1

CHAPTER 1

THE PROBLEM AND ITS BACKGROUND

Introduction

Hepatitis is an inflammation of the liver caused by infections, toxic

substances, and autoimmune substances. According to the World Health

Organization, Hepatitis B is a major global health problem and a potentially life-

threatening liver infection caused by the hepatitis B virusthat may cause chronic

infection and puts people at risk of death from cirrhosis and liver cancer. WHO

added that the virus is transmitted through contact with the blood or other body

fluids of an infected person.

According to André (2000), countries with intermediate

endemicityfor Hepatitis B virus includes India, Korea, the Philippines, Taiwan and

Thailand. Lansang, M. (1996) wrote that the prevalence of chronic hepatitis B

virus (HBV) infection in the Philippines, as indicated by hepatitis B surface

antigen (HBsAg) positivity, ranges from 2% to 16.5%, with an average of 12% in

a study of rural villagers as studied by Perz. The educator also have a study

assessing the possibility and effectiveness of including hepatitis B vaccine into

the national ExpandedProgrammeon Immunisation, with a coverage rate of fully

immunised 1 year olds ranged from 80.9-84% and anti-HBs seroconversion rates

ranged from 72-88%.

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“An estimated 7.3 million Filipinos, or 16.7% of the adult population,

are chronically infected with the hepatitis B virus…” WHO (2014 April, 17).

Hepatitis B Infection in the Philippines. The site also added that aside from the

physical battle that affected people faces are also discrimination from other

people who though thatviruses from Hepatitis B can only be acquired through

immoral acts, and that the disease can be transmitted through casual contact.

“…Hepatitis B can be unknowingly transmitted through contaminated blood

products including during blood transfusions, contaminated medical devices and

from infected mothers to infants during childbirth.”

The hepatitis B virus according to the UPMC website is spread

through contact with body fluids of an infected person, such as blood, semen,

vaginal fluids, and saliva. Some Hepatitis B cases are contacted by children

through being born to a mother who has hepatitis B, living in the same house

with someone who is infected with hepatitis B, and sharing items such as

toothbrushes or razorblades, receiving multiple transfusions of blood or blood

products, as hemophiliacs do, being bitten so that the skin is broken by someone

whose saliva contains the hepatitis B virus, and being a hemodialysis patient.

In addition, the WHO also published that in highly endemic areas,

hepatitis B is most commonly spread from mother to child at birth (perinatal

transmission), or through horizontal transmission, most especially from an

infected child to an uninfected child during the first 5 years of life. Chronic
 3

infection is also common in infants infected from their mothers or before the age

of 5 years old.

The WHO analyzed Hepatitis B being spread by percutaneous or

mucosal exposure to infected blood and various body fluids, as well as through

saliva, menstrual, vaginal, and seminal fluids. Hepatitis B may occur through

sexual transmission, particularly in unvaccinated men who have sex with men

and/or heterosexual persons with multiple sex partners and those who

havecontacts with sex workers. The organization also added that an infection in

adulthood leads to chronic hepatitis in less than 5% of cases. Reusing of needles

and syringes either in health-care settings or among persons who inject drugs

also transmits virus. Infection can also occur during medical, surgical and dental

procedures, through having a tattoo, or through the use of razors owned by

someone infected and similar objects that are contaminated with infected blood.

The World Health Organization also stated that about 1% of

persons living with HBV infection (2.7 million people) are also infected with HIV.

Conversely, the global prevalence of HBV infection in HIV-infected persons is

7.4%. WHO has recommended treatment for everyone diagnosed with HIV

infection, regardless of the stage of disease since 2015.

According toAlexander, Amarapuka,Chutaputti, Chien, Hasnian,

Leung, Lesmana,Phiet, Sjalfoellah, Sollano, Sun, Xu (2006),prevention of HBV

infection thorough vaccination is still, therefore, the best strategy for decreasing

the incidence of hepatitis B‐associated cirrhosis and HCC.A similar perception

 4

was said that BV can be controlled with drugs and prevented with a vaccine, but

the drugs have to be taken for a lifetime and vaccine coverage is spotty, even in

many wealthy countries according to Cohen (2018).

WHO also recommends the use of oral treatments such as

tenofovir or entecavir, because these are the most potent drugs to suppress

hepatitis B virus where they rarely lead to drug resistance as compared with

other drugs that have few side effects. In 2015, of the 257 million people living

with HBV infection, 9% (22 million) knew their diagnosis. The statistics showed of

those diagnosed, the global treatment coverage was only 8% (1.7 million), thus

many people are diagnosed only when they already have advanced liver

disease.

The hepatitis B vaccine is the mainstay of hepatitis B prevention,

resulted for the recommendation coming from WHO that all infants should

receive the hepatitis B vaccine as soon as possible after birth, preferably within

24 hours. Worldwide, in 2015, the estimated prevalence of HBV infection in this

age group was about 1.3%, compared with about 4.7% in the pre-vaccination

era.

The global coverage with the third dose of hepatitis B vaccine

during 2015 reached 84%, and global coverage with the birth dose of hepatitis B

vaccine according to WHO was 39%. In addition, implementation of blood safety

strategies, including quality-assured screening of all donated blood and blood

components used for transfusion, can prevent transmission of HBV. It was also

added that eliminating unnecessary and unsafe injections, can be effective

 5

strategies to protect against HBV transmission through safe injection practices

resulted from a 39% decreased in 2000 to 5% in 2010 worldwide of unsafe

injection. Furthermore, safer sex practices, including minimizing the number of

partners and using barrier protective measures (condoms), also protect against

transmission.

To further investigate the issue, the researcher planned to conduct

the study from the health workers’ attitude, knowledge about the issue, and

towards the proper vaccination practice. This study is aimed to inform

intervention strategies based on the findings. The basic questions that the

researcher wished to address are stated as follows:

 What are the respondents' knowledge of viral hepatitis B infection?

 What are the attitudes of the respondents towards Viral Hepatitis B?

 Are the respondents aware of the vaccination practices for Hepatitis B?

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Statement of the Problem

This study is conducted to know the prevalence knowledge, attitude, and

vaccination practices against viral hepatitis B infections among health workers in

Calbayog City.

Specifically, this study seeks to answer the following questions:

1. What is the profile of the respondents in terms of:

1.1 Age;

1.2 Sex;

1.3 Religion;

1.4 Marital Status;

1.5 Occupation?

2. What are the respondents' knowledge of viral hepatitis B infection?

3. What are the attitudes of the respondents towards Viral Hepatitis B?

4. Are the respondents aware of the vaccination practices for Hepatitis B?

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Scope and Limitations of the Study

This study will be conducted to assess the knowledge, attitude, and

vaccination practice against viral Hepatitis B infection among Health Workers in

Calbayog City to have a statistical result to what the response and action would

be.

According to the study of Hegde&Nagpal (2016), the overall

awareness regarding hepatitis B disease was found to be lacking among their

respondents, therefore this research tries to know the prevalence of knowledge

of health workers and the attitude and vaccination practices against Viral B

Infection. This study only limits to the health workers specifically in Calbayog City

and the availability of their schedule.

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Significance of the Study

The findings of this study will benefit the society in terms of

assessing the knowledge of health workers in order to provide them trainings and

programs to ensure quality of treatment that they are giving to their patients in

Calbayog City, and perhaps to other cities that they are going to work or

dispatched to.

This study will also benefit the following beneficiaries:

Teachers and/or Professors. The following beneficiary will have

an idea whether they provided enough or little amount of information towards

their students in order to adjust and take action.

Health Workers. The following beneficiary will have an adequate

amount of knowledge thru the trainings and seminars provided. If not, the

beneficiaries may have a self-realization whether or not they have the right

amount of knowledge in terms of Hepatitis B, and vaccination practices through

the questionnaires given.

Future Researchers. The following beneficiary will be equipped

with knowledge, and with springboard and references for further investigation in

the field and issue.

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Definition of Terms

For better understanding of the study, the researchers provided

several terms and abbreviations that were defined conceptually and operationally

as used in the study.

Conceptual

 Hepatitis – An inflammation of the liver. (2018, December 27). Hepatitis.

Retrieved from https://medlineplus.gov/hepatitis.html

 Cirrhosis – A serious liver disease that occurs when healthy cells in the liver are

damaged and replaced by scar tissue, usually as a result of drinking too much

alcohol or chronic hepatitis. (No date). Understanding Cirrhosis of the Liver

WebMD Medical Reference. Retrieved from https://www.webmd.com/digestive-

disorders/understanding-cirrhosis-basic-information#1

 WHO – World Health Organization

 HBV – (Hepatitis B Virus) Hepatitis B is life-threatening infection of your

liver. It is a virus that spread when people come in contact with the blood,

semen, saliva and other body fluids of someone who has the hepatitis B

virus. Retrieved from https://www.webmd.com/hepatitis/digestive-diseases-

hepatitis-b#1-1

 HCV – (Hepatitis C Virus) Hepatitis C usually only spreads or transmit

through blood-to-blood contact. Nall, R. (2018, October 25). "What is the

difference between hepatitis B and C" Medical News Today. Retrieved

 10

from

https://www.medicalnewstoday.com/articles/323455.php.

 HCC – (Hepatocellular Carcinoma) is the most common type of primary

liver cancer. It occurs most often in people with chronic liver diseases,

such as cirrhosis caused by hepatitis B or hepatitis C infection. (2018,

March 6).Liver Cancer. Retrieved

fromhttps://www.mayoclinic.org/diseases-conditions/hepatocellular-

carcinoma/cdc-20354552

 HBsAg – (Hepatitis B surface antigen) a "positive" or "reactive" HBsAg

test result means that the person is infected with hepatitis B. (ND).

Hepatitis B Blood Test. Retrieved from http://www.hepb.org/prevention-

and-diagnosis/diagnosis/hbv-blood-tests/

 HBeAg – HBeAg is the Hepatitis B envelope antigen, and anti-HBe are

antibodies produced against this antigen. The presence of HBeAg

suggests that the person is infected and can spread the virus to other

people. (Daniel 2018).Understanding the Hepatitis B e-Antigen. Retrieved

from https://www.verywellhealth.com/hbeag-meaning-and-test-results-

1759933
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Operational

 Hepatitis – is a contagious liver infection caused by a virus and can

spread to other people.

 Cirrhosis – A condition of the liver that is scarred and damaged. Scar

tissue replaces healthy liver tissue and prevents your liver from functioning

properly.
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CHAPTER 2

REVIEW OF RELATED LITERATURE

This chapter presents the related literature and studies after the thorough

and in-depthsearch done by the researchers. This will also present the

theoretical andconceptual framework to fully understand the research to be

doneand lastly the research hypothesis that will be tested by the study.

According to Gloor (2015), the experts and officials from the Department

of Health (DOH), the National Institute of Health, and the World Health

Organization (WHO) in the Philippines assembled to review the current condition

of hepatitis in the country. The meeting concord on the understanding of the

disease burden and the program of actions needed to deal with the challenges

posed by hepatitis in the Philippines. The participants agreed to develop a

National Hepatitis Action Plan as one of the basis in “understanding the true

burden of chronic viral hepatitis in the Philippines”.

The World Health Organization (WHO) said that Hepatitis B and C

infections lead to chronic liver disease, which is usually a cause of liver cirrhosis

and liver cancer in the case of hundreds of millions with hepatitis. Medical

Observer, a Philippine-based medical and health online publication says a report

that in the Philippines, about one in seven adults are infected with hepatitis B and
 13

more than half a million have hepatitis C. Medical Observer stated that Hepatitis

B is the second major cause of cancer deaths in the country.

According to familydoctor.org (2018), Hepatitis is a general term for

inflammation of the liver. Mainly, the liver breaks down waste products in your

blood. When the liver is inflamed, it can cause to build up waste products in our

blood and tissues. Hepatitis B is caused by the hepatitis B virus, a serious liver

infection that virus is usually spread from person to person through contact with

blood and/or body fluids of someone who has the infection.

Acute and chronic hepatitis B virus (HBV) infection is a major cause of

liver disease worldwide. It is estimated that approximately 350 million people

worldwide have chronic HBV infection and that 1 million persons die each year

from HBV-related chronic liver disease(Mahoney, 1999).

According to World Health Organization (2018), for at least 7 days, the

Hepatitis B virus can survive outside the body. The virus can still cause infection

if it infiltrates the body of a person who is not protected by the vaccine. In

addition, infection can occur during medical, surgical and also dental procedures.

The transmission of the disease occur when an individual comes into contact

with the semen, other body fluid of an infected person or blood (National

Foundation for Infectious Diseases, ND).It can get through unprotected sexual

contact with an infected partner. People who use intravenous (IV) drugs can get

hepatitis B when sharing needles, syringes, or other drug-injection equipment

with an infected person/someone who has the virus.Health care workers (such as

nurses, lab technicians, and doctors) can get hepatitis B if unintentionally stuck
 14

with a needle that was used on an infected patient. The infection can also be

passed from a mother to her baby during childbirth and also can get hepatitis B if

travel to areas of the world where hepatitis B is common. Hepatitis B cannot be

transmitted through casual contact. For example, by hugging or shaking hands

with someone who is infected of Hepatitis B (familydoctor.org, 2018).

Research shows that there are two major modes of transmission of HBV

that occur in the world. Perinatal transmission occurs at birth from infected

mothers to their newborns, accounts for the majority of HBV transmission

worldwide. Horizontal transmission occurs through open cuts and scratches;

transfusion of blood products; breaks in good practices to prevent blood-borne

infections in the health care setting; sexual transmission and risky behavior,

including the injecting-drug use or tattooing, body piercing, and scarification

procedures without the use of sterilized equipment and needles (Nelson, 2016).

According to World Health Organization, hepatitis B is most commonly

spread in highly endemic areas from mother to child at birth or through horizontal

transmission especially during the first 5 years of life from an infected child to an

uninfected child. The development of chronic infection is most common in infants

infected from their mothers. The disease is also spread by percutaneous or

mucosal exposure to infected blood and various body fluids, as well as through

saliva, menstrual, vaginal, and seminal fluids. Hepatitis B may occur through

sexual transmission, particularly in unvaccinated men who have sex with men

and heterosexual persons with multiple sex partners or contact with sex workers.

Reusing of needles and syringes may also transmit the virus, either in health-
 15

care settings or among persons who inject drugs. Moreover, infection can occur

during medical, surgical and dental procedures, through tattooing, or through the

use of razors and similar objects that are contaminated with infected blood.

Transmission of HBV from infected mothers to their newborn infants

during the perinatal period represents a significant source of chronic infections.

Studies of women of childbearing age in various ethnic, racial, and

socioeconomic groups have shown a wide variation in the rates of chronic HBV

infection (Margolis, Alter, &Hadler, 1991).

The Hepatology Society of the Philippines (2014) stated that not everyone

develops symptoms. Symptoms and signs of hepatitis B are ranged from mild to

severe. Although majority of adults (70%) develop symptoms and many young

children do not. Mainly, adults and children over the age of 5 years are more

likely to have symptoms.

Most people do not encounter any symptoms during the acute infection

phase. However, some people with symptoms can last several weeks, including

fever, fatigue, and loss of appetite, nausea, vomiting, abdominal pain, dark urine,

clay-colored bowel movements, joint pains, and jaundice (yellow color in the skin

or the eyes. The Hepatitis B Virus can also cause a chronic liver infection that

can later develop into cirrhosis, a scarring of the liver or liver cancer (World

Health Organization, 2018).

 16

The World Health Organization (2018) stated that a number of blood tests

are available to monitor and diagnose people with hepatitis B and it can be used

to distinguished acute and chronic infections. WHO recommends that all blood

donations be tested for hepatitis B to avoid accidental transmission to people

who receive blood products and assure blood safety. There are several blood

tests your doctor can request for to diagnose hepatitis B: Acute HBV infection is

distinguished by the presence ofimmunoglobulin M antibody to the core antigen,

HBcAg and Hepatitis B Surface Antigen (HBsAg). The presence of

HBeAgdenotesthat body fluids and the blood of the infected individual are highly

infectious.Chronic infection is distinguished by the persistence of HBsAg for at

least 6 months (with or without concurrent HBeAg). Persistence of HBsAg is the

principal marker of risk for developing chronic liver cancer (hepatocellular

carcinoma)and liver disease later in life.

The complete vaccine series presents protective antibody levels in more

than 95% of infants, children and young adults. Protection lasts at least 20 years

and is probably constant. Thus, World Health Organization does not recommend

booster vaccination for persons who have finished the 3 dose vaccination

schedule. The vaccine has an outstanding record of effectiveness andsafety.

Over 1 billion doses of hepatitis B vaccine have been used worldwide since
 17

1982. Vaccination has decreased the rate of chronic infection to less than 1%

among immunized children.

The WHO Region of the Americas and WHO Western Pacific Region were

the only regions that have extensive coverage. In addition, implementation of

blood safety strategies, including quality-assured screening of all donated blood

and blood components used for transfusion can prevent transmission of HBV

(WHO, 2018).

According to the most recent World Health Organization estimate, 2 billion

people worldwide have serologic evidence of past or present HBV infection, and

360 million are chronically infected and at risk for HBV-related liver disease.

Hepatitis B virus infection may result in subclinical or asymptomatic infection,

acute self-limited hepatitis, or fulminant hepatitis requiring liver transplantation.

Persons affected with HBV may also develop chronic HBV infection, which can

lead to hepatocellular carcinomaor cirrhosis. The chance that newly infected

persons will develop chronic HBV infection is dependent on their age at the time

of infection (Shepard et al., 2006).

The prevalence of HBV infection varies widely throughout the world and

ranges from a highly endemic disease in most of the developing world, to a

disease of low-intermediate regions in developed countries (Margolis H., Alter M.,

&Hadler S. 1991).The majority of infections in the highly endemic countries in

Asia are contracted postnatally or perinatally. There are three phases that are

recognized of having chronic HBV infection: first phase patients are HBeAg

positive with high levels of virus in the serum and minimal hepatic inflammation;
 18

second phase patients have intermittent or continuous hepatitis of varying

degrees of severity; third phase is the inactive phase during which viral

concentrations are low and there is minimal inflammatory activity in the liver

(Merican et al., 2000).

The epidemiology of HBV infections among teenagers has not been

studied extensively, and it would be safe to assume that most health care

providers overlook this age group when considering persons at risk for infection.

Nine percent of the acute cases of hepatitis B reported to the Centers for

Disease Control and Prevention (CDC) are in persons 11 to 19 years old.Of the

cases of hepatitis B in adolescents with a known source for their infection, 50%

can be attributed to sexual or other person-to-person contact and 47% to

parenteral drug use.Adolescents who had sexual intercourse earlier had a

greater number of sexual partners, and they have been shown to have a greater

risk of sexually transmitted disease(Margolis, Alter, &Hadler, 1991).

Prevention of promotion of physical and lifestyle-related diseases and

mental well-being in adolescents require an understanding of how life situations

place adolescents at risk. The most risk factors for hepatitis B virus (HBV)

infection are sexual activity with more than one partner and injecting drug use.

Risk behaviors of an individual are often associated; adolescents who have

frequent sexual intercourse and also drink more alcohol, smoke more cigarettes,

often use marijuana than adolescents who have little or no sexual

activity(Meheus, 2000).
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Hepatitis B is the most infectious occupational illness for health care

workers. The high risk of being infected is the result of the prevalence of virus

carriers in the assisted population, the high frequency of being exposed to

contact with blood and other high contagiousness and the body fluids of hepatitis

B virus (HBV). Vaccination is able to stop the most threatening result of the

infection in responders, even after loss of detectable antibodies.Newly advanced

vaccines seem more immunogenic are presently under evaluation and should

further decrease the number of non-immune workers in the near future. In the

mean time, coverage with standard vaccines should be made better also by

supplying complete detail on the risks of hepatitis B and on the safety and

efficacy of active immunization (Bonnani, 2001).

Related Studies

Ghomraoui, Alfaqeeh, Algadheeb, Al-alsheikh, Al-Hamoudi, &Alswat

(2016), “Medical students’ awareness of and compliance with the hepatitis B

vaccine in a tertiary care academic hospital: An epidemiological study” this study

showed that hepatitis B virus poses a health risk to healthcare workers who are

close to infected individuals. Medical students are particularly the high-risk group

due to the lack of an obligatory vaccination program and a post-vaccination

screening program to determine immunity status, which results in a lack of

awareness and practices with the HBV vaccine. The researchers recommended

that programs and campaigns be developed to increase the overall awareness

 20

and improve the compliance rate among medical students by implementing

Hepatitis B virus vaccination program.

Abiola, Agunbiade, Badmos, Lesi, Lawal, &Alli (2016), “Prevalence of

HBsAg, knowledge and vaccination practice against viral hepatitis B infection

among doctors and nurses in a secondary health care facility in Lagos state,

South-western Nigeria”.This study aimed to determinethe knowledge and

vaccination practices against hepatitis B infection and the prevalence of HBsAg,

among doctors and nurses in a health care facility. Based on findings, the

prevalence of HBsAg was generally low. Among the respondents, the knowledge

of viral hepatitis B was fair and practices of hepatitis B vaccination testing were

poor.Majority of the participants had good basic knowledge of viral infection; it

could be due to hepatitis B vaccination programme organized for health workers

by the Lagos State government. However, only less of them werefamiliar with

HBV immunology and the implications of resolved HBV infection.Therefore, it is

recommended that the state ministry of health should organize further health

education program, institute compulsory occupational hepatitis B vaccination

programme and post vaccination anti-HBS testing to ensure sufficient antibody

level in this adult population.

Shah, NighatNisar,HafeezQadri,&Majid (2007), “Knowledge regarding

Hepatitis-B among EPI vaccinators working in District South, Karachi”, this study

determines the level of knowledge among Expanded Program on Immunization

(EPI) vaccinators of district South, Karachi, concerning Hepatitis B virus infection.

The respondents demonstrated poor knowledge of this disease. Majority of the

 21

vaccinators were aware of the cause of the hepatitis B virus infection, yet they

underestimate its mode of transmission and symptoms. This study is quite

encouraging the fact that knowledge is usually the first step towards modification

of their behavior. Awareness about hepatitis B virus infection is necessary in

prevention and control of disease, particularly among health care workers.

Researchers recommended that there should be ongoing training program for

their professional development.

Setia, Gambhir, Kapoor, Jindal, Garg, &Setia (2013), “Attitudes and

Awareness regarding Hepatitis B and Hepatitis C amongst Health Care Workers

of a Tertiary Hospital in India”. This study aimed to assess the knowledge and

attitude toward hepatitis infection among the health care interns and correlate the

level of awareness to the attitude they behold toward the disease. Health care

workers are at high-risk of acquiring this disease due to their regular contact with

patient. Although most of the interns were aware of the existence of hepatitis B,

the level of awareness regarding the modes of transmission and vaccination was

found be dissatisfactory. Based on the findings, the level of awareness among

nursing interns regarding the infection was significantly lower than the dental and

medical interns. Between the awareness and behavior scores, a direct positive

correlation was found which reveals that interns with better awareness level had

better attitudes toward the infection and prevention of its transmission. There is

an urgent need to increase the level and quality of training among Healthcare

workers to prevent the spread of hepatitis B.

 22

Synthesis

Hepatitis B virus poses a health risk to healthcare workers, since these

workers are exposed daily to the infected individuals.Studies highlight the

dissimilarities in knowledge, attitude, as well as practices among difference

categories of healthcare personnel regarding hepatitis B infection. The level of

awareness among nursing interns regarding this infection was significantly lower

that dental and medical interns. Majority of the health-care workers had good

basic knowledge of viral infection and it could be due to hepatitis B vaccination

programme organized. However, some demonstrated poor knowledge regarding

this disease.Although most of the health workers were aware of the existence of

hepatitis B, the level of awareness regarding the modes of transmission and

vaccination were very low.Health-care workers might differ in what they know

about hepatitis B infection and vaccine because of the differences in levels of

education, training, and perceived relevance within hospital settings. Programs

and campaigns should be developed, anda mandatory HBV vaccination program

should be implemented to increase the overall awareness of the hepatitis B

infection and to improve the compliance rate among medical students.Therefore,

provision of satisfactory knowledge through orientation programme as well

 23

as educational campaign will help to create awareness regarding HBV infection

can only bring about a positive attitude, thereby, leading to good practices.

TheoreticalBackground

This study is based from the theory of Health Belief Model (HBM),

was developed in the early 1950’s by social scientist which relies to understand,

adopt disease prevention strategies and compliance with medical treatments.

There are six concepts of HBM.The primary concepts are perceived

susceptibility, benefits, severity, barriers and cues toaction and self-efficacy.The

first four were developed as the original principle of the HBM and the last two

were added as research about the HBM evolved.

Perceived susceptibility is described as belief in the chance of

suffering a condition, for example hepatitis B and risk of getting a disease.

Perceived severity is the capacity to believe in the seriousness of contracting an

illness or disease and its consequences, that hepatitis B is harmful. Perceived

benefits are an effectiveness of various actions able to be used to reduce the

threat of illness or disease and example of this is the vaccine against hepatitis B.

Perceived barriers are obstacles in performing a recommended health action to

return and get the vaccine a total of three times during 6 months. A young adult

also has to have definite cues to action, namely strategies to be present with
 24

information. A young adult has higher risk of suffering from anxietywithout

confidence in one self to take action(Glanz, Rimer&Viswanath, 2008).

Conceptual Framework of the Study

Figure 1. Conceptual Framework

Hypothesis

1. Ho- Health workers lack proper vaccination practice against Hepatitis B.

 25

2. Ho- Health workers are not very knowledgeable regarding viral Hepatitis B

infection.

3. Ho- Calbayog City still have insufficient professionals, vaccines, tools, and

materials to reduce the prevalence of Hepatitis B.

4. Ho- Health workers haven’t yet encountered viral Hepatitis B infection in

Calbayog City.

CHAPTER 3

METHODOLOGY OF RESEARCH

This chapter describes the method to be used in this study, research

design, research locale, research participants, sampling technique, research

instruments, the data collection procedure, and the data analysis.

Research Design

In this study the researchers uses correlational type of quantitative

research. In the design, the researchers measure, and assess the statistical

amount of knowledge in terms of understanding Hepatitis B, and the vaccination

process the health workers responds to.

This study uses descriptive method because it will be appropriate to use in

our study since descriptive studies are aimed at finding out "what is," so observational

and survey methods are often used to gather descriptive data (Borg & Gall, 1989).
 26

Research Locale

The research will be conducted around Calbayog city proper. The researcher will

go around the city to hand out questionnaires to the health workers that are currently

available.

Calbayog City is one of the cities in Samar and is the 3rd largest in the Philippines

and often referred to as the 1st class city in the province of Samar and is the home of

more than 184 000 Calbayognons. It is comprised of 3 private hospitals which are St.

Camillus Hospital, Adventist Hospital and Our Lady of Porziuncola Hospital, Inc.

(Olphi) and a government-run hospital named Calbayog General Hospital and 5 branches

of city health offices.

Figure 2. Map of Calbayog City

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Research Participants

The respondents of the study will be the health worker such as nurses, dentist,

midwives, etc. in different facilities around Calbayog city proper. There will be an

estimate of 60 respondents that will hopefully participate in our study.

The health workers will be evaluated based on their knowledge, attitude and

vaccination practices regarding viral Hepatitis B infection. There will be 20 respondents

in each health services providers which includes, Hospitals, Clinics and Health centers.

Table 1

Respondents of the Study

(Target Sample =

60)
Respondents Sample Percentage
Hospitals 20 33.33%
Clinic 20 33.33%
Health Centers 20 33.33%
Total 60 100
 28

Sampling Technique

This research applied the convenience sampling which is a distinct type of non-

probability sampling method that depends on data collection from population members

who are conveniently available to participate in the study (Saunders, Lewis & Thornhill,

2012).

Since the study will be using convenience sampling, the researcher will determine

60 respondents among health workers in different facilities based on their availability due

to the tight schedule of the health workers.

Research Instrument

The researcher utilized an article-based questionnaire that is very similar to our

study, Retrieved from Abiola, A., Agunbiade, A. B., Badmos, K. B., Lesi, A. O., Lawal,

A. O., &Alli, O. Q. O. (2016).Prevalence of HBsAg, Knowledge, and Vaccination

Practice Against Viral Hepatitis B Infection Among Doctors and Nurses in a Secondary

Health Care Facility in Lagos State, South-Western Nigeria.The first part of the

questionnaire tackles about the profile of the respondents which is their socio-

demographic characteristics. The second part about the respondents' knowledge about the
 29

viral hepatitis b and its vaccination practices. The third and last part of the questionnaire

involves the attitude of the respondents towards the viral hepatitis B.

This questionnaire is made to assess the knowledge, attitudes and

vaccination practices of health workers against viral Hepatitis B in Calbayog city.

The scales are also defined as follows:

Part 2

3 – Aware. Means that respondents are aware of the vaccination practices that

given to the patients.

2 – Not Aware. Means that respondents doesn’t know anything about the viral

hepatitis b vaccination practice.

1 – Undecided. Means that respondents are still doubting their answers on the

following questions.

Part 3

3 – Agree. Means that the respondents agree to the questions given by the

researchers.

2 – Disagree. Means that the respondents oppose to the statements in the

questionnaire

1 – Undecided. Means that the participants of the study is still unsure of decision

on what option to choose.

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Data Collection Procedure

In the conduct of the study in Calbayog city proper, the researchers will

ask for the cooperation of the health workers in different facilities around

Calbayog.

The researchers will ask permission to private and public health care

providers to allow us to conduct our research in their proud institute and we will

also ask permission to the respondents to allow to spare some of their times in

answering the survey form, the information regarding the respondents will be

kept confidential however the results of the survey will be tallied and recorded by

the researcher to have a realistic and reliable information. The data will be

charted, analyzed and interpreted based on the answers from the respondents.

Data Analysis

In order to assess the knowledge, attitude and vaccination practices, a

survey method was used in the questionnaire that contains 3 parts that include

different set of questions. To interpret the data gathered, the researchers will use

the following statistical treatment:

1. Relative Frequency. It will be used to determine the profile of the

respondents. The formula is:

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𝒇
𝑷= 𝒙𝟏𝟎𝟎
𝒏

where: P = relative frequency

f= frequency

n=total number of observation

2. Weighted Mean. It will be utilized to compute the average knowledge of

the respondents regarding their knowledge toward the viral hepatitis b and

its vaccination practice and the respondents' attitude. The formula is:

𝚺𝒇𝒙
𝞵=
𝒏

where: 𝞵 = Weighted mean

𝛴 = Summation

f = No. of responses each scale

x = Weight assigned to each scale

n = Total number of respondents

An interpretation will be assigned to give verbal interpretation to the

computed weighted mean. The following scale shall be used:

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Table 2

Data Interpretation

Table 2.1 Level of Awareness/ Knowledge towards Vaccination Practices.

Scale Range Verbal Interpretation

Tab 3 2.26 - 3.00 Aware

le 2 1.51 - 2.25 Not Aware

2.2 1 1.00 - 1.50 Undecided

Attitudes of the Respondents towards viral Hepatitis B.

Scale Range Verbal Interpretation

3 2.26 - 3.00 Agree

2 1.51 - 2.25 Disagree

1 1.00 - 1.50 Undecided

3. Chi-square. The Chi-square test of independence will be used to

determine if there is really a connection or relationship between the profile

of the respondents and the knowledge, attitude and practice. The formula

is as follows:

𝜮√(𝒐 − 𝒆𝟐
𝒙𝟐 =
𝒆

where: 𝒙𝟐 = Chi-square value

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o = observed frequency

e = expected frequency