CHAPTER I

THE PROBLEM AND RESEARCH DESIGN

Introduction

TB is a preventable disease, even in those who have been exposed to an

infected person. Today, especially, with the current economic downturn, it is

critical that we focus on prevention and health protection to avoid the need for

secondary and tertiary health care. According to DOH CARAGA, the cost of

treating each patient affected by tuberculosis is estimated at P21, 000.00 for

medicine requirements alone.

Integral parts of the national TB control programs are advocacy,

communication and social mobilization (ACSM) activities which aim to bring

about behavioral change are. However, selecting the most appropriate ACSM

activities depends, in part, on the specific desired behavioral outcome. The

ultimate aim is positive behavioral modification.

Tuberculosis is everywhere and present in household and relatives of the

researchers, which lead to their interest in gaining further understanding about

the disease. Also, as consumers of the Mayor Salvador L. Calo Supermarket,

located in the business district of Butuan City, the researchers noticed that
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spitting, a behavior that increases risk of transmitting tuberculosis, can be

observed in the market. It is on the vendors that the researchers focus this study

because they are those who spend most time in the market and have close

contact with the consumers.

In this study, the researchers aim to determine the individual

characteristics of the respondents, as one of the recipients of the TB awareness

programs. It aims to provide an appraisal of what is known about the disease, an

assessment of habits and attitudes of the respondents as they relate to the

behavioral modification for the primary prevention measures for PTB among

them, and to present specific means to remedy observed deficiencies.

Data on knowledge, attitudes and practices from researches or survey are

significant because it can be used as an evidence base for planning, refining and

evaluating advocacy, communication and social mobilization (ACSM) activities as

part of a broader TB control strategy. To bring about sustainable social and

behavioral change, ACSM interventions need to be evidence-based. This study

will provide a baseline data.

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Theoretical Framework of the Study

This study utilized the health promotion model (HPM) proposed by Nola J.

Pender (1982; revised, 1996), which is directed at increasing a client’s level of

wellbeing. It describes the multidimensional nature of persons as they interact

within their environment to pursue health. The model focuses on following three

areas: the individual characteristics and experiences, behavior-specific

cognitions and affect, and behavioral outcomes.

The health promotion model notes that each person has unique personal

characteristics and experiences that affect subsequent actions. The set of

variables for behavioral specific knowledge and affect have important

motivational significance and can be modified through nursing actions.

Enactment of health promoting behavior is the desired behavioral outcome and

end point of the HPM. HPM proposes that prior behavior and inherited and

acquired characteristics influence beliefs, affect, and enactment of health-

promoting behavior and that persons can modify cognitions, affect, and the

interpersonal and physical environment to create incentives for health actions.

Identifying this set of characteristics is important to influence positively the

behavior specific cognitions and affect and the behavioral outcome through

effective assessment, support and education. In conducting communication

activities of TB control program, personal characteristics must be identified first in

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order to effectively increase awareness, influence social norms, and create

behavioral change among selected individuals, subpopulations or general public.

Conceptual Framework of the Study

The Conceptual Framework of the study is based on the concepts that

primary prevention activities avoid the development of the disease in an

individual and health promoting behaviors, the end point of HPM, result in

improved health, enhanced functional ability and better quality of life at all stages

of development. The independent variable pertains to the individual

characteristics and experiences related to the primary prevention activities

necessary to avoid acquiring pulmonary tuberculosis, which includes the

awareness of PTB, health attitude and lifestyle, and environmental sanitation and

hand hygiene. The dependent variable pertains to the preventive health behavior

for the primary prevention of pulmonary tuberculosis. The study was conducted

among the meat stall-owners of Mayor Salvador L. Calo Supermarket, Butuan

City.

Dependent Variable
Independent Variable

Individual Characteristics of the Meat Stall-

owners of MSLC Supermarket: Preventive Health
Behaviors for the
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Dependent Variable
Independent Variable

Individual Characteristics of the Meat Stall-

owners of MSLC Supermarket: Preventive Health
Behaviors for the
Knowledge on PTB Primary Prevention
of Pulmonary
Health Attitude and Lifestyle Tuberculosis
Environmental Sanitation and Hand Hygiene

Figure 1. Schematic Diagram

Statement of the Problem

The main purpose of this study is to determine the primary prevention

measures for pulmonary tuberculosis of the meat stall-owners of Mayor Salvador

L. Calo Supermarket in relation to its effectiveness in terms of the incidence of

the disease among them. This also would particularly answer the following

questions:

1. What are the individual characteristics of the respondents that affect the

prevention of TB in terms of:

1.1 Knowledge on PTB

1.2 Health Attitudes and Lifestyle

1.3 Environmental Sanitation and Hand Hygiene

2. What is the effectiveness of preventing pulmonary tuberculosis among the

Meat Stall-owners of MSLC Supermarket?

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3. Is there a significant relationship between the individual characteristics of

the respondents and the preventive health behavior for the primary

prevention of PTB among the Meat Stall-owners of MSLC Supermarket?

Statement of the Hypothesis

Ho: There is no significant relationship between the individual

characteristics of the respondents and the preventive health behavior for the

primary prevention of PTB among the Meat Stall-owners of MSLC Supermarket.

Significance of the Study

This study will be of great help and benefit to the following groups:

To the vendors. Respondents will benefit the study by identifying their

level of awareness and risk factors to tuberculosis and from the health promotion

interventions that would help develop their skill in caring for themselves and

dependents, enabling them to live healthier and more productive lives.

To the consumers. This study is useful in terms of awareness and

prevention of the disease in given conditions that are present in the supermarket.

To the Local Government Unit. The study may be able to determine the

impact of the health promotion and prevention programs or campaign against TB

to their constituents, specifically to the respondents.

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To the TB Advocates or Networkers. The study could assist in improving

their advocacy that is appropriate for the respondents in order to effect in a

positive direction, health behavior change or progress. Prevention of the disease

can also mean reduced health care cost.

To Butuan Doctors’ College. This study may be used as a tool in planning

community extension programs related to TB control. Activities can be tailored to

the local situation, which can provide increased impact to the recipients. The

study may broaden their outlook of the nursing students by becoming more

aware of giving service to the people, especially in public health.

To the researchers. This study will not only enhance the knowledge and

skills in conducting nursing research but also in delivering individualized health

teachings on PTB, in role modeling, and in planning programs that focus on

health promotion and disease prevention. Better understanding of the disease

and preventive health behaviors may intensify interest to become advocates of

the national TB control programs.

To the future researchers. The research can be used as a guide in similar

studies or may be duplicated in other settings so that there can be comparison of

data.
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Scope and Limitation of the Study

Content

The study is focused on the knowledge, health attitudes and lifestyle, and

environmental sanitation and hand hygiene of the vendors of Mayor Salvador L.

Calo Supermarket on the primary prevention of tuberculosis. In order to assure

manageability of the collected data, a structured instrument was used in the

interview. Observation, although a very good data gathering tool, was not used

as basis by the researchers.

Subject

The respondents of the study are the meat stall owners of the Salvador L.

Calo Supermarket, which is located in Langihan, Baragay Holy Redeemer,

Butuan City.

Time

The conceptualization of the topic was done in September 2008. The first

research proposal was submitted in October 2008. With some revisions, the

second research proposal was presented in November of the same year, then

designing the survey questionnaire followed in January 2009. After the approval,

the questionnaire was pre-tested and then finalization of the questionnaire was

done in February 2009. The selected participants were interviewed in the March

2009. Tabulation of results, interpretation and analysis of results, summarization

 9

of the findings immediately followed, as well as the drawing of conclusion and

formulation of recommendation.

Definition 0f Terms

Individual characteristics are the vendor’s nature, behavior or personal attributes

Environmental sanitation refers to the measures that limit the exposure to

Mycobacterium tuberculosis in the supermarket, specifically in the meat

section. This includes the ventilation in the section, agents used in cleaning

table top, covering of mouth when coughing and sneezing and refraining

from spitting anywhere.

Hand hygiene refers to frequent hand washing using soap and running water.

Health Attitudes are perceptions of favor or disfavor that influences behavior or

decisions .

Preventive Health Behaviors. The action the meat stall-owners takes to

understand his/her health state, maintain an optimal state and prevent

illness and injury, such as pulmonary tuberculosis.

Knowledge on PTB. The vendors’ level of awareness on the mode of

transmission, signs and symptoms and means of avoiding the disease.

Lifestyle. A pattern of individual practices and personal behavioral choices of the

vendors.
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Primary Prevention. Activities directed toward the decreasing the probability of

acquiring PTB, promoting health to avoid the need for secondary and

tertiary health care.

Research Design

The researchers used the descriptive, correlational method of research,

which is a non-experimental, quantitative study that determines the relationships

between variables. Specifically, this study seeks to find the relationship between

the individual characteristics of the meat stall-owners of Mayor Salvador L. Calo

(MSLC) supermarket and the behavioral modification for the primary prevention

of PTB among them. In addition to that, it employs an orderly planning, analysis,

interpretation of data and logical presentation of findings. Descriptive research

provides new information and describe phenomenon affecting the nursing

profession. In this type of study the researchers observed, counted, delineated,

and classified the data collected.

Research Locale

The researchers chose Mayor Salvador L. Calo Supermarket as the locale

for the study. The supermarket, located in Langihan, Butuan City, the center of

trade in the district, has an area of 2 hectares with different sections such as the

meat, fish, vegetable, fruits, rice, textile, general merchandise and eateries. It is
 11

accessible by private vehicles and public utility vehicles such as the jeep, tricycle

and motorized “sikad”. It has a regular garbage collection schedule daily at 4 o’

clock in the afternoon by the Waste Management Bureau. It is virtually a one-

stop shop where prices are relatively cheap due to the presence of wholesalers.

Because of this, the supermarket is frequented by consumers from Butuan City

and neighboring towns. There is high people traffic in the area, which makes the

market noisy and crowded.

Respondents and Sampling Procedure

The chosen respondents of the study were the meat stall-owners of MSLC

supermarket. The vendors comprise individuals representing a broad range of

lifestyle, habits, which may provide more information for the researchers on the

complexity of human nature. Based on the records, the vendors reach a total

population of 140. Using the Sloven’s Formula and allowing 5% margin of error,

we obtained a sample size of 104, which is 74.29% of the total population. Then

the respondents were selected in a non – random way using purposive-

accidental sampling.

Research Instrument
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The study utilized the questionnaire as the research instrument to gather

needed data from the respondents pertinent to the purpose of the study. It’s a

paper and pen approach in which the participants were asked to answer a set of

printed questions that were based on our independent variables. The

questionnaire was then submitted to the research instructor for a series of

corrections. After the constructive suggestions and criticisms were noted during

the series of corrections, the research instructor advised us to conduct a pilot

study to ten (10) respondents to test the validity and reliability of the

questionnaire at Libertad Public Market. Thus, the final drafts of the

questionnaire were then distributed to our respondents. The questions were

close ended and the respondents were asked to indicate the ideas they want to

express through the indicator. They chose from the five categories, namely: 5 –

strongly agree, 4 – agree, 3 –neither agree/ nor disagree, 2 – disagree, 1 –

strongly disagree.

Data Gathering Procedure

The researchers observed the following sequence in data collection.

Letter of Request. A letter requesting the Market Supervisor’s approval to

conduct this research relative to the topic, assuring them proper handling of this

research and confidentiality is promised.

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Distribution of Questionnaires. The research respondents were the meat

stall owners. The researchers personally distributed the survey questionnaire to

the respondents. During the survey, they were given proper orientation about the

purpose and concept of the study, and instructions on how to answer the

questionnaires. Respondents were given 1 day to supply the necessary

information needed in the study.

Retrieval of Questionnaires. After a day, the answered questionnaires

were retrieved personally by the researchers and prepared for the consolidation

of data.

Consolidation of Data. The data collected were then tallied, presented,

analyzed and interpreted with the application of the following statistical tools.

Statistical Techniques

To have a better analysis and interpretation of the collected data, the

following statistical tools were used.

Frequency Distribution – this was employed by counting the number of the

respondents per category.

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Percentage Rating – this was employed to determine the number of times

a frequency falls on a certain category or level.

The formula used was: % = f / n x 100

Where:

% - Percent

f - Partial frequency

n – Total number of respondents

Weighted Mean – this was employed to determine the central location of

the distribution of the scores in the responses using the Likert-type point

continuum scale with the following numerical and verbal scales below.

Numerical Rating Ranging of Means Verbal Description

5 4.21 – 5.00 Strongly Agree
4 3.41 – 4.20 Agree
3 2.61 – 3.40 Neither Agree/ Nor Disagree
2 1.81 – 2.60 Disagree
1 1.00 – 1.80 Strongly Disagree

Chi Square – The Chi Square of equal probability was used to determine

whether there is a significant relationship between the knowledge on the

prevention of TB, health attitudes and lifestyle, and environmental sanitation and

hand hygiene of the meat stall-owners of Mayor Salvador L. Calo (MSLC)

supermarket and the effectiveness of prevention of tuberculosis among them.

The formula used was:

x² = Σ (fo – fe)²
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fe

Where:

x² = Chi – square

Σ = Summation Of

fo = Observed Cell Frequency

fe = Expected Cell Frequency

CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

In public health nursing, there is a concern for the connection between the

health status of the population and the environment in which the population lives.

Also, there is an imperative to work with the members of the community to carry

out core public health functions which are on disease prevention, on health

promotion and protection, and on primary, secondary and tertiary health care

services. All these services are important to the health of the population and thus

must be a part of a health care system with health as a goal. According to the

U.S. Public Health Service in 1994/2000, the greater the effectiveness of the
 16

services in the lower tiers, the greater is the capability of the higher tiers to

contribute efficiently to health improvements. (Stanhope, et. al., 2004)

Pulmonary tuberculosis (PTB) is a common and often deadly infectious

disease commonly caused the Mycobacterium tuberculosis. It can primarily be

acquired from person to person by breathing infected sputum from the air during

close contact, not just by touching the clothes or shaking the hands of someone

who is infected, but when the bacteria get into the air when someone who has a

tuberculosis lung infection coughs, sneezes, shouts, or spits. (Smeltzer, 2004)

People who are nearby can then possibly breathe the bacteria into their lungs. A

PTB positive individual, if left untreated, can infect at least 10-15 persons yearly,

thus making TB widespread and contagious. (Nettina, 2006)

According to the Department of Health (DOH) National TB Control

Program in 2006, eighty (80%) percent of people afflicted with tuberculosis are in

the most economically productive years of their lives, and the disease sends

many self-sustaining families into poverty. The rising incidence of tuberculosis

has economic repercussions not only for the patient’s family but also for the

country. This disease not only brings threat to adults but to the children too. The

CARAGA TB control program is performing well and reaching global targets with

a case detection rate of 99.64 percent in 2007. However, TB still remains the fifth

leading cause of death in the region.

Health Promotion Model

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Health can be viewed as a continuum and dynamic state that is influenced

by the perception of the individual. Along this continuum, a person moves

between health and illness. Health and wellness include several dimensions:

physical, emotional, spiritual, intellectual, occupational, and social. Achieving

wellness, however, always involves being actively engaged in choosing health

seeking behaviors. The HPM synthesizes research findings from nursing,

psychology and public health into an explanatory model of health behavior that

still must undergo further testing. Multiple variable models are needed to explain

human health behavior.

Assumptions of the Health Promotion Model. The HPM is based on seven

(7) assumptions, which reflect both nursing and behavioral science perspectives.

Among them are the following assumptions, which this study focused on: (1.)

Persons seek to create conditions of living through which they can express their

unique human health potential; (2.) Persons have the capacity for reflective self-

awareness, including assessment of their own competencies; (3.) Health

professionals constitute a part of the interpersonal environment, which exerts

influence on persons throughout their lifespan; (4) Self-initiated reconfiguration of

person-environment interactive patterns is essential to behavior change.

Theoretical Propositions. Theoretical statements derived from the model

provide a basis for investigative work on health behaviors. The HPM is based on
 18

the thirteen (13) theoretical propositions; however, the study is focused only to

these propositions; prior behavior and inherited and acquired characteristics

influence beliefs, affect, and enactment of health-promoting behavior, and that

persons can modify cognitions, affect, and the interpersonal and physical

environment to create incentives for health actions.

(www.nursing.umich.edu/faculty/pender/HPM.pdf)

The Major Concepts and Definitions of the Health Promotion Model. The

health promotion model identifies the following factors as having a potential

influence on the health promoting behavior of a person. One of three is the

individual characteristics and experience. This category consists of prior related

behavior, and characteristics that are inherited and acquired, which includes the

habits, skills, and knowledge acquired in the past, as well as biological,

psychological and socio-cultural factors. (Rankin, et.al., 2004)

Some of the concepts under this category are defined as: (1) Prior related

behavior is the frequency of the similar behavior in the past, direct and indirect

effects on the likelihood of engaging in health promoting behaviors; (2) Personal

factors are categorized as biological, psychological and socio-cultural. These

factors are predictive of a given behavior and shaped by the nature of the target

behavior being considered. (3) Personal psychological factors include variables

such as self-esteem, self-motivation, personal competence, perceived health

status and definition of health.

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Behavioral specific cognition and affect is another factor that has a

potential influence on the health promoting behavior of a person. Some of the

concepts under this category which determines health promotion activities are:

(1.) Perceived benefits of action is the anticipated positive out comes that will

occur from health behavior; (2.) Perceived barriers to action are anticipated,

imagined or real blocks and personal costs of understanding a given behavior;

(3.) Perceived self-efficacy is the judgment of personal capability to organize and

execute a health-promoting behavior and influences perceived barriers to action

so higher efficacy result in lowered perceptions of barriers to the performance of

the behavior; (4.) Activity related affect is the subjective positive or negative

feelings that occur before, during and following behavior based on the stimulus

properties of the behavior itself. Activity-related affect influences perceived self-

efficacy, which means the more positive the subjective feeling, the greater the

feeling of efficacy. In turn, increased feelings of efficacy can generate further

positive affect; (5.) Situational Influences- Personal perceptions and cognitions of

any given situation or context that can facilitate or impede behavior. Include

perceptions of options available, demand characteristics and aesthetic features

of the environment in which given health promoting is proposed to take place.

Situational influences may have direct or indirect influences on health behavior.

Behavioral Outcome. Health promoting behavior is the endpoint or action

outcome directed toward attaining positive health outcome such as optimal well-
 20

being, personal fulfillment, and productive living. This includes exercise,

obtaining optimum nutrition, stress management, and the development and

maintenance of social support systems. (Sitzman, et. al, 2004)

Pender explains the importance of the Health Promotion Model in her

book about this model in 2003. It became apparent to Pender that health

professionals intervened only after people developed acute or chronic disease

and experienced compromised lives. This reactive approach did not reflect the

philosophical beliefs of the predecessors in nursing, which focused on

maintaining conditions of a healthy interaction between self and environment. It is

much to better experience exuberant well-being and to prevent disease that let

disease happen when it is avoidable and then try to cope with it. The HPM is a

heuristic device that encourages scholars to look integratively at variables that

have been shown to impact health behavior. (Sitzman, et. al, 2004)

Neumann who created the Systems Model also realized the role of nurse

in health promotion or primary prevention. She stated that the nurse may be

involved in the process of primary prevention wherein general knowledge is

applied in client assessment and preventive healthcare measures aimed at

reducing the chance of possible stressors and resultant illness. (Sitzman, et. al,

2004)

Health Behavior
 21

Health behavior proposed by S. Kasl and S. Cobb, defined three

categories of health behavior as preventive health behavior, illness behavior,

sick-role behavior. The preventive health behavior involves any activity

undertaken by individuals who believe their selves to be healthy for the purpose

of preventing or detecting illness in an asymptomatic state. This can include self-

protective behavior, which is an action intended to confer protection from

potential harm, Self-protective behavior is also known as cautious behavior. K.

Wallstone identifies perceptions of control, the ability to determine or influence a

behavior or the consequence of a behavior, as one of the many factors that have

been associated with whether or not a person engages in some form of health

behavior. (Baum, 2006)

Understanding and improving health-related behavior is critical to the

future of public health and to the well-being of individuals, and has become

central to public health activities. While policies, laws, and regulations can affect

health behaviors, there are also many individual factors that must be considered

in these public health efforts. Gochman proposed, cited by Glanz, et.al, that the

definition of health behavior, which includes not only observable, overt actions

but also the mental events and emotional states that can be reported and

measured. Health behavior as "those personal attributes such as beliefs,

expectations, motives, values, perceptions, and other cognitive elements;

personality characteristics, including affective and emotional states and traits;

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and overt behavior patterns, actions, and habits that relate to health

maintenance, to health restoration, and to health improvement." This definition

emphasizes the actions and the health of individuals. A public health perspective,

in contrast, is concerned with individuals as part of a larger community. These

perspectives are interrelated, as the behaviors of individuals determine many of

the social conditions that affect all people's health. (Glanz, 2002)

Advocacy, Communication and Social Mobilization for TB

Advocacy, communication and social mobilization (ACSM) are three

distinct sets of activities, all of which have the shared goal of bringing about

behavioral change. Sound TB control principles, flexibility, and a patient-centered

approach are essential. (WHO)

Published in the 17 March 2006 issue of the Lancet medical journal, the

new Global plan to stop TB 2006–2015 and the Stop TB Strategy launched by

WHO in 2006 position ACSM as an important component of the TB Control

programs that must be promoted for wider use. It also outlines fundamental

activities that will be led by the ACSM Working Group over the next 10 years to

ensure wider strategic application of ACSM. ACSM activities create greater

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social commitment and support behavioral change in order to ensure access to

treatment and care for all, particularly poor, vulnerable and hard-to-reach

populations. (HDN, 2005)

In Bangladesh, BRAC Health Program conducted conducting advocacy,

communication and social mobilization (ACSM) activities to reach target of case

detection and treatment outcome since 2004. Following these activities case

detection increased from 68 % in 2005 to 80% in 2006 maintaining a cure rate of

about 93% in 2005. It was concluded that ACMS activities empowered people

affected with TB to change attitude and behavior for increasing early access to

services. (Akramul Islam, et.al., 2007)

However, the greatest challenge in health promotion cost control

measures is demonstrating the efficacy of interventions offered. Aside from an

educational component, perhaps the greatest accomplishment in the health

promotion arena is to effect in a positive direction, health behavior change or

progress (Galloway, 2003)

Although there are good examples of IEC (Information, Education, and

Communication) programs that have improved knowledge and attitudes, there

are few good examples of communications programs with measurable changes

in behavior. It is critical to measure actual changes in behavior, not just assume it

has occurred. (Steinhart, NYU, 2009)

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Communication for Behavioral Impact (COMBI) is a dynamic approach to

behavior change that utilizes strategic social mobilization and social

communication to achieve measurable changes in behavior, not just changes in

knowledge or attitude. Based on behavior change theories, communication

theory and marketing practice, it is a methodology for planning sustained actions

mobilize various sectors of society to take action on a common issue and create

a sense of shared responsibility. In 1994, Dr. Everold Hosein offered the first

integrated marketing communication (IMC) for behavioral impact in health and

social development as course at New York University, and in 2000, WHO

promoted the COMBI methodology for planning communication and social

mobilization actions. COMBI is now used for prevention and control of leprosy,

dengue, malaria, filariasis, TB, HIV/AIDS in many countries. To achieve

behavioural results, people must hear about the new behavior, inform their

selves about it, convince their selves that it is worthwhile, then decide to do

something about it, act on this decision and reconfirm that your action has had a

positive result and maintain the behavior. IEC focuses on the first three actions,

while COMBI focuses on the last four actions. The first COMBI mantra states that

“Do nothing, produce no T-shirts, no posters, no leaflets, no videos - do nothing

until you have a specific behavioural objective!” Thus, the COMBI’s first two (2)

steps out of fifteen (15) are to assemble a multidisciplinary planning team to

review the formative research results and determine the prelimenary behavioral

objetives. (Steinhart-NYU, 2009)

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Primary Prevention for Pulmonary Tuberculosis

Primary prevention is true prevention. It generally involves the prevention

of diseases and conditions before their biological onset and it is applied to an

individual or general population who are considered physically and emotionally

healthy. Activities are directed decreasing the probability of specific illness, which

can be done in a variety of ways minimizing environmental exposure through

sanitary measures and hygiene, improving human resistance to disease by

physical and nutritional fitness activities and immunization, and diminishing risk

taking behaviors through education of the disease. (Potter, et. al. 1993)

Removing and reducing strains and building supports in the environment

are also major kinds of interventions in primary prevention. In the case of

tuberculosis, primary prevention focuses on the non-specific interventions, where

one might seek to maintain or achieve normal hormonal balance by removing

sources of emotional upsets, develop psychological and physical stamina so that

critical situations would be less critical to them; or turning to the environment, one

would try to arrange things so that people will not be subjected to mounting

strains, or where always assured of someone to talk to or to lean upon when they

were in trouble. (Sanford, 2006)

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Although TB can be treated, cured, and can be prevented if persons at

risk take certain drugs, scientists have never come close to wiping it out. A BCG

vaccination to prevent TB is given in some countries, with a high incidence of TB,

such as the Philippines. TB can be spread in many places, such as homes or

worksites. TB is most likely to be transmitted when one comes in contact with

patients who have unsuspected TB disease, who are not receiving adequate

treatment, and who have not been isolated from others. People with TB disease

are most likely to transmit TB before the disease has been diagnosed and

treatment has started. TB patients who may be infectious should cover their

mouth and nose with a tissue when coughing or sneezing. Three types of

engineering controls that can be used to prevent the transmission of TB in

facilities: ventilation, high-efficiency particulate air (HEPA) filtration, and

ultraviolet germicidal irradiation (UVGI). HEPA filters and UVGI should be used in

conjunction with other infection control measures. In places where administrative

and engineering controls may not fully protect people from infectious droplet

nuclei, thus, use personal respirators to filter out droplet nuclei is a must. With

increased attention and resources, TB rates in US have been decreasing 12

years in succession to historic lows. However, if diligence is decreased, it is

obvious that cases will rise once again.

(http://www.umdnj.edu/ntbcweb/infection.htm)

Knowledge on Pulmonary Tuberculosis

 27

In communicable disease control, health education commonly includes an

appraisal of what is known by a population about a disease, an assessment of

habits and attitudes of the people as they relate to spread and frequency of the

disease, and the presentation of specific means to remedy observed

deficiencies. The ultimate aim of health education is positive behavioral

modification. Thus, health education is a valuable tool in maintaining good health.

(Simons-Morton, et.al., 1995) Considering medication costs, and length of

treatment, prevention is the best strategy, and is achievable only by education

and awareness. (Nazareno, 2005)

Health education messages should be simple and appropriate — the story

method often carries some weight. Skills/capacity building of non-medical or non-

health professionals who volunteer and contribute effectively to TB control

programs should be supported. (HDN, 2005)

The rise in the incidence of tuberculosis has been due to the low priority

accorded to anti-tuberculosis activities by many countries. This is not the case in

China, which ranks first in Southeast Asia. According to Jiang Shiwen, director

of the National Centre for TB Control and Prevention, "TB awareness-raising

campaigns among workers should be intensified, as many simply endure the

disease without seeking timely treatment for fear of being fired and inability to

pay high medical costs". The hundreds of millions of China’s migrant workers are

more at risk because of comparatively poor medical awareness, high-density

 28

living conditions, and mobile lifestyles. This was written in an article that

appeared in the print edition of the Irish Times in 2008. (Coonan, 2008)

In United States, after a TB elimination program was formulated by the US

Advisory Council for the Elimination of Tuberculosis (ACET) in 1985, TB cases

had been dropping for many years and many experts thought that TB was no

longer going to be a serious disease. Then, in the late 1980s, the number of TB

cases began to rise, both in the United States and around the world. One of the

factors that are thought to play a role in the return of TB as a major health

problem is the efforts to educate people about the disease may have lessened as

the perceived threat of TB decreased. (http://www.faqs.org/health/Sick-

V4/Tuberculosis.html)

Knowledge on TB also facilitates early detection and compliance to

treatment. The Speak Your Mind TB primer of the Health and Development

Networks in 2005, states that the lack of health-related information, especially on

tuberculosis, leads to delay in diagnosis and initiation of treatment among chest

symptomatic patients. Poorly educated patients also tend to skip drugs or drop

out of treatment. (HDN, 2005)

Health Attitudes Regarding Prevention of PTB

 29

Prospects for good health and long life are remarkably dependent upon

mental habits learned in childhood. These attitudes cause emotional reactions

which strongly affect your immune system, circulatory system and even your risk

of accidents. The strength of this correlation between attitudes and health have

been grossly underestimated by the medical profession. Though the idea of

improving health prospects by changing attitudes may seem unrealistic,

experiments by Dr. Grossarth-Maticek in 1973 have shown that a small amount

of training spread over a year can be remarkably effective. He randomly divided

1200 people who had scored poorly on his tests into two equal-sized groups.

One group of 600 was given a self-help brochure and six, one-hour training

sessions spread over a one year period. The other 600 were given no training or

placebo training. When the health status of the two groups was checked 13 years

later, 409 of the people given the training were still alive versus only 97 of the

equal-sized control group. The author of “The Attitude Factor”, a book published

in London by Thorsons/Harper-Collins is currently trying to replicate Dr

Grossarth-Maticek's experiments to be able to provide a significant contribution

to preventative health care. (Blakeslee, 1997)

Health is as much an individual effort as a group effort, a medical effort as

a social effort, and an outcome of research and communication on so many

levels. Through collaboration and communication health professionals of the TB

control program must continue to work with partners and affected communities to

ensure objectives are met. Most importantly, conscious effort to pay attention to
 30

achievements as well as mistakes, to hold one self accountable and to

communicate better with concerned parties. (Fenton, 2009)

Stigma and discrimination associated with PTB combine to create an

environment where people are less likely to confront TB. Social isolation and

rejection, as well as misconceptions about TB transmission, contribute to the

idea that TB is a disease to be feared. Thus, a communication strategy that helps

overcome social and gender disparities, as well as myths and mystique

associated with the disease is essential to achieving compliance and successful

treatment outcomes. (HDN, 2005)

Lifestyle Regarding Prevention of PTB

Tuberculosis cannot be treated with drugs alone. The issues of poverty,

lack of food and nutrition, which create the ideal conditions for infectious

diseases, also have to be addressed. (HDN, 2005)

A person must give attention to the body, mind, and spirit to be healthy. In

order to manage health and illness along this continuum, everyone requires skills

that promote health and prevent disease. Health promotion strategies target

behavior change that reduces risk for disease and promotes movement up the

health continuum. Disease prevention strategies target ways to avoid illness or

disease. Choosing effective health promotion (e.g., enhancing current activity

and/or dietary practices, incorporating meditation or relaxation techniques to

 31

enhance life balance) strategies depends on the degree of risk for an individual

or group. Health risk can be determined through focused risk appraisal and/or

disease screening, and can be estimated using evidence-based

recommendations. The leading health indicators -- lack of physical activity,

tobacco use, substance abuse, poor environmental quality, lack of adequate

immunizations, and inability to access to care. (National Association of School

Nurses, 2004)

Change is incremental. Many people have practiced a lifetime of less than

optimal health behaviors of one sort or another. It is unreasonable to expect that

significant and lasting changes will occur during a short period of time. Public

health programs need to identify and maximize the benefits of positive change,

pull participants along the continuum of change, and consider changes in

educational programs and environmental supports to help people maintain

changes over the long term. (Glanz, 2002) Nurses are in a unique position to

counsel individuals, families, and communities on the importance of regular

physical activity and to correct misconceptions that only vigorous exercise has

health benefits. (Speck, 2002) Drug users often have weakened immune

systems as well. As the number of people in these categories increases, so does

the rate of tuberculosis. (www.umdnj.edu/ntbcweb/infection.htm)

Epidemiological studies provide evidence of the role modifiable risk factors

play in many chronic diseases. Unfortunately, health trends are unfavorable.

 32

Tuberculosis, together with cancer and other chronic diseases continue to

burden our health care system and also appear to be linked to largely

preventable causes. By modifying health behaviors, many of these health

problems can be prevented. The savings in direct and indirect health care costs

is yet to be realized. (National Association of School Nurses, 2004)

In most people who breathe in TB bacteria and become infected, the body

is able to fight the bacteria to stop them from growing. The bacteria become

inactive, latent TB infection, but they remain alive in the body and can become

active later. A person can have latent TB infection for years. But if that person's

immune system gets weak, the infection can quickly turn into active TB disease.

Also, if a person who has a weak immune system spends time with someone

with active TB disease, he or she may become infected with TB bacteria and

quickly develop active TB disease. (Fenton, 2009)

Environmental Sanitation and Hand Hygiene Regarding Prevention of PTB

Two other factors identified in the increase of TB cases in the US during

the late 1980s, are the living conditions and population movement. People who

are poor, or homeless, or who live in crowded and unsanitary conditions may

also develop weakened immune systems, or increase their chances of coming in

contact with the disease. The increased movement of people across national

boundaries is another factor. When people take vacations, conduct business, or

 33

move to new countries, they may take TB with them.

(http://www.umdnj.edu/ntbcweb/infection.htm)

Low air change rate and excellent air mixing within an area are favorable

condition for TB transmission. In an in-depth ventilation assessment was made

by National Institute for Occupational Safety and Health (NIOSH) to document

conditions that likely occurred during the period that the employee with TB was

infectious. This involved a tracer gas evaluation to quantify the extent and speed

of contaminant dispersion and contaminant removal rate. The evaluation

determined that ventilation conditions were favorable for TB transmission based

on a low air change rate and excellent air mixing within the plant. Thus, TB

bacteria would have spread quickly and uniformly throughout the plant and

remain suspended for hours before being removed from the air. Other factors

that may have influenced TB transmission include prolonged infectiousness of

the individual, virulence of the organism, and TB exposure outside the workplace.

Recommendations for improving general ventilation were made in the report.

(CDC-NIOSH, 2001)

Related Studies – Foreign

In the study cross-sectional conducted on the knowledge, attitudes and

perceptions of the Latin-American immigrant population of tuberculosis in the

Community of Madrid, after being discharged from hospital study. The identified
 34

the sociodemographic indicators (sex, education level, age) and clinical variables

(case definition, location of the disease) and relate it to having the correct

knowledge of the disease and its treatments. Using the odds ratio (OR) and 95%

confidence intervals (95% CI), the results showed that a high percentage had

correct knowledge of the disease (77.3%), its transmission (94.7%) and

treatment (77.3%). An extra-pulmonary location was associated with a lower

level of knowledge of the general characteristics of tuberculosis [OR (95% CI),

0.21 (0.05-0.85)] and its transmission [OR (95% CI) 0.05 (0-0.66)]. A high

percentage of the population identified erroneous transmission routes, such as

blood (42.3%); sexual fluids (50%), or utensils used for eating (81.3%). (Sanz,

2009)

In India, where tuberculosis like leprosy is still not considered a disease

caused by bacteria. It is a social stigma. A cross sectional study was done to

reveal the etiology of the disease as perceived by the 110 patients diagnosed to

have tuberculosis either by sputum test or radiological findings or both in a

tertiary care centre, between December 24, 2006 and January 6, 2007. The

result showed that only 11.2% of all the patients realize the true nature of the

disease and the correct etiology. 30.3 % of the males still believe their lifestyle

characteristics like smoking and drinking alcohol is the reason they developed

tuberculosis. Among the females, 19.1% of them think that they developed the

disease due to their occupation and another 19.1% attribute the cause as

psychological stress. It was concluded that ignorance and lack of awareness

about this disease are well portrayed through this study. Irrespective of the
 35

various national programs, people still don’t know that tuberculosis spreads by

droplet nuclei. Only when people are informed and know the mode of spread of

disease will they be able to take proper precautions to avoid the disease. So,

there should be widespread awareness of Tuberculosis to prevent the spread of

the disease. (Dinesh Kumar Kanagasabapathy Kannabhiran, et. al., 2007)

A cross-sectional study to assess the knowledge attitude and practice of

pulmonary tuberculosis patients as well as health care workers (HCWs) in Iraq

toward tuberculosis (TB) was conducted on 500health care workers and 500

Tuberculosis patients selected from 259 Primary Health Care Centers. The

results showed that acceptable optimum (64.4%) knowledge of TB among

patients was found. It is significantly was higher (OR=1.19) in males than

females. On the other hand, considering TB as a stigma was still high

(54.86).Optimum knowledge of HCWs toward TB was excellent (95.5%).

Education training and supervision of NTP shows good impact on the knowledge.

It conclusion the kind of practicing and attitude toward TB patients play a major

role in seeking advice and not only knowledge alone. (Zaidoon Ali Musa, et. al.,

2007)

The development of DOTS and overwhelming amount of money and

efforts of wide-ranging partnership against TB, TB cases are steadily decreasing.

However, the government, health care workers and organizations can only do so

much. An individual must be responsible for his or her own health. TB is an

 36

avoidable disease. Much of the researches done to assess the knowledge,

attitudes and practices of the general public or subgroups are related to early

detection and compliance to treatment, which are considered secondary and

tertiary care. Other researches concluded that only when people are informed

and know the mode of spread of disease will they be able to take proper

precautions to avoid the disease, and that misconceptions lead to fear and

vulnerability. Thus, the researchers saw the need to study on the primary

prevention of the said disease. Primary prevention, which is the true prevention,

will have positive health, economic and social benefits for the general public but

for the country as well.

CHAPTER III

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter shows the results drawn from the collected data. The data

presented in this chapter were gathered through the questionnaires distributed to

the respondents. The results were interpreted and analyzed using the statistical

treatment in the previous chapter. The discussion is arranged systematically

according to the presentation to the research problem.

Table 1
 37

The distribution of the MSLC supermarket meat stall-owners as to their

knowledge on PTB is presented in Table 1. Particular 1, which pertains to the

respondents’ perceived contagiousness of PTB, has a weighted mean of 4.71

which corresponds to “Strongly Agree”. Particular 2 pertains to the perceived

severity of PTB; this particular has a weighted mean of 4.39 which corresponds

to “Strongly Agree”. Particular 3 pertains to the awareness of the mode of

transmission of PTB; this particular has a weighted mean of 4.42 which

corresponds to “Strongly Agree”. Particular 4 pertains to the respondents’

knowledge of the signs and symptoms of PTB; this particular has a weighted

mean of 4.31 which corresponds to “Strongly Agree”. Particular 5 pertains to the

respondents’ knowledge of the use of personal protective measures to prevent

transmission of TB and has a weighted mean of 4.53 which corresponds to

“Strongly Agree”. Particular 6 pertains to the respondents’ knowledge of the

purpose of BCG vaccine and has a weighted mean of 3.72 which corresponds to

“Agree”. Particular 7 pertains to the respondents’ avoidance of exposure to

anyone who has active and untreated TB and has a weighted mean of 4.65

which corresponds to “Strongly Agree”.

Table 1.

The Distribution of Respondents as to the as to Knowledge on PTB

Weighted Verbal
Knowledge on PTB 5 4 3 2 1
Mean Description
1. TB is easily transmitted and Strongly
93 4 1 0 6 4.71
anyone can acquire it. agree
2. TB is a very serious disease. 81 5 2 10 6 4.39 Strongly
 38

agree
3. A person can be infected
with TB bacteria when he or
Strongly
she inhales when someone 78 7 10 3 6 4.42
agree
with TB coughs, sneezes,
shouts, or spits near him or her.
4. I can distinguish a person Strongly
58 28 11 6 1 4.31
who is showing signs of PTB. agree
5. The use of protective
measures, such as face masks,
Strongly
can prevent the transmission of 76 17 3 6 2 4.53
agree
TB if I am near someone who
has untreated TB.
6. BCG vaccine prevents me
50 16 12 11 15 3.72 Agree
from PTB infection
7. If I know someone who has
active PTB, I avoid staying in a
stuffy, enclosed room with Strongly
84 9 8 1 2 4.65
them, until that person has agree
been treated for at least 2
weeks.
Strongly
TOTAL 4.39
agree
Analysis

The results show that the respondents have adequate knowledge on PTB,

which can be gleaned from their responses and as reflected in the over-all

weighted mean that is 4.38 which corresponds to “Strongly Agree.” Awareness

on how the infection occurs can help prevent or control its spread by avoiding

high risk situations.

Table 2
 39

The distribution of the MSLC supermarket meat stall-owners as to the

health attitudes and lifestyle regarding PTB is presented in Table 2. Table 2 is

composed of 7 particulars which have weighted means ranging from 3.57-4.55.

Particular 1 pertains to the respondents’ intake that provides adequate nutrition;

this particular has a weighted mean of 4.48 which corresponds to “Strongly

Agree”. Particular 2 pertains to the respondents’ avoidance of tobacco smoking;

this particular has a weighted mean of 3.83 which corresponds to “Agree”.

Particular 3, which refers to the respondents’ avoidance of alcohol drinking, has a

weighted mean of 3.83 which corresponds to “Agree”. Particular 4 pertains to the

respondents’ rest and sleep pattern; this particular has a weighted mean of 3.57

which corresponds to “Agree”. Particular 5 pertains to the respondents’ physical

activity; this particular has a weighted mean of 3.93 which corresponds to

“Agree”. Particular 6 pertains to the respondents’ personal self-efficacy in

maintaining a healthy lifestyle; this particular has a weighted mean of 3.73 which

corresponds to “Agree”. Particular 7 pertains to the respondents’ social

acceptance with regards to PTB; this particular has a weighted mean of 4.55

which corresponds to “Strongly Agree”.

Table 2

The Distribution of Respondents as to the

Health Attitudes and Lifestyle Regarding PTB

Health Attitudes Weighted Verbal

5 4 3 2 1
and Lifestyle Mean Description
 40

1. I eat a well balanced diet

especially with rice, vegetables
Strongly
and fruits to boost my 83 7 3 3 8 4.48
Agree
resistance against diseases
such as PTB.
2. I avoid smoking. 60 10 6 12 16 3.83 Agree
3. I avoid drinking alcoholic
59 1 20 15 9 3.83 Agree
beverages.
4. I sleep at least 6-8 hours a
36 23 16 22 7 3.57 Agree
day.
5. I exercise to increase my
52 22 9 13 8 3.93 Agree
resistance against PTB
6. It is easy for me to maintain
a healthy lifestyle, which
includes proper nutrition and
48 14 19 12 11 3.73 Agree
moderate physical activity, and
avoiding use of harmful
substances.
7. I feel that TB is a disease
Strongly
that I should not be ashamed 86 6 2 3 7 4.55
Agree
of.
TOTAL 3.99 Agree

Analysis

As shown in this table, the respondents agreed that health attitudes and

lifestyle affects the effectiveness of the preventing PTB among the meat stall-

owners of MSLC supermarket, as reflected in the over-all weighted mean of 3.96,

which corresponds to “Agree.” Many believe that maintaining a healthy lifestyle

helps boost resistance against diseases such as PTB. Moreover, they know that

avoidance of using harmful substance, such as tobacco and alcoholic beverages,

prevents depletion of body’s natural defenses and dietary problems. Most of

them agree that people with TB should not be feared or rejected.

 41

Table 3

The distribution of the MSLC supermarket meat stall-owners as to the

environmental sanitation and hand hygiene is presented in Table 3. Table 3 is

composed of 6 particulars which have weighted means ranging from 3.87-4.93.

Particular 1 pertains to the respondents’ ventilation in their workplace; this

particular has a weighted mean of 3.87 which corresponds to “Agree”. Particular

2 pertains to the respondents’ regularity of garbage collection; this particular has

a weighted mean of 4.93 which corresponds to “Strongly Agree”. Particular 3

pertains to the respondents’ avoidance of spitting anywhere; this particular has a

weighted mean of 4.15 which corresponds to “Agree”. Particular 4 pertains to the

respondents’ practice of covering mouth when coughing and sneezing; this

particular has a weighted mean of 3.98 which corresponds to “Agree”. Particular

5 pertains to the respondents’ use of soap and disinfectants when cleaning

surroundings; this particular has a weighted mean of 4.38 which corresponds to

“Strongly Agree”. Particular 6 pertains to the respondents’ frequent practice of

proper hand washing; this particular has a weighted mean of 4.83 which

corresponds to “Strongly Agree”.

Table 3

The Distribution of Respondents as to the

Environmental Sanitation and Hand Hygiene

 42

Environmental Sanitation Weighted Verbal

5 4 3 2 1
and Hand Hygiene Mean Description

1. I have well ventilated

55 15 12 9 13 3.87 Agree
workplace.
2. Our garbage collection Strongly
97 7 0 0 0 4.93
is regular. Agree
3. I avoid spitting
68 4 18 8 6 4.15 Agree
anywhere.
4. I cover my mouth when I
52 23 11 11 7 3.98 Agree
cough and sneeze.
5. I use disinfectants or
Strongly
soap when cleaning my 70 16 11 2 5 4.38
Agree
surroundings.
6. I frequently wash my
hands with the use of soap Strongly
92 7 4 1 0 4.83
and running water to wash Agree
away dirt and bacteria.
Strongly
TOTAL 4.36
Agree

Analysis

As shown in this table, the respondents agreed that environmental

sanitation and hand hygiene greatly affects the effectiveness of the preventing

PTB among the meat stall-owners of MSLC supermarket, as reflected in the

over-all weighted mean of 4.35 which corresponds to “Strongly Agree.” They

believe that environmental sanitation and hand hygiene minimizes their exposure

to pathogens, which can be gleaned from their responses. Many of them handle

discharges as though they contain pathogens. They know that a cough or sneeze

may force large amount of organisms from the mouth, nose and throat into the air

where they may be inhaled by others. They also know that poor sanitation is
 43

conducive for microorganisms to thrive and accumulation of trapped organisms

on the work surfaces and body provides the opportunity for their growth and

multiplication. They use soap and disinfectants to reduce the amount of

pathogens because breaks up dirt into tiny particle that can be rinsed off easily

with running water.

Table 4

Incidence Rate of PTB Among the Respondents for the Year 2007-2008

Year Total No. New Percentage

Population PTB cases
140 1 0.71 %
2007
140 0 0%
2008

Table 4

Table 4 shows that in 2007, there was one (1) new PTB case among the

meat stall-owners, which is 0.71% of the total population, while in 2008, there

was no new PTB case. Raw data is presented in Appendix 5

Analysis

The decrease in incidence of TB in the area is an important indicator that

defines effectiveness in preventing TB transmission. This demonstrates the

 44

efficacy of interventions offered. There is a positive effect in the direction of the

health behavior change or progress.

Table 5

Table no. 5 shows the chi square correlation between the independent

variables and the dependent variables. The computed X2 value is 30.50 which is

greater than the tabled X2 value of 9.488 at 0.05 level of significance with 4 as the

degree of freedom (df); hence, the researchers made a decision to reject the null

hypothesis. Therefore, there is a significant relationship between the individual

characteristics of the MSLC supermarket meat stall-owners to the effectiveness

of preventing PTB among them for the years 2007-2008.

Table 5

Chi – Square Correlation between the Identified Independent Variables

and its Relationship to the Preventive Health Behaviors for PTB

Among Meat Stall-owners of MSLC Supermarket

Df Computed X2 Tabled X2 Value Decision

Value

4 30.5 9.488 Rejected

Analysis
 45

This table shows that there is a definite relationship between the

independent variables and the dependent variable. The theories presented are a

focus of importance and centrally of illness prevention. It is imperative that due

emphasis should be given in identifying individual characteristics and behavior

first in providing health education and maintaining healthy lifestyles, positive

affect and proper sanitation and hygiene

Chapter I V

SUMMARY, FINDINGS, CONCLUSIONS, RECOMMENDATIONS

This chapter presents the summary, significant findings, conclusions and

recommendations of this study.

Summary

The descriptive study was conducted by the researchers to broaden their

outlook of the nursing profession by becoming more aware of giving service to

 46

people, especially to the community. The research involved one hundred four

(104) non-randomly selected respondents of the one hundred forty (140) stall

owners in the meat section of the Mayor Salvador L. Calo Supermarket,

Langihan, Butuan City. The needed data were gathered from the respondents

through a structured interview during the school year 2008-2009.

Findings

The significant findings on the individual characteristics of the meat

vendors of Mayor Salvador L. Calo Supermarket in the prevention of pulmonary

tuberculosis are as follows:

1. Knowledge of Primary Prevention of PTB

Most meat stall owners are aware that PTB is very contagious and a

serious disease. They know that PTB is airborne- transmitted (droplet spread).

They can distinguish someone who is showing signs of PTB. The respondents

also know that if they could not avoid staying in an enclosed room with someone

who has active PTB they should wear protective measures, such as face masks.

Not everyone knows the purpose of BCG vaccine.

 47

Although most of the respondents have correct knowledge about the

disease, there is still a prevalence of erroneous beliefs and practices.

2. Health Attitudes and Lifestyle

Most of the respondents think that PTB is a disease that one should not

be ashamed of. Most of them eat a well balanced diet. Many of the respondents

are able to have adequate sleep daily, can exercise a few times a week and

avoid tobacco smoking and alcohol drinking. Although, not all of them can avoid

smoking and alcohol drinking, but most of them do so in moderation. Many of

them believe that they are able to maintain a healthy lifestyle.

3. Environmental Sanitation and Hand Hygiene

The Mayor Salvador L. Calo Supermarket has a regular garbage

collection. Most of the respondents clean their respondents with soap or

disinfectants and practice frequent hand washing with soap and running water.

Many of them consider that they have a well ventilated workplace. They avoid

spitting anywhere and cover their mouth when they cough or sneeze.
 48

The significant findings on the incidence rate of tuberculosis among the

meat vendors of Mayor Salvador L. Calo show that there is a decline in the

number of new positive sputum smear cases in the area for the past 2 years.

Conclusions

The meat stall-owners of the Mayor Salvador L. Calo Supermarket has a

high level of knowledge, not only on PTB disease itself, but also on how to take

care of themselves and their environment, and the benefits these actions,

improves their skills and ensures sustained practice of the necessary behaviors;

thus, helping them overcome barriers in preventing PTB. Despite the unfavorable

conditions, such as insufficient ventilation and crowding in the area that puts

them in an increased risk of acquiring PTB, they are able to cope. This implies

that education and the right attitude empowers people. If they are empowered,

they become more self-reliant, proactive and avoid health risks in the future. This

is evident in the incidence rate each year. Thus, knowledge, health attitudes,

lifestyle, hygiene and environmental sanitation are important factors in order to

bring about behavioral change for the primary prevention of PTB among them.

Recommendations
 49

Considering the importance of the individual characteristics, specifically

the knowledge on PTB, health attitudes and lifestyle, and environmental

sanitation and hand hygiene of the meat stall owners to the primary prevention of

PTB, the main goal of these recommendations is to reinforce positive behaviors

and provide further teachings to sustain the low incidence rate among them and

prevent resurgence. Also, recommendations for different groups that may have

direct or indirect influence on the meat stall-owners were given to enhance the

knowledge and skills and attitude and improve the working conditions of the

respondents with regards to PTB. The findings of the study will be used as a

base line data for evaluation.

The following specific recommendations are given to these groups of

individuals:

1. For Market Administrators. The administrators’ play a key role in the

prevention by assessing their area’s level of TB risk, putting in place measures to

reduce those risks, and helping link clients with possible active TB to a health

care provider.

1.1 Institute a Tuberculosis (TB) Prevention and Control Guidelines specific

for Mayor Salvador L. Calo Supermarket.

1.1.1 Require TB awareness for all staff and orientation for vendors so

that employees and clients understand the nature of TB and about

conditions that put people at higher risk of developing TB disease.

 50

Coordinate with the Health Center for the training. New employees and

clients should be given training or orientation at hire or before doing

business in the market. Annual refreshers may be given to old staff

and clients.

1.1.2. Require that all staff, vendors and helpers of the vendors be tested

for TB through chest X-ray at hire & every six to twelve (6-12) months.

1.1.3. Prohibit everyone -stall-owners, helpers, suppliers, consumers and

staff, from spitting anywhere.

1.1.4. Institute a “Cough Alert” policy. Listen for chronic coughers & take

action by referring clients to the Barangay Holy Redeemer Health

Center.

1.2 Use research findings to learn about what can put your area at higher or

lower risk for TB transmission. These guidelines should be updated in

future years as conditions change.

1.3 Strict Implementation of the “No Smoking in Public Areas” Law

1.4 Provide a bulletin board for health information for the vendors and

consumers to read. Coordinate with the health center for TB and healthy

lifestyle topics to be posted. This should be updated every two (2) months.

2. For the Holy Redeemer Barangay Health Center.

2.1 Give oral feedback from the research results to members of the

population interviewed in one of their meetings in the third (3rd) quarter

 51

of the year or after the researchers’ disseminated with them the

research results and identified communication strategies.

2.1.1 Identify and prioritize behaviors that need to be enhanced and

conditions that increase the risk of acquiring TB. Prevalence of

erroneous beliefs and practices, such misconceptions on mode of

transmission and ideas on exercise, must be corrected, since it could

increase the stigmatization and vulnerability of the patient.

2.1.2 Provide further teachings to enhance health behaviors, such as

instructing them to spit inside a covered reusable container with water

or a plastic bag and properly dispose of after. Instruct vendors and

staff to cover their mouth when coughing. If tissues are unavailable,

personal handkerchief or hand towel may be used. Wash hand after

coughing or sneezing.

2.1.3 Use findings as a tool to engage them in planning more community-

oriented services, such as awareness campaigns or expanding the TB

network by simply referring someone who is showing signs of TB.

2.2. After exchange of information about the likelihood and consequences of

adverse events, develop communication plans to correct misinformation

and reduce the likelihood of rumors. Deliver public health messages by

working with the media and the market administrators.

3.3 Remain vigilant in case finding and identifying high risks situations at all

times.
 52

3.4 Ensure that active TB patients wear protective measures to prevent

spread of TB.

4. For City Engineering Office

4.1 Conduct an in-depth ventilation assessment which involves a tracer gas

evaluation to quantify the extent and speed of contaminant dispersion and

contaminant removal rate. The evaluation will determine if that ventilation

conditions are favorable for TB transmission based on a low air change

rate and excellent air mixing within the market.

4.2. Improve general ventilation by installing exhaust system.

4.3 Provision of exhaust or ventilation system, especially in an enclosed

public area should be required for building permits.

5. For the Government of Butuan City.

5.1 Coordinate with the City Engineering Office and allot budget to make

necessary changes to improve ventilation in meat section of the Mayor

Salvador L. Calo Supermarket.

5.2 Educate political leaders and encourage them to draw attention to

awareness of the disease and the free services for TB diagnosis and

treatment, to fight against stigma in their public addresses. This will help in

facilitate campaign in other areas of the city, and in due time will reduce

the incidence rate of tuberculosis in Butuan City. TB control programs

 53

should not be focused on the market alone because other areas still serve

as reservoir for the bacteria.

6. For NTP, NGOs, and other organizations and institutions in Butuan City

6.1 NTP program managers should present research results to journalists,

public officials and politicians as evidence for TB advocacy and

communication. This builds credibility of the program and provides a

strong evidence of the need for action.

6.2 Coordinate data to help broaden understanding of health behaviors

specific to their local area to formulate relevant media tools and

community-based activities. The data will allow designing messages that

are tailored to address the needs or barriers to behavioral change

identified in the survey. Integrate statistics into TB information materials

and media packages distributed to mass media and journalists.

7. For the nursing students.

7.1 Ensure that they possess the correct knowledge, attitudes, and practices

regarding TB. As students, they are already interacting with people during

clinical experiences. When the need arises, they must be able to provide

correct health education to the patient and their family, and treat them

without discrimination. They must also take care and protect themselves

as well.
 54

7.2 Similar study should be conducted to enrich the knowledge on general

public’s health behavior with regards to TB.

8. For future researchers.

8.1 Conduct follow up study on measurable health behavior change based on

the health promotion provided after the research.

8.2 Conduct a more in-depth research to explore factors affecting health

behaviors, the possible individual determinants influencing his or her

decision. Determine whether these factors are due to deficiencies in

knowledge, attitudes or practices and if they are personal, social or

system-related.

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Nettina, Sandra M. Lippincott Manual Of Nursing Practice. Lippincott Williams &
Wilkins, 7th ed., 2006.
 55

Potter, P. A. and Perry, A. G. Fundamentals of Nursing: Concepts, Practice &

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Sanford, Nevitt. Self & Society: Social Change and Individual Development.
Aldine Transaction, 2006.
Simons-Morton, B. G., Greene, W. H. & Gottlieb, N. H. Introduction to Health
Education and Health Promotion. Waveland Press, 2nd edition. 1995.
Sitzman, Kathleen and Eichelberger, Lisa Wright. Understanding the Work of
Nurse Theorists: A Creative Beginning. Jones & Bartlett Publishers, 2004.
p123-128.
Smeltzer, S. C., & Bare, B.G.. Brunner and Suddarth’s Textbook of Medical-
Surgical Nursing (10th ed.). Lippincott William & Wilkins, 2004.
Stanhope, Marcia & Lancaster, Jeanette. Community & Public Health Nursing.
Elsevier Health Sciences, 6th ed., 2004.

WEBLIOGRAPHY

1. Researches

Akramul Islam, “Action for Mobilization in TB Control in Bangladesh”. Free Oral

Paper: International Union Against Tuberculosis & Lung Diseases – Asia
Pacific Region, 2007.
Dinesh Kumar Kanagasabapathy Kannabhiran, et. al. “The Cause of
Tuberculosis as Perceived by the Patients Affected by the Disease”. Free
Oral Paper: International Union Against Tuberculosis & Lung Diseases –
Asia Pacific Region, 2007.
http://www.maptb.org.my/events/iuatldapr2007/free%20paper%20oral%203.pdf)
Galloway, Robert D. “Health Promotion: Causes, Beliefs and Measurements”
Department of Health Administration, San Marcos, TX, 2003
Nazareno, et. al.. “Effect on Tuberculosis Awareness among High School
Students in Selected Schools in Metro Manila after Using Educational
Intervention”. Chest, 2005
(http://meeting.chestjournal.org/cgi/content/abstract/128/4/216S-b)
Puvaneswari Subramaniam, “A Study On Patients Knowledge Of Tuberculosis
And Timeline To Treatment”. Free Oral Paper: International Union Against
Tuberculosis & Lung Diseases – Asia Pacific Region, 2007.
Sanz, Barbero B. and Blasco, Hernández T. “Knowledge, attitudes and
perceptions of the Latin-American immigrant population of tuberculosis in
the Community of Madrid" Aten Primaria. Spain, 24 March 2009
(http://www.ncbi.nlm.nih.gov/pubmed/19324469?
ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPa
nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)
Zaidoon Ali Musa, “Knowledge Attitude and Practice of the Health Care Workers
And Tuberculoses Patients in Iraq Toward Tuberculosis”. Free Oral Paper:
 56

International Union Against Tuberculosis & Lung Diseases – Asia Pacific

Region, 2007.
(http://www.maptb.org.my/events/iuatldapr2007/free%20paper%20oral%203.pdf)

2. Articles

Coonan, Clifford. “China marches on TB”. Irish Times (Culture). 15 July 2008
(http://www.irishtimes.com/newspaper/health/2008/0715/1215940925092.
html)
Center for Disease Control. “CDC's Response to Ending Neglect” 18 May 2008
(http://www.cdc.gov/tb/pubs/iom/iomresponse/lead.htm)
Fenton, Kevin. “Moving Forward with Prevention”. National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention Health Protection Perspectives.
CDC, 2009.
Fenton, Kevin. “Reflecting on the Social Determinants of Health” National Center
for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Health Protection
Perspectives. CDC, 2009.
Health and Development Networks (HDN). “Fighting TB On The Front Lines, Key
Findings and Recommendations on the crucial Role Played By Front-Line
Health Workers In TB Control” Speak Your Mind TB Primer, 2005.
“Health Hazard Evaluations:Tuberculosis 1990-1999” NIOSH Publication No.
2001-116. CDC, 2001 (http://www.cdc.gov/niosh/docs/2001-116/)
Institute of Medicine. “Ending Neglect: The Elimination of Tuberculosis in the
United States”. National Academy Press, 2000.
(http://www.iom.edu/Object.File/Master/4/119/TB8pagerfinal.PDF)
Serrano, Ben. “Workers at two other mining firms in Surigao found to have
Tuberculosis”. Mindanao Magazine (Feature), 11 February 2008.
(http://mindanao.com/blog/2008/02/workers-at-two-other-mining-firms-in-surigao-
found-to-have-tuberculosis/)

3. Other World Wide Web Sources

Blakeslee, Thomas R. “Attitudes: key to Health, Happiness & Longevity”, 1997

(http://www.attitudefactor.com/)
DOH National TB Control Program (2006) http://www.doh.gov.ph/programs/tb
Free Health Encyclopedia: http://www.faqs.org/health/Sick-V4/Tuberculosis.html
Global Tuberculosis Institute New Jersey Medical School
http://www.umdnj.edu/ntbcweb/infection.htm
Glanz, K. & Maddock J. “Behavior, Health-Related” Gale Encyclopedia of Public
Health. Michigan: The Gale Group, Inc., 2002.
(http://www.answers.com/topic/health-related-behavior)
Health Promotion Model (http://www.nursing.umich.edu/faculty/pender/HPM.pdf)
IMC/COMBI: (http://steinhardt.nyu.edu/scmsAdmin/uploads/002/841/IMC
%20Application%202009-FINAL.pdf)
 57

National Association of School Nurses. “Health Promotion and Disease

Prevention: School Health Nursing Services Role in Health Care”, 2004
(http://www.nasn.org/Default.aspx?tabid=271)
Seattle-King County. “TB Control Guidelines for Homeless Service Agencies”
May 2008) (http://www.metrokc.gov/health/tb/tbguidelines.pdf)
Speck, Barbara J., “From Exercise to Physical Activity” Holistic Nursing Practice:
Volume 17, October 2002. p 24-31.
http://journals.lww.com/hnpjournal/pages/articleviewer.aspx?
year=2002&issue=10000&article=00007&type=abstract
Wallace, Robert B., “Primary Prevention” Gale Encyclopedia of Public Health.
The Gale Group Inc: New York, 2002.
(http://www.healthline.com/galecontent/primary-prevention?
utm_medium=ask&utm_source=smart&utm_campaign=article&utm_term=
Primary+Prevention&ask_return=Primary+Prevention)
WHO Advocacy, Communication and Social mobilization
(http://www.who.int/tb/people_and_communities/advocacy_communication/en/i
ndex.html)

APPENDIX A
Letter of Request to Conduct an Interview (Pilot Study)
 58

Letter of Request to Conduct an Interview (Actual Study)

 59

APPENDIX B
Different Sections of Mayor Salvador L. Calo Supermarket
60
 61
APPENDIX C
 62

APPENDIX D

QUESTIONNAIRE
Date: ___ / ___ / ___ No:_____

Age:_____ Sex: [ ] Male [ ] Female

Educational Attainment: [ ] Elementary [ ] Elementary Graduate
[ ] High school [ ] High school Graduate
[ ] College [ ] College Graduate

Below are sentences that relate to ideas about tuberculosis, your health habits and sanitation.
Please place a check (√) in the box to show how true each sentence is about you.

Legend:
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
5- 4 3 2 1
Strongly Agree Neither agree Disagree Strongly
Agree nor disagree disagree

I. Knowledge on Pulmonary Tuberculosis 5 4 3 2 1

1. TB is easily transmitted and anyone can acquire it.

Ang sakit nga TB dali mokanat ug maskin kinsa possible

matakdan.
2. TB is a very serious disease.

Ang sakit nga TB usa ka seryosong sakit ug dili kini pwede nga
i-balewala.
3. A person can be infected with TB bacteria when he or she
inhales when someone with TB coughs, sneezes, shouts, or
spits near him or her.

Ang usa ka tao posibling matakdan sa sakit nga TB kung siya

makasinghot/hanggab, hatsing o pagpangluwa sa usa ka tao
nga adunay sakit nga TB.
4. I can distinguish when a person is showing signs of PTB.

Akung mailhan ang usa ka tao nga adunay mga simtomas sa

sakit nga TB.
5. The use of protective measures, such as face masks, can
prevent the transmission of TB if I am near someone who has
untreated TB.

Ang paglikay o paggamit sa mask magapugong kanako sa

 63

pagtakod sa TB kung ako duol sa tao nga adunay TB.

6. BCG vaccine prevents me from PTB infection

Ang bakuna BCG magapugong kanako nga matakdan sa sakit

nga TB.
7. If I know someone who has active PTB, I avoid staying in a
stuffy, enclosed room with them, until that person has been
treated for at least 2 weeks.

Kung ako nakabalo nga adunay tao nga dunay sakit nga TB,
magalikay ako sa pagpuyo sa usa ka sirado nga lugar mintras
wala pa siya napatambalan sulod sa duha ka semana.

II. Health Attitudes and Lifestyle 5 4 3 2 1

1. I eat a well balanced diet especially with rice, vegetables and
fruits to boost my resistance against diseases such as PTB.

Mo kaon ko og balanse nga pagkaon labi na naay luto, gulay

og prutas para pag depensa sa sakit sama sa PTB.
2. I avoid smoking.

Ginalikayan nako ang pagpanigarilyo.

3. I avoid drinking alcoholic beverages.

Ginalikayan nako ang mga ilimnong makahubog.

4. I sleep at least 6-8 hours a day.

Ako nagatulog dili mo ubos sa unom ngadto sa walo ka oras

matag adlaw.
5. I exercise to increase my resistance against PTB

Mas madali kanako ang pagmentina sa usa ka himsog nga

panginabuhian, nga nagalangkob sa pagkaon sa husto nga
nutrisyon, sakto nga ehersisyo ug paglikay sa mga bisyo.
6. It is easy for me to maintain a healthy lifestyle, which
includes proper nutrition and moderate physical activity, and
avoiding use of harmful vices.

Dali kanako ang pagmentina sa usa ka himsog nga

panginabuhian, nga nagalangkob sa pagkaon sa husto nga
nutrisyon, sakto nga ehersisyo ug paglikay sa mga bisyo
7. I feel that TB is a disease that should not be ashamed of.

Ako nagatoo nga ang sakit nga TB usa ka sakit nga dili angay
ikaulaw.
 64

III. Environmental Sanitation

5 4 3 2 1
1. I have well ventilated workplace.

Mahayahay nga balay trabaho-an.

2. Our garbage collection is regular.

Regular ang pag kolekta sa among basura.

3. I avoid spitting anywhere.

Ginalikayan nako ang pag-pangluwa sa bisan asa.

4. I cover my mouth when I cough and sneeze.

Ginatabunan ko ang akung baba kung ako moubo o

manghatsing.

5. I use disinfectants or soap when cleaning my surroundings.

Maggamit ako ug sabon sa pagpanglimpyo sa among palibot.

6. I frequently wash my hands with the use of soap and running

water.

Ako kanunay nga nagahugas sa akung mga kamot gamit ang

sabon ug tubig.

Thank you for your assistance!

Daghang salamat!
 65

APPENDIX E

TB Symptomatic Cases of Brgy. Holy Redeemer, 2007-2008

66
 67

APPENDIX F
Requirements for a Business Permit
 68

APPENDIX G
Application for Lease Form
 69

Appendix H

Statistical Computations

Computations for Weighted Mean

Total Number of Respondents = 104

I. Knowledge on PTB

1.
93 x5 + 4 x4 + 1 x3 + 0 x2 + 6 x1
104

= 4.71 Strongly Agree

2. 8 1 x
1 x5 + 5 x4 + 2 x3 + 0 x2 + 6 1
= 4.39 104
Strongly
Agree

3.
7 1 x
8 x5 + 7 x4 + 0 x3 + 3 x2 + 6 1
= 4. 42 104
Strongly Agree

4. 5 2 1 x
8 x5 + 8 X4 + 1 x3 + 6 x2 + 1 1
104
= 4.31 Strongly Agree

5. 7 1 x
6 x5 + 7 X4 + 3 x3 + 6 x2 + 2 1
104

= 4.53 Strongly Agree

6. 5 1 1 1 1 x
0 x5 + 6 x4 + 2 x3 + 1 x2 + 5 1
104
 70

= 3.72 Agree

7. 8 x
4 x5 + 9 X4 + 8 x3 + 1 x2 + 2 1
104
= 4.65 Strongly Agree

II. Health Attitudes and Lifestyle regarding PTB

1.
8 x
3 x5 + 7 X4 + 3 x3 + 3 x2 + 8 1
104

= 4.48 Strongly Agree

2.
6 1 1 1 x
0 x5 + 0 x4 + 6 x3 + 2 x2 + 6 1
104
= 3.83 Agree

3.
5 2 1 x
9 x5 + 1 x4 + 0 x3 + 5 x2 + 9 1
104

= 3.83 Agree

4.
3 2 1 2 x
6 x5 + 3 x4 + 6 X3 + 2 x2 + 7 1
104
= 3.57 Agree

5.
5 2 1 x
2 x5 + 2 X4 + 9 x3 + 3 x2 + 8 1
104
= 3.93 Agree
6.
 71

4 1 1 1 1 x
8 x5 + 4 x4 + 9 X3 + 2 x2 + 1 1
104

= 3.73 Agree

7.
8 x
6 x5 + 6 x4 + 2 x3 + 3 x2 + 7 1
104

= 4.55 Strongly Agree

III. Environmental Sanitation and Hand Hygiene regarding PTB

1.
5 1 1 1 x
5 x5 + 5 x4 + 2 x3 + 9 x2 + 3 1
104

= 3.87 Agree

9 x 2.
7 x5 + 7 X4 + 0 x3 + 0 x2 + 0 1
104
= 4.93 Strongly Agree

6 1 x 3.
8 x5 + 4 x4 + 8 x3 + 8 x2 + 6 1
104

= 4.15 Agree

4.
5 2 1 1 x
2 x5 + 3 x4 + 1 x3 + 1 x2 + 7 1
104

= 3.98 Agree

5.
7 1 1 x
0 x5 + 6 x4 + 1 x3 + 2 x2 + 5 1
104
 72

= 4.38 Strongly Agree

9 x 6.
2 x5 + 7 x4 + 4 x3 + 1 x2 + 0 1
104
= 4.83 Strongly Agree
Appendix I

Statistical Computation

CHI SQUARE OF EQUAL PROBABILITY

Strongly Agree Neither Disagree Strongly TOTAL

Agree agree/nor Disagree
disagree
(5) (4) (3) (2) (1)

fo 11 9 0 0 0 20

fe 4 4 4 4 4 20

Total fo 20
fe=
No. of Verbal Description = 5 = 4

Where:
fo = the observed cell frequency

fe = the expected cell frequency

CHI SQUARE VALUE:

∑(fo-fe)2
X2 = fe

X2 = (11-4)2 + (9-4) 2 + (0-4) 2 +(0-4) 2 +(0-4) 2

4
X2 = 7 + 5 + -4 + -4 + -4 2
2 2 2 2

4
 73

X2 = 49 + 25 + 16 + 16 + 16
4

X2 = 30.5

Computed Chi-Square Value = 30.5

Table Chi-Square Value = 9.488
APPENDIX J
 74

PERSONAL PROFILE

Name:Evangeline Diong Abansa

Nickname: Vanch

Address: # 979 2nd street Brgy. Bayanihan Pareja Subd. Butuan City

Date of Birth: March 4, 1978

Place of Birth: Basilan City

Civil Status: Married

Religion: Roman Catholic

Name of Father: Rogelio D. Diong

Name of Mother: Alberta B. Diong

Educational Attainment Year Attended

Primary: Urios College 1983- 1986

Intermediate: Urios College 1986 -1990

 75

Secondary: Urios College 1990-1994

Tertiary: Ateneo de Cagayan Xavier University 1994-1998

PERSONAL PROFILE

Name: Rufino O. Castillo Jr.

Nickname: Finn’s

Address: P-5 Pomelo Street, Bayugan City

Date of Birth: January 26, 1979

Place of Birth: Sta. Irene, Bayugan City

Civil Status: Married

Religion: Roman Catholic

Name of Father: Rufino B. Castillo Sr.

Name of Mother: Esther S. Ortiz

EDUCATIONAL ATTAINMENT YEAR ATTENDED

Primary: Bayugan Central Elementary School 1986 - 1990

Intermediate: Bayugan Central Elementary School 1990 - 1992

Secondary: Father Urios High School 1992 - 1996

 76

Tertiary: Saint Peter’s College Seminary 1996 – 1999

Father Saturnino Urios University 1999 – 2000

Butuan Doctor’s College

PERSONAL PROFILE
Name: Ida Sherri Llanto Corvera

Nickname: Ida

Address: Cubio St., District 7, Triangulo, Nasipit , Agusan del Norte

Date of Birth: July 1, 1982

Place of Birth: Bay, Laguna

Civil Status: Single

Religion: Roman Catholic

Name of Father: Enrico R. Corvera

Name of Mother: Shirley L. Corvera

EDUCATIONAL ATTAINMENT YEAR ATTENDED

Primary: Angelicum Montessori School 1989-1991
(formerly Angelicum Leaning Center)

Intermediate: Northwestern Agusan Colleges 1991-1995

Secondary: Marymount School 1995-1996

 77

Science and Technology School of Los Baños 1996-1999

Tertiary: University of the Philippines Los Banos 1999-2004

(B.S. Agribusiness Management)
Butuan Doctor’s College 2007-present
(B.S. Nursing)

PERSONAL PROFILE

Name: Dexter E. Dela Riarte Jr.

Nick Name: Jun Jun

Address: 037 7th St.Guingona Subd. Butuan City

Date of Birth: September 07, 1979

Place of Birth: Butuan City

Civil Status: Single

Religion: Roman Catholic

Name of Father: Dexter B. Dela Riarte Sr.

Name of Mother: Angelina E. Dela Riarte

EDUCATIONAL ATTAINMENT YEAR ATTENDED

Primary: Urios College Grade School 1986 - 1989

Intermediate: Urios College Grade School 1989 - 1992

Secondary: Urios College High Shool 1992 - 1996

 78

Tertiary: Xavier University (Ateneo de Cagayan) 1996 – 2002

Butuan Doctor’s College 2007- present

Determining the total population of the meat stall-owners based on records

from the MSLC Administration Office
 79

Interviewing selected participants with the use of pre-tested questionnaires

The Researchers
 80

The Researchers with the Evaluators during the Oral Defense

Making Corrections after the Oral Defense

 81

Providing the Barangay Health Center a Copy of the Research