activities of 4Ps justified by the weighted mean of 2.76; they have enough time for their physical, emotional and spiritual needs and it doesn’t hinder their compliance it has a weighted mean of 2.57 and lastly, they are able to give adequate time for the needs of their other children but it doesn’t interrupt their allotted time for 4Ps this account for a weighted mean of 2.54.

2.2 Accessibility of Barangay Health Center. The study revealed that the respondents perceive the location and availability of the Barangay Health Center as appropriate and convenient for their needs. The distance of BHC is always near from the home of the respondents and it was always easy for them to secure a mode of transportation going to BHC, both has a weighted mean of 2.96. The Barangay Health Center is always open and available to accommodate their needs anytime with a weighted mean of 2.92, The respondents always find it conducive to walk and attend the activities of 4Ps in BHC accounting for a weighted mean of 2.77. The respondents don’t have any special needs or physical disability that must be considered in designing the Barangay Health Center it has a weighted mean of 2.67.

2.3 4Ps’ Household Beneficiaries – Parent Leader Relationship. The existing relationship between the parent leader and the 4Ps household beneficiaries shows satisfactory result. The parent leaders always understand the needs and situation of the respondents as one of the 4Ps household beneficiaries it was justified by its weighted mean of 2.88. A good communication of necessary informations about activities of 4Ps is effectively facilitated by the parent leaders; they have adequate knowledge about the program that answers the query of the beneficiaries both has a weighted mean of 2.86. The parent leaders ensure their compliance by personally reminding and inviting them about the schedule of the activities of 4Ps it has a weighted mean of 2.81; lastly, they are always approachable and friendly for the 4Ps household beneficiaries it has a weighted mean of 2.80.

2.4 Motivation to comply. The motivation of the respondents to comply on the activities and conditions of 4Ps was revealed in the study as at satisfactory level. The 4Ps household beneficiaries are certain that the program supply them enough and useful information about taking good care of their family, it has a weighted mean of 2.92. The health services of 4Ps always prevent diseases and provide good nutrition for their children; it has a weighted mean of 2.77. They agreed that the cash grants from 4Ps are another source of income for their family to sustain their basic needs it has a weighted mean of 2.76. The education services of the program for their children also serve as one of the motivating factor for the beneficiaries it has a weighted mean of 2.75. Furthermore, the respondents appreciate the safety and assurance offered by the program before, during and after their pregnancy it has the weighted mean of 2.74.

The determinants that affect the beneficiaries’ level of compliance to conditions of 4Ps are chronologically written as follows: the time allocation of the beneficiaries, their relationship with their respective parent leader, their motivation to comply and the least affecting determinant is the accessibility of the barangay health center. Some of the respondents encounter problems in allocating their time to attend the scheduled activities of 4Ps. It might be because the schedule of the said activity do not conform to their daily schedule of activities and might also be due to the time – demanding members of the respondents’ family. However, the venue of the activities of 4Ps which is the barangay health center was claimed to be accessible and accommodating by the respondents.

CONCLUSION

1. The DSWD, as the implementing agency, must consider some factors that might affect the level of compliance of the 4Ps’ household beneficiaries and be able to developed strategies such as rotational scheduling of the activities of 4Ps to resolve their difficulties of complying.

 2. The Compliance Verification System of the

program must further be developed by the implementing agencies to specifically recognize the level of compliance of each beneficiary and determine the reasons of the identified poor complying beneficiaries.

RECOMMENDATIONS

Problem 3. What are the areas of assessment in determining the level of compliance?

3.1 Health3.2 Nutrition3.3 Education3.4 Family Development Sessions

3.1 Health. The conditions for health are rated “fully complied” by the respondents. The pregnant beneficiaries avail the pre – natal check – up for the entire months of their pregnancy it has a weighted mean of 2.81. The childbirth or delivery of the respondents is/will be supervised by the health professionals; they also avail the complete immunization of their 0 – 5 years old children both of these has a weighted mean of 2.79. The newly – delivered mother avails the post – natal care rendered by the program it accounts for a weighted mean of 2.63. Majority of the respondents also avail the clinical check – up for their 0 – 5 year old children which has a weighted mean of 2.61.

FINDINGS

3.2 Nutrition. In this area of assessment the most fully complied condition is the weight monitoring of the 0 – 5 year old children of the respondents and the serving of nutritional foods each meal a day for their children both have a weighted mean of 2.83. The de – worming of their 6 – 14 year old children twice a year was also availed by the respondents it has a weighted mean of 2.66. It was also ensured by the respondents that their children maintain a normal weight appropriate for their age; it has a weighted mean of 2.62. The least fully complied by the respondents is the condition to prevent illness of their children within a month it has a weighted mean of 2.60.

3.3 Education. The condition under this area of assessment has a “fully complied” rating by the respondents. Their 6 – 14 year old children are enrolled at elementary or secondary school it has a weighted mean of 2.92. Their children know how to read and write according to their level of learning it is justified by the weighted mean of 2.91. They utilize the cash grant that they get from the program to support the educational needs of their children it accounts for a weighted mean of 2.88. The absences of their children do not exceed three day per month it has a weighted mean of 2.56. Lastly, their 3 – 5 year old children are enrolled in a Day Care Center it has a weighted mean of 2.46.

3.4 Family Development Session. In this area of assessment the respondent rated this condition as “fully complied” except to family planning related condition which has a “partially complied” rating. The respondents help in community development activities facilitated by the barangay health workers it has a weighted mean of 2.86. They help in disseminating information about the services and conditions of 4Ps with a weighted mean of 2.83. They also attend to seminars held at barangay health center as suggested by the barangay health workers it has a weighted mean of 2.81. They always attend to family development sessions as scheduled by 4Ps this has a weighted mean of 2.77. The respondents together with their husband practice family planning but only few of them did resulting to a level of partially complied condition with a weighted mean of 1.89.

The level of compliance of the respondents to the conditions of 4Ps in the areas of assessment in health, nutrition, education and family development session gave a rating of “fully complied”. The most complied among these areas of assessment is education while the least is the family development session. The respondents highly prioritized the need of education of their children than planning their family and participating in community development activities.

CONCLUSION

1. The University of Nueva Caceres – College of Nursing, as an

affiliating student nurses in Barangay Calauag, Naga City and the researchers of the study, must conduct thorough information dissemination about family planning method giving emphasis on its importance to maternal and child health.

2. The Department of Health, as one of the implementing agency, in cooperation with local government unit, must conduct home visits, seminars and couple - counseling to strengthen campaign on family planning.

RECOMMENDATIONS

3. The DSWD together with DOH and DepEd, must establish a simultaneous assessment not only on the level of compliance of the 4Ps’ household beneficiaries but also the health and learning status of the respondents to determine if the goal of the program has been met.

Problem 4. Is there any significant relationship between the level of compliance and the demographic profile?

Based from the result of the Pearson Correlation, performed between level of compliance and demographic profile of the respondents, there is a significant relationship between the age (0.4512), number of children (0.4075) and maternal status (0.3551) to the level of compliance in education conditions of 4Ps but no significant relationship with civil status (0.1045), educational attainment (-0.0388) and monthly income (0.0540). However, there is no significant relationship between level of compliance to Health conditions and demographic profile of the respondents; with correlation coefficient of – 0.1301 for age, -0.1388 for civil status, 0.0147 for educational attainment, 0.0278 for monthly income,

FINDINGS

-0.0947 for maternal status and -0.1350 for number of children. There’s also no significant difference between level of compliance to nutrition condition and demographic profile of the respondents with correlation coefficient of 0.1804 for age, civil status –0.0705, educational attainment -0.0243, monthly income 0.1509, maternal status 0.1422 and number of children 0.1867. As well as for Family Development Session, it has no significant relationship with demographic profile specifically with age (-0.0508), civil status (- 0.0005), educational attainment (-0.0325), monthly income (0.0404), maternal status (0.1940) and number of children (-0.0052).

The demographic profile do not significantly affect the level of compliance to conditions of 4Ps except in the case of age, number of children and maternal status in the level of compliance to education condition of the program. The three identified demographic profile is positively related to the level of compliance which means that as age and number of children increases better compliance is also expected while, as the maternal status becomes better there is a possibility of higher compliance from the 4Ps’ household beneficiaries.

CONCLUSIONS

1. The barangay health officials, local government unit and DSWD must have a record of up – to – date and properly documented profile of the beneficiaries to avoid errors in determining their compliance and to serve as a representation of the beneficiaries’ individual characteristics justifying their level of compliance.

2. For the future researchers, a higher number of respondents to represent the 400 total populations of 4Ps household beneficiaries in Barangay Calauag Naga, City are suggested to entirely validate the findings of the present study.

RECOMMENDATIONS

CHAPTER SUGGESTIONSTITLE

Chapter I

Statement of the problem

Definition of Terms

Scope and Delimitation

Conceptual framework

Conceptual Paradigm

Title was changed to Determinants Affecting the Level of Compliance of 4p’s Beneficiaries in Barangay Calauag Naga City: An assessment

Problem #3 was changed to “what are the areas of assessment in determining the level of compliance”3.1 Health3.2 Nutrition3.3 Education3.4 Family Development sessionHead of the Family and Local Government Unit was removed and DEpEd as well as DOH was included since one of the lead agency in the implementation.Of 4Ps.The 43 respondents was changed to 83 respondents who are 4Ps household beneficiaries Was changed to determine the relationship between demographic profile and level of compliance to 4Ps.Gender was removed as part of demographic profile and Include Areas of assessment as part of conceptual framework specifically the health, nutrition, education and FDS.

Delete “compliance to 4Ps as to health, nutrition, education and FDS” under box number 2. Change “level of compliance to areas of assessment” under box number 3. State level of compliance on box number 4. Use an arrow to connect box number 1 and box number