Baseline Questionnaire: Client Beneficiaries

‐ 1 ‐

Baseline Questionnaire: Client Beneficiaries

Pakisulat ang mga sumusunod na impormasyon tungkol sa kalahok: Please note the following information about the respondent

i) ID Number: ___________________________________________________________[F1.1]

ii) Pangalan: First Name: ___________________________________________________________[F1.2]

iii) Apelyido: Last Name: ___________________________________________________________[F1.3]

iv) Tirahan: Address: ___________________________________________________________[F1.4]

v) Numero ng Telepono/Cellphone: Landline/Cellphone No.:

___________________________________________________________[F1.5]

Sa tagapanayam: Una, bisitahin ang tutugon o respondent sa kanyang tirahan na nakatukoy. Kung wala ang tutugon, ipagtanong sa kanyang mga kapitbahay, barangay at kapamilya na maaaring makausap. Dear Interviewer: First, visit respondent at the address provided. If respondent cannot be found, then please try to find the person by asking neighbors in surrounding area, barangay hall officials/records, and family members that can be reached.

ID ng

Interviewer Interviewer ID

Petsa ng Pagbisita

Date of Visit

Oras ng Pagdalaw Time of Visit

Oras na natapos ng panayam Ending time of

interview

Lugar kung saan ginanap ang panayam

Place where interview was conducted

May iba pa bang may edad na kaharap nang ginanap ang panayam?

Were other adult persons present during interview?

[F2.X.1] [F2.X.2] [F2.X.3] [F2.X.4] [F2.X.5] [F2.X.6]

Ex. 12 03/27/13 1:10pm 2:50pm at business no

Visit 1 [F2.1]

Visit 2 [F2.2]

Visit 3 [F2.3]

Komentaryo ng tagapanayam (kung may istorbong naganap sa panayam o kung hindi maganap ang panayam) Surveyor Comments (if disturbances during interview occur or if respondent cannot be interviewed)

[F3]

‐ 2 ‐

Survey on Health and Health Behavior in Metro Manila Sa Kalahok, Dear study participant,

Ang panayam na ito ay bahagi ng isang pag‐aaral ng dalawang pamantasan sa Vienna (Austria) kasama ng Kasagana‐ka Development Center Inc. tungkol sa kalusugan at ang mga pananaw kaugnay nito. Nais naming maunawaan ang iba’t ibang paraan ng pagpapabuti ng kalusugan ng komunidad. Malaki ang maitutulong ninyo sa paglahok sa panayam na ito. Aabutin ng 60‐90 na minuto ang pagtugon dito at matapos ay makakatanggap po kayo ng Php80. Maaari po kayong magtanong sa gitna ng panayam o hindi sumagot sa kahit anong tanong.

This survey is conducted as part of a non‐commercial research project on health and health behavior by two universities from Vienna (Austria) in cooperation with the Kasagana‐Ka Development Center. In particular, we are interested in finding ways to improve the health of community members. With this interview you can make an important contribution to the success of this study. Answering the survey questions will take approximately 60‐90 minutes. You will receive 80 PHP after completing this questionnaire. Of course you can always interrupt the interview or skip a question.

Bilang kalahok, dumaan po kayo sa sistema ng pagpili mula sa lahat ng mga CBs ng KDCI. May 800 na CBs ang kakapanayamin sa loob ng isang buwan. Nais rin po naming makapanayam ang mga kalahok sa Marso 2015. Ikalulugod po naming kung muli naming kayong maisasama sa survey isang taon mula ngayon.

As a participant of this study you were randomly selected among all Kasagana‐Ka client beneficiaries of your loan center. In total, 800 participants are interviewed in this month. In addition to this survey we want to conduct another survey with the same participants in March 2015. We would be happy if you were also willing to participate in our second survey one year from now.

Lahat po ng inyong tugon sa pag‐aaral na ito ay ituturing na kumpidensyal. Hindi po ihahayag ang pangalan ninyo kaugnay ng inyong mga sagot. Ang mga tagapanayam ay HINDI empleyado ng KDCI kaya’t mangyari po lamang na maging tapat at huwag itago ang inyong opinion at kaugnay na impormasyon. Mahalaga po na matugunan ng tapat ang lahat ng katanungan.

All responses that you give during the study are anonymous and will be treated confidentially. At no time, your name and address will be saved together with your survey responses. The interviews are conducted by interviewers who are not staff‐members of Kasagana‐Ka. Please do not hide any information or opinion from us. It is very important that you answer honestly to all questions.

Pagkatapos po ng pag‐aaral na ito, ipaparating po namin sa lahat ng lumahok ang resulta sa pamamagitan ng Kasagana‐ka. Kung mayroon po kayong katanungan, maaari niyo kaming tawagan sa 0908‐621‐5280 o magpadala ng email sa [email protected].

After the completion of the study in a year the results of the study will be provided to the participants by Kasagana‐Ka. If you have any questions or comments please contact us via e‐mail ([email protected]) or call us under 09086215280.

Sa ngalan po ng mga kabilang sa proyektong ito, taos‐puso kaming nagpapasalamat sa inyo.

On behalf of all project members I want to thank you very much for your support!

Bago mag‐umpisa ang panayam, kinakailangan lang makuha ang inyong pagsang‐ayon.

Before starting with the interview, I would like you to confirm a short consent form.

Sumasang‐ayon ako na lumahok sa pag‐aaral na ito tungkol sa kalusugan ng aking komunidad. Nauunawaan ko na proyekto ito ng mga mananaliksik mula sa pamantasan at walang kinalaman, sa kahit anong paraan, sa pribadong interes, pamamahala ng buwis, o sa kahit sino sa gobyerno ng Pilipinas. Sumasang‐ayon ako na ang datos na aking ibibigay ay gagamitin para lamang sa pananaliksik at sa pagpabuti ang mga alituntunin kaugnay sa kalusugan. Batid ko na ang impormasyon na ibibigay ko ay ituturing na kumpidensyal, at ang aking pangalan ay hindi isasama sa ulat ng pag‐aaral na ito. Batid ko din na ang mga tagapanayam ay hindi mga empleyado ng Kasagana‐ka at hindi malalaman ng Kasagana‐ka kung ano ang aking mga naging sagot. Maglalahad ako ng totoong mga impormasyon lamang.

I am willingly participating in this research activity about health in Metro Manila and surrounding areas. I understand that this research project is run by university researchers and that it is not related to any private interest, the tax administration, or anybody of the Philippine government. I agree that the data I am providing will be used only for scientific purposes and policy improvements regarding health. I understand that the information I provide is strictly confidential, and that my name will not be included in any report of the study. Also, I understand that the interviewers are not Kasagana‐Ka staff members and that Kasagana‐Ka is not able to trace back the given answers to the respondent. I will be providing truthful information.

Nauunawaan ko ang nakasaad sa taas at sumasang‐ayon ako: I understood the aforementioned and I agree:

O hindi no O oo yes

‐ 3 ‐

A. KDCI Client History Nais kong mag‐umpisa sa ilang mga tanong tungkol sa iyong karanasan sa Kasagana‐ka. I would like to start with a couple of questions concerning your experiences with Kasagana‐Ka.

1. Anong taon ka naging CB ng Kasagana‐ka? Since which year have you been a client of Kasagana‐Ka?

taon year

2. Narinig mo na ba ang programang K‐Kalusugan? Have you heard of the K‐Kalusugan program?

1 Hindi No 2 Oo Yes [IF HINDI/NO GO TO Q 4]

3. Anong mga serbisyo at produkto ang kasama sa programang K‐Kalusugan? Which services do you know that are offered as part of the K‐Kalusugan program?

___________________________________________________________________________________

___________________________________________________________________________________

4. ANG K‐Kalusugan ay bagong programa ng Kasagana‐ka na naglalayon na mapabuti ang kalusugan ng mga CBs. Ikaw ba o ang iyong kapamilya ay nakagamit nang maski anong serbisyo/produkto ng K‐Kalusugan? Maaaring higit sa isa ang sagot. K‐Kalusugan is the new Kasagana‐Ka health program, which aims at improving the health of the client beneficiaries. Have you or one of your household members used any services of the K‐Kalusugan program yet? Multiple answers are possible.

[4.1] 1. Wala sa aking pamilya/kasambahay ang gumamit na ng programang ito Nobody in household used health program

[IF WALA/ NO GO TO SECTION B]

[4.2] 1. Nagamit ko na ang K‐Kalusugan Used health program personally

[4.3] 1. Ang ibang kasambahay ko ay nagamit na ang K‐Kalusugan Other household member used health program

5. Ikaw ba o kahit sino sa pamilya o kasambahay ay nakautang mula sa K‐Kalusugan? Have you or somebody from your household already taken a loan as part of the K‐Kalusugan program before?

1. Hindi No 2. Oo Yes [IF HINDI/NO GO TO Q 7]

6. Sa kabuuan, magkano ang natanggap na utang ng inyong pamilya mula sa K‐Kalusugan? What is the sum of all K‐Kalusugan loans that your household has received so far?

1. 1‐1000 PHP 2. 1001‐5000 PHP 3. 5001‐10000 PHP 4. More than 10000 PHP

7. Ikaw ba o ang kapamilya mo ay nakapag‐medical o lab check up na sa K‐Kalusugan? Did you or somebody from your household undergo one of the K‐Kalusugan medical and laboratory examinations yet?

1. Hindi No 2. Oo Yes [IF HINDI/NO GO TO SECTION B]

8. Ano sa mga Lab Package ang nagamit mo at ng pamilya mo? Maaaring higit sa isa ang sagot. [IPAKITA ANG SHEET 1 – LAB PACKAGES] Which of the lab packages did you or another member of your household use? Multiple answers are possible. [SHOW SHEET 1 – LAB PACKAGES]

[8.X.1]

CB mismo ang nakagamit ng package

Used package personally

[8.X.2]

Nagamit ng aking pamilyaOther family members

used package

[8.1] 1. Package A (Window 1) 1 1

[8.2] 2. Package B (Window 1) 1 1

[8.3] 3. Package C (Window 1) 1 1

[8.4] 4. Package D (Window 1) 1 1

B. Socio‐Demographics: Personal Information Ngayon naman po ay may ilan akong katanungan tungkol sa personal niyong mga katangian. Now I have some questions concerning your personal characteristics.

9. Saan ka ipinanganak? Pakibanggit ang munisipyo/lungsod/probinsiya at bansa kung sa labas ng Pilipinas Where were you born? Please name city and country (if outside of the Philippines).

[9.1]

Munisipyo o Lungsod City

[9.2] Bansa Country

‐ 4 ‐

10. Sa kabuuan, gaano ka kakontento sa iyong kasalukuyang buhay? [IPAKITA ANG SHEET 2‐SCALE A] On the whole, how satisfied are you with the life you lead at the moment? [SHOW SHEET 2‐SCALE A]

“

Hindi Kontento Not at all satisfied

Lubos na kontento

Completely satisfied

1 2 3 4 5 6 7 8 9 10 11

11. Ilang taon ka na? How old are you?

taong gulang years

12. Ikaw ba ay nasa permanenteng relasyon (kasal man o hindi)? Are you currently in a permanent relationship?

1. Hind No 2. Oo Yes

13. Ano ang iyong kasalukuyang kalagayang sibil? What is your current marital status?

1. Kasal married 2. hindi kasal not married

3. hiwalay separated 4. balo widowed

C. Socio‐Demographics: Job and Personal Income Sa susunod na bahagi ng panayam, ang mga tanong ay tungkol naman sa iyong trabaho. In the following section I am interested in your work situation.

14. Anong edad ka nag‐umpisa kumita upang suportahan ang sarili at/o pamilya? At what age did you start working for money to support yourself and/or your family?

Mula sa edad na At the age of

15. Ano ang kasalukuyang kalagayan mo sa paghahanap‐buhay? Maaaring higit sa isa ang sagot. What is your current employment status? Multiple answers are possible.

[15.1] 1. May trabaho at sahod Employed for pay

[15.2] 1. Naghahanap‐buhay, sariling sikap Self‐employed

[15.3] 1. May trabaho subali’t kabahagi ng negosyo ng pamilya

Working, but not for pay, at a family‐owned job or business

[15.4] 1. Naghahanap, walang trabaho Looking for work, unemployed [IF ONLY “NAGHAHANAP” GO TO Q 20]

[15.5] 1. Estudyante Student [IF ONLY “ESTUDYANTE” GO TO Q 20]

[15.6] 1. Retirado Retired [IF ONLY “RETIRADO” GO TO Q 20]

‐77 Walang sagot / hindi alam No reply/ don’t know

16. Ano ang inyong trabaho? Pakipaliwanag ang inyong pangunahing gawain. Gumamit ng hiwalay na section (1‐2) kung marami kang trabaho. What is your main job activity? Use separate sections if you have multiple jobs.

[16.1] Ano ang unang trabaho: Name of 1

st job: _______________________________________________________________

[16.2] Ano ang ikalawang trabaho: Name of 2

nd job: _______________________________________________________________

17. Humigit kumulang, magkano ang kinikita mo sa bawat linggo (bago bawasan ng buwis at iba pang kaltasin)? What is on average your personal gross income (before taxes, deductions) from your work every week?

about

Kada l inggo PHP per week

‐77 Hindi alam/walang sagot Don’t know/no reply

18. Ilang oras ka nagtatrabaho sa isang linggo (sa isang karaniwang linggo)? How many hours do you usually work for income per week (in a “typical week”)?

about Oras kada linggo hours per week

‐ 5 ‐

D. Educational Background and Cognitive Abilities Sa susunod na bahagi, interesado naman po kami sa pinag‐aralan mo at ng iyong pamilya. In the following, I am interested in the educational background of yourself and your family.

21. Ikaw ba ay nakapag‐aral o nakatuntong sa paaralan? Did you ever visit a school or receive any formal education?


22. Ano ang pinakamataas na antas ng pag‐aaral na iyong narating? What is your highest level of education?

1. Visited primary school (1st‐5

th grade) 2. Primary school completed (6

th grade)

3.

Lower secondary education (1st or 2

ndyear

of high school) 4.

Upper secondary education (3rd or 4

th year

of high school)

5.

Post‐secondary education (technical or vocational) not at college/university

6. Visited college (university education not completed)

7. Bachelor degree (lower college) 8 Master or doctoral degree (upper college)

19. Ano ang antas ng iyong pagsang‐ayon o di pagsang‐ayon sa mga sumusunod na pahayag tungkol sa iyong pangunahing trabaho (ang pinakaginugugulan mo ng oras)? Walang TAMA o MALING sagot. Pag‐isipan mabuti ang bawa’t pangungusap. [IPAKITA ANG SHEET 3 – SCALE B] How strong do you agree or disagree with the following statements about your primary job for which you spend most hours? Please be as honest and accurate as you can, there is no right or wrong answer. Think about each statement on its own. [SHOW SHEET 3 – SCALE B]

Lubos na di Sang‐ayon

Strongly disagree

Di sang‐ayon

Disagree a l ittle

Hindi sumasang‐ayon o

tumututol Neither

agree nor disagree

Sang‐ayon Agree a l ittle

Lubos na Sang‐ayon Strongly agree

Walang sagot/

Hindi alam no reply/ don’t know

[19.1]

Madalas sobrang ingay ang lugar ng aking pinagtatrabahuhan. At my workplace it is often very noisy

1 2 3 4 5 ‐77

[19.2]

Mausok at madumi ang hangin sa aking pinagtatrabahuhan. The air that I breathe at my workplace is polluted and not clean

1 2 3 4 5 ‐77

[19.3] Sa aking trabaho, madalas akong gumalaw okumilos . In my work I move a lot

1 2 3 4 5 ‐77

[19.4]

Madalas kong inaalala ang aking trabaho kahit sa gabi o nang magdamag. I often think about my work in the evenings and nights

1 2 3 4 5 ‐77

[19.5] Sa trabaho ko, madalas akong balisa o nag‐aalala.During my work I am often stressed

1 2 3 4 5 ‐77

[19.6] Delikado ang aking trabaho. My work is dangerous 1 2 3 4 5 ‐77

[19.7] Namemeligro ang aking kalusugan dahil sa aking trabaho. My work is unhealthy

1 2 3 4 5 ‐77

20. Matapos ang trabaho, tutungo naman tayo sa iyong sarili. Ano ang antas ng pagsang‐ayon o pagtutol sa mga sumusunod na pahayag? Walang TAMA o MALING sagot. Pag‐isipan mabuti ang bawa’t pangungusap. [IPAKITA ANG SHEET 3 – SCALE B] After having talked about your work, I now would like to focus more on you as a person. How strong do you agree or disagree with the following statements? Please be as honest and accurate as you can, there is no right or wrong answer.Think about each statement on its own [SHOW SHEET 3–SCALE B]


Strongly disagree

Di sang‐ayon

Disagree a l ittle


tumututol Neither

agree nor disagree

Sang‐ayon

Agree a l ittle

Lubos na Sang‐ayon

Strongly agree

Walang sagot/ Hindi

alam No reply/ don’t know

[20.1] Kapag may problema ako, madalas na ipinagpapaliban ko ito. If I have a problem, I usually try to postpone it

1 2 3 4 5 ‐77

[20.2]

May tiwala ako na makakayanan kong epektibong harapin ang mga hindi inaasahang pangyayari. I am confident that I could effectively deal with unexpected events.

1 2 3 4 5 ‐77

[20.3]

Madalas na mag‐aantay na lang ako na may mangyarikaysa kusang kumilos. I usually wait for something to happen rather than taking the initiative myself

1 2 3 4 5 ‐77

[20.4]

Madali akong sumuko sa pag‐abot ng mga pangarap ko kapag nakakaharap ako ng mga pagsubok. I easily give up my goals if unexpected difficulties occur.

1 2 3 4 5 ‐77

[20.5] Sa mga alanganing panahon, inaasahan ko na mabuti ang mangyayari. In uncertain times, I usually expect the best

1 2 3 4 5 ‐77

‐ 6 ‐

23. Ilang taon ka nag‐aral, kasama ang high school at kolehiyo? Huwag po isama ang taon na inulit. How many years of schooling, including higher education have you completed? Please do not count the years in which you had to repeat a grade.

In total taon years

24. Pakibalikan ang huling taon mo sa elementarya. Mga ilan ang mga naging kaklase mo? Please remember the last year that you spent in primary school. Approximately how many students were in your class?

about

estudyante students

‐77 Hindi nakatuntong sa elementarya never visited primary school

25. May mga babasahin akong mga salita at tandaan niyo po ang mga ito. Pakinggang mabuti kasi hindi na uulitin ang mga salita. Pagkatapos, itutuloy ako ang pagtatanong. Mamaya, ipapaulit ko sa inyo sa kahit anong ayos ang mga salitang una kong nabanggit. [BASAHIN ANG LISTAHAN NG MARAHAN AT MALINAW) Bus…Bahay… Silya… Saging… Araw…Ibon… Palda…Bigas…Unggoy…Pusa

Now, I am going to read a list of words and I want you to recall it. Please listen carefully as the set of words will not be repeated. When I have finished, I will continue with other questions. Afterwards I will ask you to recall aloud as many of the words as you can, in any order. [READ OUT THE ENTIRE LIST OF WORDS SLOWLY AND CLEARLY] Bus…House…Chair…Banana…Sun…Bird…Skirt…Rice…Monkey…Cat

26. Anong naabot na edukasyon ng iyong ina? What is / was the highest level of education of your mother?

1. No formal education 2. Visited primary school (1st‐5

th grade)

3.

Primary school completed (6

th grade)

4. Lower secondary education (1

st or 2

nd year

of high school)

5.

Upper secondary education (3

rd or 4

th year of high school)

6. Post‐secondary education (technical or vocational) not a college/university

7.

Visited college (university education not completed)

8. Bachelor degree (lower college)

9 Master or doctoral degree (upper college)

27. Anong naabot na edukasyon ng iyong ama? What is / was the highest level of education of your father?

1. No formal education 2. Visited primary school (1st‐5

th grade)

3.

Primary school completed (6

th grade)

4. Lower secondary education (1

st or 2

nd year

of high school)

5.

Upper secondary education (3

rd or 4

th year of high school)

6. Post‐secondary education (technical or vocational) not a college/university

7.

Visited college (university education not completed)

8. Bachelor degree (lower college)

9 Master or doctoral degree (upper college)

28. Marunong bang bumasa at sumulat ang iyong mga magulang? Are / were your parents able to read and write?

1. Hindi No 2. Oo, si nanay Yes, my mother

3. Oo, si tatayYes, my father

4. Oo, pareho silaYes, both of them

29. Ngayon, alalahanin ang mga salitang binasa ko sa inyo. Pakibanggit pong muli ang mga ito, kahit hindi magkasunod‐sunod. Now please try to remember the words that I have read to you some moments ago. Please try to recall as many of the words as you can in any order.

[29.1] 1. Bus Bus [29.2] 1. Bahay House

[29.3] 1. Silya Chair [29.4] 1. Saging Banana

[29.5] 1. Araw Sun [29.6] 1. Ibon Bird

[29.7] 1. Palda Skirt [29.8] 1. Bigas Rice

[29.9] 1. Unggoy Monkey [29.10] 1. Pusa Cat

30. Marunong ba kayong bumasa at sumulat? Are you able to read and write?


‐ 7 ‐

31. Pakibasa po ng malakas ang susunod na maikling talata [IBIGAY SA PARTICIPANT ANG SHEET 4 READING TEST] [HUWAG BASAHIN NG MALAKAS. PAKIBIGYAN NG GRADO ANG HUSAY NG KALAHOK SA PAGBASA AYON SA MGA SUMUSUNOD] I would now like to ask you to read aloud this short paragraph for me [GIVE PARTICIPANT SHEET 4–READING TEST] [DO NOT READ THE FOLLOWING LOUD. PLEASE GRADE THE PARTICIPANT’S READING SKILLS ACCORDING TO THE FOLLOWING CRITERIA]

good,

excellent fair

bad, i l l iterate

[31.1] FLUIDITY OF READING 1 2 3

[31.2] PRONOUNCIATION OF WORDS 1 2 3

32. Humigit kumulang, ilang minuto kang nanood ng telebisyon araw‐araw? Please estimate: About how many minutes of TV do you watch everyday?

Minuto araw‐araw minutes everyday

33. Subukang tandaan, mayroon bang bakuna laban sa dengue fever? [ONLY FOR READING TEST] Please try to remember: Is there any vaccination against dengue fever? [ONLY FOR READING TEST]

1. Hindi No 2. Oo Yes ‐77 Hindi alam Don’t know

E. Decision Making Sa bahaging ito, unawain naman natin ang paraan niyo ng pagpapasya. In this section, I am interested in the way you make decisions.

35. Paano mo susukatin ang iyong sarili mula 1 hanggang 11: Sa kabuuan, ikaw ba ay taong mahilig makipagsapalaran? [IPAKITA ANG SHEET 5 – SCALE C] How do you see yourself on a scale from 1 to 11: Are you generally a person who l ikes to take risks or do you try to avoid taking risks? [SHOW SHEET 5 – SCALE C]

Hindi mahilig makipagsapalaran Very risk averse

Mahilig makipagsapalaran

Likes a lot to take risks

1 2 3 4 5 6 7 8 9 10 11

F. Neighborhood and Health Infrastructure Pag‐usapan naman natin ang inyong barangay kung saan ka nakatira. Interesado kami sa kalusugan ng komunidad. After having talked about you as a person, I would l ike to shift the focus to the neighborhood you live in. Particularly, I am interested in the health infrastructure of your neighborhood.

36. Anong pangalan ng iyong barangay? What is the name of the Barangay you live in?

_________________________________________________________________________________

34. Halimbawa, nanalo ka ng premyo sa lotto na maaring mong agad‐agad na matanggap. Subalit, mayroon kang pagkakataong maghintay ng isang taon upang matanggap ang pera. Kung ikaw ay magpasyang maghintay, makakatanggap ka ng halagang kasinlaki o mas malaki sa iyong kasalukuyang premyo. [KUMPLETUHIN ANG BILANG 1 HANGGANG 10] Kunwari makakatanggap ka ng premyo may halagang X ngayong araw o halagang Y pagkalipas ng isang 1 taon, gugustuhin mo bang maghintay ng isang taon?

Suppose you have won a prize in a lottery, which you can claim immediately. However, you can choose to wait exactly one year to claim the prize. If you do wait, you will receive a prize that is at least as high or higher than your prize today. [PLEASE FILL IN THE NUMBERS FROM THE ROWS 1‐10 BELOW]. Suppose you could receive X today or wait and receive Y in exactly one year. Would you prefer to wait a year?

X or Y

Bayad agad‐agad Payment immediately

Bayad sa susunod na taon Payment next year

[34.1] 10.000 PHP now or 10.000PHP next year 1. 2.

[34.2] 9000 PHP now or 10.000PHP next year 1. 2.









‐ 8 ‐

37. Simula anong taon ka nanirahan sa iyong barangay? Since which year have you been living in this Barangay?

Taon

Year ‐77 Buong buhay ko A l l my l ife

39. Kung may kapamilya kang may tanong tungkol sa problemang kaugnay sa kalusugan, mayroon ka bang malapit o personal na kilalang matatanungan ukol sa problemang ito? If someone in your household had a question about a health problem, would you know somebody in your circle of family, friends and acquiantances to ask for advice?

1. Hindi No 2. Oo Yes [IF HINDI/NO, GO TO Q 41]

40. Gaano kahirap marating o maabot ang tao o lugar na pagkukunan ng kailangan na impormasyon? In general, how difficult is it to reach that person or place when information is needed?

napakadali very easy

Madali easy

hindi gaanong mahirapnot too difficult

mahirapdifficult

napakahirap very difficult

hindi alam/walang tugon don’t know / no reply

1 2 3 4 5 ‐77

41. Ang personal health care provider ay isang propesyunal na kilala kang mabuti at pamilyar sa iyong kalusugan. Maaari itong isang doktor, espesyalista, nars, parmasist, assistant ng doktor, barangay health worker (BHW) o kahit sinong makakapagbigay ng serbisyong pangkalusugan. Mayroon ka bang maiisip na taong maituturing mong health care provider? A personal health care provider is a health professional who knows you well and is familiar with your health history. This can be a general doctor, a specialist doctor, a nurse practitioner, a pharmacist, a physician’s assistant, a health community worker, or another type of provider. Do you have one or more persons you think of as your personal health care provider?

1. wala no 2. meron yes [IF WALA/NO GO TO Q 43]

42. Kung iisipin mo ang iyong health care provider, paano mo sasagutin ang mga sumusunod? [IPAKITA ANG SHEET 3 – SCALE B] If you think of your main health care provider, how strongly do you agree with the following statements? [SHOW SHEET 3 – SCALE B]

Lubos na Di Sang‐ayon

Strongly disagree

Di sang‐ayon

Disagree a l ittle


tumututol Neither agree nor disagree

Sang‐ayon

Agree a l ittle


Strongly agree

[42.1]

Mahirap marating ang health care provider sa aking komunidad. It is difficult to reach my health care provider

1 2 3 4 5

[42.2]

Sa tingin ko hindi ako matutulungan ng aking health care provider. I do not think that my health care provider can help me with my health problems

1 2 3 4 5

[42.3] Mahusay at maraming alam ang aking health care provider. My health care provider is very competent

1 2 3 4 5

43. Gaano ka kontento o nasisiyahan sa kasalukuyang sistemang pangkalusugan ng inyong komunidad? How satisfied are you with the way the health care system is run...

Lubos na Kuntento

Very satisfied

Sapat Fairly

satisfied

Walang masabi Neither satisfied nor dissatisfied

Medyo hindi kuntento

Fairly dissatisfied

Lubos na hindi kuntento

Very dissatisfied

[43.1] Sa iyong Barangay 1 2 3 4 5

[43.2] Sa buong Philippines 1 2 3 4 5

38. Gaano katagal o ilang minuto ang byahe mo para makarating sa mga sumusunod na pagamutan at paano mo ire‐rate ang kalidad ng serbisyo nito? Isipin ang pagamutan na pinakamalapit sa iyong bahay. How many minutes would you have to travel to get to the following health institutions and how would you rate their quality? Think of the health institution which is nearest to your home.

I lang minuto ang byahe mula sa iyong bahay?

What is the traveling timefrom your home to the

institution in minutes?

Paano mo ire‐rate ang kalidad ng serbisyo nito?[IPAKITA ANG SHEET 6]

And how would you rate the quality of the institution on a scale

from 1‐5 [SHOW SHEET 6]

Ikaw ba mismo ay nakagamit ng serbisyo nito?

Did you personally use the institutions’ services in the

past 12 months? [38.X.1] [38.X.2] [38.X.3]

[38.1] Health care center

minutes 1 2 3 4 5 ‐77 1 wala no

2 meron yes

[38.2] Medical doctor


2 meron yes

[38.3] Hospital


2 meron yes

‐ 9 ‐

G. Individual Health Constitution Sa pag‐aaral na ito, nais naming maunawaan ang kalagayan ng inyong kalusugan at ang salik na kaugnay nito. Maaari pong sumagot nang tapat at huwag magmadali sa pagsagot. In our research we are interested in your health constitution and factors contributing to it. I now would l ike to talk about your experiences with your health. Please answer as honest as possible and take your time for each question.

44. Ang 1 ay nangangahulugan ng matinding sama ng kalagayan at ang 11 ay napakabuting kalagayang pangkalusugan. Paano niyo bibigyan ng grado ang inyong kasalukuyang kalusugan? [IPAKITA ANG SHEET 7 – SCALE E] Please think of a scale from 1 “very bad health state” to 11 “very good health state”. How would you classify your own health these days on this scale? [SHOW SHEET 7 – SCALE E]

Napakasamang kalagayan Very bad health

Napakabuting kalagayan

Very good health

1 2 3 4 5 6 7 8 9 10 11

45. May babasahin naman akong listahan ng iba’t ibang sintomas. Balikan niyo po ang nakaraang tatlong (3) buwan. Naranasan niyo ba ang sintomas na ito kahit isang beses? I am now going to read to you a list with different symptoms. If you think back, did you experience the following symptoms at least once in the last three (3) months?

Balikan niyo po ang nakaraang tatlong (3) buwan. Naranasan

niyo ba ang sintomas na ito kahit isang

beses?

KUNG OO , i lang araw mo naranasan ang sintomas nitong nakaraang tatlong (3) buwan? On how many

days did you in total experience the symptom in the last 3 months?

KUNG OO , May kinausap/ nilapitan ka bang doktor? If YES Did you contact a health professional for treatment or

advice?

[45.X.1] [45.X.2] [45.X.3]

Hindi No Oo Yes Hindi No Oo Yes

[45.1] Hindi makatulog o hirap makatulog Insomnia / troubles sleeping

1 2

1 2 Araw days

[45.2] Kahinaan, pagkapagod, matinding pagkaantok Weakness, fatigue or excessive sleepiness

1 2

1 2 Araw Days

[45.3] sipon o trangkaso cold or flu 1 2

1 2 Araw days

[45.4] Problema sa panunaw, pagtatae Digestion problems, diarrhea

1 2

1 2 Araw days

[45.5] Tuyong ubo, masakit na lalamunan Dry coughing, sore throat

1 2

1 2 Araw days

[45.6] Lagnat na higit sa isang araw Hot fever on more than one day

1 2

1 2 Araw days

[45.7] Paulit‐ulit na sakit ng ulo Recurring headache (other than migraine)

1 2

1 2 Araw Days

[45.8] Pagduduwal at/o pagsusuka Nausea and/or vomiting

1 2

1 2 Araw days

[45.9] Paninikip/pananakit ng dibdib Chest pain 1 2

1 2 Araw days

[45.10] Pagsakit ng tiyan Abdominal pain

1 2

1 2 Araw Days

[45.11] Hirap sa paghinga Trouble breathing

1 2

1 2 Araw Days

[45.12] Dugo sa dura Blood in spit

1 2

1 2 Araw Days

[45.13] Sakit sa pag‐ ihi Painful urination

1 2

1 2 Araw Days

[45.14] Problema sa balat (maliban sa eczema at allergies) Skin problems (other than eczema or allergies)

1 2

1 2 Araw Days

[45.15] Sakit sa ngipin Dental pain

1 2

1 2 Araw Days

[45.16] Pananakit ng kalamnan o buto Muscle or bone pain

1 2

1 2 Araw Days

[45.17] Kalungkutan, pagkabalisa, masidhing pagka‐depress. Sadness, anxiety, feeling very depressed

1 2

1 2 Araw days

[45.18] Problema sa paningin Problems with vision

1 2

1 2 Araw days

[45.19] Problema sa pandinig Hearing problems

1 2

1 2 Araw days

‐ 10 ‐

46. Balikan ang nakaraang apat (4) na linggo. Mayroon akong mga babanggiting mga gawain o kilos. [IPAKITA ANG

SHEET 8–SCALE F] Gaano kayo nahirapan sa… Now think of the last 4 weeks. Did you have any difficulties in doing the following activities? By difficulty I mean requiring increased effort, discomfort or pain. Please answer this question taking into account any assistance you have available. [SHOW SHEET 8 – SCALE F]

Wala None

Konti lang Mild

May kahirapan Moderate

Matindi Severe

Hindi makayanan Extreme/ Cannot do

Hindi alam, walang sagot Don’t know/ No reply

[46.1] Pagwawalis sa bahay o bakuran sweeping the house, floor, or yard

1 2 3 4 5 ‐77

[46.2] karaniwang pagkikilos moving around

1 2 3 4 5 ‐77

[46.3] matinding mga gawain tulad ng pagtakbo o pagbibisikleta vigorous activities(running or cycling)

1 2 3 4 5 ‐77

[46.4]

Paglalakad ng 20 metro na buhat ang isang baldeng tubig (o ibang mabigat na bagay)

carrying a heavy load, such as a pail of water for 20 meters

1 2 3 4 5 ‐77

[46.5] pag‐ i isip/pagpokus at pagtanda sa mga bagay‐bagay concentrating or remembering things

1 2 3 4 5 ‐77

47. Sa kasalukuyan, mayroong ka bang sakit or karamdamang na‐diagnose ng doktor? (TB, Hypertension, etc.) Anu‐ano ito? Are you aware of any diagnosed diseases that you currently have? Which ones?

__________________________________________________________________________________________

__________________________________________________________________________________________

48. Kung iisipin ninyo ang gastusin ng inyong pamilya para sa kalusugan (gamot, check‐up, konsultasyon, lunas), magkano ang inyong nagastos sa loob ng 12 buwan? If you think of the medical expenses of your household (medicine, treatments, consultations), how much did you spend in the last 12 months?

about

PHP in the last 12 months ‐77 Hindi alam/ walang sagot Don’t know/no reply

49. Kailan ka huling nagpacheck‐up sa doktor o ibang health care provider para sa medical check‐up o laboratory routine check‐up kahit walang sakit? Pakibanggit ang taon kung kailan ito naganap. When was the last time you were examined by a doctor or other health care provider for a medical or laboratory routine check‐up without being sick? Please name the year of this last routine check‐up.

Taon Year ‐77 Never [IF NEVER GO TO Q 51]

50. Maging tiyak hangga’t maaari: Sa kabuuan, nakailan na kayong medical check up o laboratory routine check up? Please try to be as exact as possible. As a whole, approximately how many medical and laboratory routine checks did you undergo…

[50.1] Sa loob ng nakaraang 2 taon? In the past 2 years (since 2012)?

routine checks

[50.2] Sa loob ng nakaraang 5 taon? In the past 5 years (since 2009)?

routine checks

51. Sa tingin ninyo, gaano kadalas dapat magpa‐check‐up ang tao na may kapareho mong edad, kahit walang sakit? What do you think, how frequently should a person of your age undergo medical and laboratory routine examinations, even without being sick?

1.

Higit sa isa kada taon More than once a year

2. Isa kada taon Once a year

3. Isa kada 2 taon Once every second year

4. Isa kada 3 taon Once every third year

5. Bihira Rarely

52. Sa tingin mo, hanggang anong taon aabot ang iyong buhay? What do you think: How old will you get in your life?

years old

53. Gaano kayo katangkad at ano ang inyong timbang (kg)? [1 foot = 30.48cm, 1 inch = 2.54cm, 1 pound = 0.45kg]How tall are you and what is your weight in kg?

Height: cm Weigth: kg

‐ 11 ‐

H. Health Behavior, Prevention, and Attitudes Sa susunod na bahagi, pag‐uusapan natin ang iyong pananaw at gawain kaugnay sa kalusugan. In the next paragraph of our survey I would like to talk to you about your health behavior and attitudes.

54. Ilang araw sa isang linggo ka nakakakain ng mga sumusunod…? On how many days of a week do you normally eat at least once…

[54.1] prutas fruit on araw kada l inggo days of the week

[54.2] Junk food (chips, sweets,etc.) on araw kada l inggo days of the week

55. Ilang araw sa isang buwan kang kumakain ng fastfood (Jollibee, Chowking, McDonalds, etc.)? On how many days of the month do you typically eat fastfood (e.g Jollibee, Chowking, McDonalds, etc.)?

on days per month

56. Regular (isang beses sa isang buwan) ka bang naglalaro ng sports o may pisikal na gawain (tulad ng pagsayaw)? Do you regularly (at least once a month) do physical training or sports (including dancing)?


57. Anong uri ng laro ang regular mong ginagawa? Pakipaliwanag kung maaari. What kind of sport do you regularly do? Please describe as exact as possible

_____________________________________________________________________________________

58. Ilang araw ka nag‐eehersisyo o naglalaro sa loob ng isang buwan? How many days do you exercise or play sports in a typical month?

Araw sa isang buwan Days per month

59. Sa nakaraang pitong (7) araw, isipin ang mga gawain sa trabaho, gawain sa bahay, pagbyahe, ehersisyo o maski anong laro. Ang tanging isasamang gawain ay yung mga ginagawa mo na hihigit sa 10 mins. Now I am going to ask you about the time you spent being physically active in the last 7 days. Think about the activities you do at work, as part of your house and yard work, to get from place to place, and in your spare time for recreation, exercise or sport. Think only about those physical activities that you did for at least 10 minutes at a time.

Sa loob nitong nakaraang 7 araw, i lang araw kang naging aktibo sa ___?

During the last 7 days on how many days did you

engage in ___?

Gaano katagal (oras/minuto) mo ito ginagawa sa loob ng isang araw?

How much time (hours/minutes) did you usually spend doing the activity

on one of those days?

Oras kada araw Hours per day

Minuto kada araw Minutes per day

[59.X.1] [59.X.2] [59.X.3]

[59.1]

Paglalakad, kasama ang pamamasyal o lakad na pang‐ehersisyo? Walking, travell ing from place to place and walking that you might do for recreation, sport, exercise, or leisure.

[59.2]

Katamtamang pagkilos na medyo mapapabilis ang paghinga tulad ng pagbubuhat ng magagaan na bagay o paglil inis ng bahay (Maliban sa paglalakad)? Moderate physical activities that make you breathe somewhat harder than normal and may include carrying l ight loads, bicycling at a regular pace, or cleaning the house. Do not include walking.

[59.3]

Nakakapagod na gawain kung saan bibilis kaysa normal ang paghinga (pagbubuhat ng mabigat, paghuhukay, ehersisyo). Vigorous activities that make you breathe much harder than normal (heavy l ifting, digging, aerobics)

‐ 12 ‐

60. Gaano ka sumasang‐ayon o hindi sumasang‐ayon sa mga sumusunod na pahayag? Mangyari lamang na maging tapat; walang tama o maling kasagutan. Isipin niyo na hindi magkakaugnay ang mga pangugusap. [IPAKITA ANG SHEET 3 – SCALE B] How strongly do you agree or disagree with the following statements? Please be as honest and accurate as you can, there is no right or wrong answer. Think about each statement on its own. [SHOW SHEET 3– SCALE B]


Strongly disagree

Di sang‐ayon

Disagree a l ittle


tumututolNeither

agree nor disagree

Sang‐ayon

Agree a l ittle


Strongly agree

walang sagot/ Hindi

alam no reply/ don’t know

[60.1]

Madalas na hindi nakakatulong sa paggaling sa sakit ang pagkonsulta sa propesyunal. Seeking help from health professionals does often not help in curing diseases .

1 2 3 4 5 ‐77

[60.2] Hindi ko gustong humihingi ng tulong sa mga health professionals. I dislike seeking help from health professionals.

1 2 3 4 5 ‐77

[60.3]

Ang mamuhay ng malusog ay nangangailangan ng matinding pagsusumikap

Living healthy often requires a lot of effort

1 2 3 4 5 ‐77

[60.4]

Para sa akin, mahirap sumunod sa mga rekomendasyon ng mga health professionals. For me it is often hard to stick to the recommendations given by health professionals.

1 2 3 4 5 ‐77

[60.5]

Bago ako humingi ng tulong sa mga health professionals, susubukan ko munang bigyang lunas ang aking karamdaman. Before seeking help from a health professional I try to cure diseases by myself.

1 2 3 4 5 ‐77

[60.6]

Wala akong tiwala sa kaalaman ng health professionals sa aming barangay. I have no trust in the knowledge of the health professionals here in my Barangay.

1 2 3 4 5 ‐77

[60.7]

Kung masama ang aking pakiramdam, madalas na mag‐antay muna ako ng isang l inggo bago magkonsulta sa isang health professional. If I feel sick, I usually wait at least a week before I seek help from a health professional.

1 2 3 4 5 ‐77

[60.8]

Kapag umiinom ako ng gamot madalas kong hindi binabasa ang nakasulat na paliwanag o instruction leaflet. When I take medicine I often do not read the enclosed instruction leaflet

1 2 3 4 5 ‐77

[60.9] Mas gugustuhin ko gumamit ng mga gamot na gawa sa bahay kaysa sa bumili. I prefer to use household medical remedies instead of buying medicine.

1 2 3 4 5 ‐77

[60.10] Hindi ako komportable kapag nagpapacheck‐up sa health professional. Being examined by a health professional makes me feel uncomfortable.

1 2 3 4 5 ‐77

[60.11] Naniniwala ako na sa maraming pagkakataon, hindi nakakapagpagaling ang gamot . I believe that in many cases, medicine does not help to cure diseases.

1 2 3 4 5 ‐77

61. Laban sa aling mga sakit ang nakatanggap ka ng bakuna sa loob ng 10 taon (since 2004)? Kung mayroon kayong talaan/record, maaaring gamitin ito. Maaring higit sa isa ang sagot. Against which of the following diseases did you receive vaccination in the past 10 years (since 2004)? For help you can use your vaccination pass if available. Multiple answers are possible.

[61.1] 1. Flu trangkaso Influenza [61.2] 1. Numonya Pneumococci

[61.3] 1. Tetanus, diphtheria, and pertussis [61.4] 1. Tigdas, beke Measles, Mumps, Rubella

[61.5] 1. Human papillomavirus [61.6] 1. Polyo Polio

[61.7] 1. Hepatitis B [61.8] 1. Hepatitis C

[61.9] 1. Bulutong‐tubig Chickenpox(varicella) [61.10] 1. Meningococcal meningitis

[61.11] 1. Tipus Typhoid [61.12] 1. Pagkamaga ng ulo Japanese Encephalitis

[61.13] 1. Yellow Fever [61.14] 1. Rabis Rabies

[61.15] ‐77 Hindi alam Don‘t know

‐ 13 ‐

62. Mayroon ka bang health insurance, kasama na dito ang: Philhealth, HMO at iba pa? Maaring higit sa isa ang sagot. [ISAMA ANG MGA MIYEMBRO NG PAMILYA]? Are you personally insured by any type of health insurance, including: Phil‐Health, Private Health Maintenance Organization (HMO) or others? [INCLUDE THOSE INSURED WITH OTHER HOUSEHOLD MEMBERS]

[62.1] 1. Wala No health insurance [62.2] 1. Phil‐Health

[62.3] 1. Private HMO [62.4] 1. Other, specify_________________________ _____

I. Health knowledge Pag‐usapan natin ngayon ang alam mo tungkol sa kalusugan at kung paano maiiwasan ang sakit. I would now l ike to talk to you about things you know about human health and health prevention

63. Paano mo igagrado ang sarili mo pagdating sa kaalaman tungkol sa sakit at ang mga lunas nito? [IPAKITA ANG SHEET 6 – SCALE D] How would you grade your knowledge about diseases and health treatments? [SHOW SHEET 6 – SCALE D]

Mabuting‐mabuti Very good

Mabuti Good

KatamtamanFair

Masama Bad

Masamang‐masamaVery bad

1 2 3 4 5

64. Naghanda po kami ng isang maikling pagsusulit na may sampung (10) maikling tanong tungkol sa kalusugan at katawan. Huwag pong magmadali, pag‐isipan mabuti ang bawat tanong at sagutin ayon sa inyong pinaniniwalaan. May isang tamang sagot at ipapaalam namin ito matapos ninyong sagutin. [IHANDA ANG SHEET 9 – HEALTH QUIZ] [SAGUTIN ANG 1‐4 SA QUESTIONNAIRE] We have prepared a quiz with 10 short questions on topics related to health and the human body. Please take your time to think about each question and answer according to your true beliefs. There is exactly one right answer to each question. We will provide you with the correct answers at the end of the survey [PREPARE SHEET 9 – HEALTH QUIZ] [FILL IN ANSWERS 1‐4 IN QUESTIONNAIRE]

[64.1] a) 1 2 3 4 ‐77 [64.6] f) 1 2 3 4 ‐77

[64.2] b) 1 2 3 4 ‐77 [64.7] g) 1 2 3 4 ‐77

[64.3] c) 1 2 3 4 ‐77 [64.8] h) 1 2 3 4 ‐77

[64.4] d) 1 2 3 4 ‐77 [64.9] i) 1 2 3 4 ‐77

[64.5] e) 1 2 3 4 ‐77 [64.10] j) 1 2 3 4 ‐77

J. Household Ang susunod na bahagi ay tutuon sa inyong kasambahay. Ang “kasambahay” ang nangangahulugang lahat ng kasalukuyan at permanenteng kasama sa inyong bahay na nakikinabang sa inyong kita at sa tagapagtaguyod ng pamilya. The following section is focused on your household. With household we mean all people who permanently live together with you at the moment and who share their income and expenditures with each other and acknowledge the authority of a man or women who is the head of household.

65. Sa kabuuan, ilan ang iyong maituturing na kasambahay? Altogether, how many persons live in your household?

Tao Persons

66. Ilan ang inyong anak? How many children did you give birth to in your life?

Anak Children

67. Mayroon po ba kayong anak na pumanaw bago umabot ng 18 taong gulang? Did any of your children die before the age of 18?

1. Hindi No 2. Oo Yes

Kung OO, i lan sila? If YES, how many of your children?

Anak [67.2]Children

68. Gawa sa anong klaseng materyales ang inyong pader?What type of wall does your dwelling/house mainly have?

1. Plastic at yero Plastic sheet, Metal sheet

2. Blak na gawa sa putik, cogon/nipa/kawayanMud brick, thatch

3. Semento, blaks, bato, kahoy Cement, brick, stone, wood

4. Iba pa other:____________________________ [68.2]

69. Pag‐isipan ang lababong pinakamalapit sa inyong kubeta. Mayroon bang magagamit na sabon dito (liquid o non‐liquid)? Please think of the lavatory / washbasin which is closest to your toilet. Do you keep any kind of (liquid or non‐liquid) soap there?

1. Wala No 2. Meron Yes

70. Ang mga sumusunod na tanong ay patungkol sa kasama sa bahay, hindi kasama ang sumasagot ng survey. Umpisahan natin sa pinakamatandang kasama sa bahay. [GUMAMIT NG DAGDAG NA TALAAN KUNG KINAKAILANGAN] [‐77 KUNG HINDI ALAM O WALANG SAGOT] [IWANG BLANKO KUNG HINDI APPLICABLE] The following questions are about the other members of your household not including yourself. We start with the oldest and continue with the younger members of your household [USE ADDITIONAL HOUSEHOLD ROOSTER IF NECESSARY] [‐77 IF DON’T KNOW / NO REPLY] [LEAVE BOX EMPTY IF DOES NOT APPLY]

Pinakamatandang miyembro

oldest household member [70.X.1]

2nd

na pinkamatanda

2nd oldest

household member[70.X.2]

3rdna

pinkamatanda 3rd oldest


4thna

pinkamatanda 4th oldest


5thna



6th na


household member [70.X.6]

[70.1] Unang pangalan First name of [HH member]? ________________ ________________ ________________ ________________ ________________ ________________

[70.2] Edad of [HH member]? Age of [HH member] in years? ________years ________years ________years ________years ________years ________years

[70.3] Kasarian of [HH member]? Sex of [HH member]?

1. Lalaki Male 2. Babae Female






[70.4]

Pakilagay kung ano ang kaugnayan ng KALAHOK sa miyembro [IPAKITA ANG SHEET 10 – RELATIONS] Please specify the relation between you and the [HH member]. [SHOW SHEET 10 ‐ RELATIONS ]

No:

No: No: No: No: No:

[70.5]

Ano ang pinakamataas na antas ng edukasyon na narating ng miyembro ng pamamahay/pamilya? [IPAKITA ANG SHEET 10 – EDUCATION LEVELS] What is the highest level of education of [HH member]? [SHOW SHEET 10 – EDUCATION LEVELS]

No:

No: No: No: No: No:

[70.6]

Gaano kalusog ang miyembro ng pamilya/pamamahay? [IPAKITA ANG SHEET 6 – SCALE D] How good is the health condition of [HH member] on a scale from 1 to 5?[SHOW SHEET 6 – SCALE D]

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

[70.7]

I lang araw umabsent sa trabaho o eskwela ng nakaraang buwan ang miyembro ng pamilya/pamamahay dahil sa karamdaman? How many days of work or school, if any, did [HH member]miss due to an i l lness in the past month?

Araw Days

Araw Days

Araw Days

Araw Days

Araw Days

Araw Days

[70.8]

I lang beses nagkasakit ang miyembro ng pamilya/pamamahay nitong nakaraang 12 buwan? How many times was [HH member] sick in the last 12 months?

Beses Times

Beses Times

Beses Times

Beses Times

Beses Times

Beses Times

[70.9]

Nitong nakaraang 12 buwan i lang beses nagpatingin sa isang health professional ang miyembro dahil sa karamdaman? How often was [HH member] examined by a health professional in the last 12 months because of i l lnesses?

Beses Times

Beses Times

Beses Times

Beses Times

Beses Times

Beses Times

[70.10]

Nitong nakaraang 12 buwan i lang beses nagpatingin sa isang health professional (doctor, health worker) ang miyembro kahit walang karamdaman para sa routine check‐up o lab test? Was [HH member] examined by a health professional (doctor, health worker) in the last 12 months without being sick for a routine check‐up or a lab test?

1. wala no 2. meron yes






‐ 15 ‐

72. May paghahanda bang ginagawa ang inyong pamilya sa panahon ng kalamidad? Does your household have any preparation in case a disaster strices?

1. Wala No 2. Mayroon Yes [IF HINDI/NO GO TO SECTION K]

73. Anu‐ano ang mga preparasyon na ginagawa ng inyong pamilya sa panahon ng kalamidad o parating na bagyo? What are the preparation measures taken by your household?

________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

74. Ginagawa ba ng inyong pamilya ang mga sumusunod? Has your household undertaken any of these measures?

[74.1] 1.

Kumpunihin o tibayan ang mga sira at kahinaan ng bahay Repaired or upgraded structural weaknesses of house

[74.2] 1. Bumili ng insurance/seguro para sa baha o kalamidad Purchased flood/disaster insurance

[74.3] 1.

Maghanda ng mga emergency survival at preparedeness kits Collected emergency survival items/ preparedness kit

[74.4] 1. Umalis palayo sa mga peligrosong lugar Moved out of disaster‐risk area

[74.5] 1.

Planong lumikas palayo sa peligrosong lugarPlanning to move away from diasaster risk‐area

K. Information about loan center Pag‐usapan po natin ngayon ang tungkol sa inyong sentro at ang ugnayan niyo sa ibang mga miyembro ng sentro. I would now l ike to talk to you about your loan center and your relationship to the other center members.

75. Ano ang pangalan ng iyong sentro? What is the name of your loan center?

76. Kung iisipin niyo ang mga kasama niyo sa loan center. If you think of the other members of your loan center.

[76.1] Ilan sa kasalukuyan ang inyong miyembro sa sentro? How many people are at the moment members of your loan center?

Tao Persons

Pag‐isipan ang buong sentro at ang lahat ng mga miyembro nito. Ilan sa kanila ang maituturing mong personal na kaibigan? Please think now of the entire group of loan center members.Approximately how many of these would you call your personal friend?

[76.2] Miyembro ng sentro Center members

At ilan naman dito ang maituturing mong kasama sa 10 best friends/matalik mong kaibigan. And how many of these would you say belong to your 10 best friends of all your friends?

[76.3] Miyembro ng sentro Center members

[76.4]

Ilan sa mga miyembro ng sentro mo ang nakakakwentuhan mo o nadadalaw maliban sa pulong ng inyong sento tuwing linggo? With how many members of your loan center do you privately meet at least once every two weeks in addition to the loan center meetings every week?

Miyembro ng sentro Center members

77. Regular (kahit minsan sa ikalawang buwan) mo bang nakakakwentuhan ang ibang miyembro ng sentro tungkol sa iyong kalusugan at mga bagay‐bagay na kaugnay nito (kasama na ang emosyonal na problema, usaping kababaihan, atbp). Kung OO, sa ilan sa kanila mo naibabahagi ito? Do you regularly (at least once every second month) speak to other loan center members about your health and health related issues? If yes, to how many persons from your loan center do you speak to about your health?


Kung OO, sa i lan sa kanila? If YES, to how many persons?

Tao Persons [77.2]

71. Nitong mga nakaraang tatlong taon (simula 2011), ikaw o ang pamilya mo ba ay nakaranas o naapektuhan ng kalamidad (bagyo, baha, landslide)? Thinking about the past 3 years (since 01/2011) were you or your family members affected by a storm or flood and its consequences (e.g. landslides)?

Naapektuhan ka ba? Were you affected?

Kung OO, makailang ulit? If yes,

appxroximately how many times?

I lang miyembro ng pamilya ang nasaktan noong panahon ng mga kalamidad? How many family members were injured

during all events?

Mga magkano ang katumbas na halaga ng nawala o nasirang

gamit? What was the estimated monetary loss for the most

damaging event? [71.1] [71.2] [71.3] [71.4]

1

wala no

2

meron yes

beses times

tao persons

PHP

78. Pag‐usapan natin ang ugnayan niyo sa ibang miyembro ng inyong sentro. Pakisaisip ang 4 sa pinakakaibigan mo sa sentro. Isipin lamang ang mga kaibigan at kapamilya na hindi mo kasama sa bahay. Kahit hindi mo gaanong kaibigan ang 4, isipin mo ang may pinakamalapit kang ugnayan. [‐77 KUNG HINDI ALAM O WALANG SAGOT] Now we are interested in your relationship to the other members of your loan center. Please think of the 4 closest (in terms of friendship) members of your loan center. Please think only of friends and family members who do not live in the same household as you do. Even if you are not friend with 5 members, please think of the persons with whom you have the best contact in the loan center. [‐77 IF DON’T KNOW / NO REPLY]

Pinakamalapit na kasama sa sentro

Closest Loan Center Member

2nd na Pinakamalapit na kasama sa sentro 2nd Closest Loan

Center Member

3rd na Pinakamalapit na kasama sa sentro 3rd Closest Loan

Center Member

4th na Pinakamalapit na kasama sa sentro 4th Closest Loan

Center Member [78.X.1] [78.X.2] [78.X.3] [78.X.4]

[78.1] Kumpletong pangalan [kung possible] Full name of [LC member]?[If possible] ________________ ________________ ________________ ________________

[78.2] Edad ng miyembro Approximate age of [LC member] in years?

Taon Years

Taon Years

Taon Years

Taon Years

[78.3]

I lang taon mo na kakilala ang miyembro? (taon = 0 kung bababa sa 1 taon) For how many years have you known [LC MEMBER]? (years = 0 if knowing less than 1 year)

Taon Years

Taon Years

Taon Years

Taon Years

[78.4]

I lang araw kayo nagkikita (hal. Pulong, huntahan/ kwentuhan, nagkakasalubong) sa loob ng 30 araw ng higit sa 15 minutos? On how many days do you have contact (e.g. meeting, chatting) with [LC MEMBER] in a typical month for more than 15 minutes?

Araw Days

Araw Days

Araw Days

Araw Days

Gaano mo sasang‐ayunan ang mga sumusunod na pahayag tungkol sa miyembro sa panukat na 1 hanggang 5? [IPAKITA ANG SHEET 3 – SCALE B] How strongly do you agree with the following statements about [LC member] on a scale from1 (strongly disagree) to 5 (strongly agree)? [SHOW SHEET 3 – SCALE B]

[78.5] Marami akong alam na personal tungkol sa taong ito. I know a lot about this person and her private issues

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

[78.6]

Kung meron akong problemang pangkalusugan, nilalapitan o kinakausap ko ang taong ito para sa tulong o payo. If I have a health problem, I contact this person for help and advices.

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

[78.7]

Kumpara sa iba, madalas kong makausap ang taong ito tungkol sa aking kalusugan at mga isyung kaugnay nito. As compared to others, I often speak with this person about my health and health issues

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

[78.8]

Sa tingin ko ang taong ito ay mas may alam sa usaping pangkalusugan kumpara sa akin. I think this person knows more about health than I do.

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

[78.9]

Ayos lang sa akin na pag‐usapan ang maseselang usapin. I do not mind discussing very private, intimate topics with this person (e.g issues in relationship)

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

‐ 17 ‐

L. Financial Situation and Restrictions Bago natin talakayin ang huling bahagi, pag‐usapan natin ang kalagayang pampinansyal ng inyong pamamahay. Pakitandaan po na lahat ng inyong sagot ay ituturing na lihim. Before coming to the last section, I want to talk to you about the financial situation of your household and financial restrictions that you experience in your everyday life. Please remember, all your answers are confidential.

79. Ilan sa inyong kasama sa bahay ang kumikita ng regular sa kasalukuyan? How many members of your household earn a regular income at the moment?

Tao Persons

80. Magkano ang nagagastos ng buong pamamahay kada linggo (upa, pagkain, para sa pag‐aaral, damit, atbp..?) How much does your household spend on average per week for living (rent, food, tuition…)?

about

PHP kada l inggo PHP per week

‐77 Hindi alam / walang sagot Don’t know / no reply

81. Kung ipagsasama‐sama ang lahat ng kinikita ng pamamahay, magkano ang kabuuang kita nito kada linggo (yung wala pang ikinakaltas na buwis at ibang gastusin)? Taking the income (before taxes) of all household members together, how high is the gross income (before taxes) of your household every week? (Without subtraction of any costs of living)

about

PHP kada l inggo PHP per week

‐77 Hindi alam / walang sagot Don’t know / no reply

83. May natitira pa bang pera ang pamamahay kada buwan para ipunin at ipambayad sa malalaking gastusin, emergency o pambili ng lupa/bahay? Kung oo, magkano? Does your household usually has an amount of money left over at the end of the month that you can save for larger purchases, emergency expenses or to acquire wealth? If yes, how much?


Kung oo, magkano? If yes, how much?

PHP kada buwan [83.2] PHP per month

84. Humigit kumulang, magkano ang lahat ng iyong kasalukuyang utang sa ibang tao at organisasyon? (halaga ng utang) Approximately, what is the sum of money that you currently owe other persons and organizations?

PHP ‐77

Wala akong maski anong utang Does not have any loans

85. Halimbawa, mangangailangan ka ng Php10,000 para sa agarang pagpapagamot, makakayan bang makalikom ng ganitong halaga ang iyong pamamahay na hindi humihingi ng tulong sa iba? Imagine you needed 10.000PHP for an urgent medical treatment, would your household be able to come up with the money without external help?

1. Hindi No 2. Oo, baka kalahati Yes, about half of it 3. Oo, buong Php10,000. Yes, all of it

82. Magkano ang kabuuang kita ng inyong pamamahay mula sa mga sumusunod para sa buwan ng Enero? [IWANG BAKANTE ANG KAHON KUNG HINDI ALAM O WALANG SAGOT] How much was the total gross income (before taxes) of your household from the following sources in the month of January? [LEAVE BOX EMPTY IF DON’T KNOW / NO REPLY]

[82.1] Saril ing hanapbuhay, negosyo ng pamilya Self‐employed activities, family‐owned business

PHP

[82.2] Sahod Wage, employment

PHP

[82.3] Interes sa ipon Interest on saving

PHP

[82.4] Kita sa paupahan ng lupa o bahay o espasyo Income from renting or leasing land or house/flat

PHP

[82.5] Padala o suporta ng mga kamag‐anak o kaibigan Support from external family members or friends

PHP

Iba pa 1 Other 1:_________________________________ [82.6]

PHP [82.7]

Iba pa 2 Other 2:_________________________________ [82.8]

PHP [82.9]

‐ 18 ‐

86. Nitong nakaraang 12 buwan, ikaw ba o ang isa sa iyong kasambahay ay nagpasya na hindi magpagamot dahil sa dahilang pinansyal? In the past 12 months, did you or a household member ever decide not to go to the doctor or seek medical treatment because of financial constraints?

1. Hindi No 2. Oo Yes ‐77

Hindi alam/walang sagot Don’t know / no reply

87. Panghuli na po bako matapos ang survey, may ilan tanong lang po ako tungkol sa inyong inaasahan at mga inaasam sa hinaharap. Ano ang inyong inaasahan at pinakamalaking pinangangambahan sa mga susunod na taon?Finally, before finishing this survey, I want to ask you a few questions about your expectations and hopes for the future. What are your hopes and biggest fears for the next years?

___________________________________________________________________________________________

M. Tracking Information Tulad ng aming nabanggit, isasagawa muli ang panayam sa March 2015. Nais naming maunawaan ang kalusugan ng mga kalahok at masundan ang pagbabago sa loob ng isang taon upang ipagpabuti ang programa ng Kasagana‐ka. Nais namin kayong makausap isang taon mula ngayon.

Mahalaga: Nais naming kayong makapanayam kahit hindi na kayo miyembre ng Kasagana‐Ka. Dahil dito, gusto namin mahingi ang contact details ng iyong malapit na kamag‐anak at kaibigan. Nais namin siguraduhin na makausap muli kayo isang taon mula ngayon.

Maari niyo bang ibigay ang contact details ng inyong malapit na kamag‐anak na nakatira sa inyo? Could you first please think of two close relative of yours that lives in your household (e.g. husband, parents, sibling, son or daughter). Could you please give us their full names and cell phone numbers?

[M1.1]

Buong pangalan ng Miyembro I Full name Household Member I

[M1.2] Cell‐phone Household Member I

[M2.1] Buong pangalan ng Miyembro II Full name Household Member II

[M2.2] Cell‐phone Household Member II

Maari niyo bang ibigay ang contact details ng inyong malapit na kaibigan na hindi nakatira sa inyo? Please think now of two very close friends who are not living in the same household as you do. Could you please give us also their full names, their cell phone numbers, and the names of their Barangays?

[M3.1] Buong pangalan ng Person I Full name Person I

[M3.2] Cell‐phone number Person I

[M3.3] Pangalan ng Barangay ni PersonI Name of Barangay of Person I

[M4.1] Buong pangalan ng Person II Full name Person II

[M4.2] Cell‐phone number Person II

[M4.3] Name of Barangay of Person II

Maraming salamat sa inyong paglahok!

[INTERVIEWER: (1) PLEASE CHECK FOR COMPLETENESS, (2) PAY INCENTIVE, (3) ASK FOR PARTICIPANTS SIGNATURE]

Documents

Baseline Questionnaire: Client Beneficiaries