Our Lady of Fatima University

College of Nursing
QUESTIONNAIRE FOR EMPLOYEES

A. PROFILE
Name: ___________________________________________
Working years in the community: _________________
Departmental Affiliation: __________________________

B.
1. What are the advantages and disadvantages after implementing
the Local Government Code?
_________________________________________________________________
_________________________________________________________________
________________________________________________________________
2. Are there any hindrances encountered during implementation of
the health related programs after the RA 7160? What are those
in terms of:
a. Allocation of funds
_____________________________________________________________
__________________________________________________________
b. Organizers
_____________________________________________________________
___________________________________________________________
c. Accessibility of services

_________________________________________________________________________
_________________________________________________

3. How do you give awareness to the community about the

programs for prevention of hypertension?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
__
4. How do you feel about the interventions of the programs?

_______________________________________________________________________________
_______________________________________________________________________________
________________________________________

5. As a health care provider, what could be your contributions to

the programs implemented during the Local Government Code?
_______________________________________________________________________________
_______________________________________________________________________________
________________________________________

Our Lady of Fatima University

College of Nursing
QUESTIONNAIRE CHECKLIST FOR CLIENTS

DYNAMICS OF A DEVOLVED IMPLEMENTATION OF

HYPERTENSION PREVENTION PROGRAMS IN RIZAL

DIRECTION:
Kindly

answer

parenthesis

the

following

questions

by

checking

the

[ / ] or filling up the blank that corresponds your

answer. Rest assured that all information provided should be taken

collectively to maintain strict confidentiality.

I. PROFILE OF THE RESPONDENTS

Age
[ ] below 15
[ ] 16 25
[ ] 26 35
[ ] 36 45
[ ] 46 55
[ ] 56 65
[ ] 66 above
Gender
[ ] Male
[ ] Female

Educational Attainments
[ ] Elementary graduate
[ ] High school graduate
[ ] College graduate
[ ] Masters degree
[ ] Doctorate degree
[ ] Other (Specify): ____________
Family history of hypertension
a. Is there anybody in the family who is suffering from
hypertension?
[ ] Yes

[ ] No

b. If yes, how are you related?

[ ] Father
[ ] Mother
[ ] Brother
[ ] Sister
[ ] Grandparents
[ ] Other (Specify): ______________
Additional information:
Family monthly Income
[ ] 100- 1,000 pesos
[ ] 1,001-5,000 pesos
[ ] 5,001- 10,000 pesos
[ ] 10, 001- 15,000 pesos
[ ] 15,001- 20,000 pesos
[ ] 20,001 and above

II. LEVEL OF AWARENESS OF THE CLIENTS

4 Very much aware
3 Very aware
2 Not much aware
1 Not aware at all

4
1. Implementation of Hypertension Program
a. Distribution of flyers
b. Public announcement
c. Mouth-to-mouth use
2. Services available
a. Free consultation
b. Free medicine
c. Free laboratory & diagnostic tests
3. Services availability frequency
a. Once a month
b. Twice a month
c. Thrice a month
d. Weekly

III. PERCEPTION ON THE IMPLEMENTATION OF REPUBLIC ACT 7160

4
3
2
1

Always
Sometimes
Seldom
- Never

1 Open opportunities

a. Receives medical treatment/services

b. Free medicines
c. Free consultation and diagnostic tests

2 Challenge met
a. Unavailability of medical practitioners
b. Overcrowding patients
c. Patients in-waiting

3 Barriers encountered
a. Financial problem
b. Availability of diagnostics and
laboratory
c. Accessibility of the facility