ST. PAUL UNIVERSITY DUMAGUETE (St. Paul University System) P.O.

Box 12 6200 Dumaguete City Philippines

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RESEARCH TOOL PERSONAL PROFILE Name:_____________________________ Address:________________________________ Age:________ Birthdate:________________ Gravida:______________ Date:___________________

Occupation:__________________ Educational Attainment:______________________ Instruction: Check the blank that correspond to your answer. Markahi ug check blanko nga matunong sa imung tubag. nurse in Barangay Candau-ay Health Center? ______ Yes ______No ang

1.) Is there an improvement in your health-seeking behaviour in the presence of the

2.) How do you perceive the effectiveness of the responsibilities being assumed by

the nurse in the delivery of prenatal care in your community? Place a check on the box. Unsa imung panglantaw sa pagkaepektibo sa mga responsibilidad nga gi-angkon sa nurse aron sa pag-implementar sa prenatal sa inyung barangay health center?

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DIN EN ISO 9001 2N: 09 100 98572

ST. PAUL UNIVERSITY DUMAGUETE (St. Paul University System) P.O. Box 12 6200 Dumaguete City Philippines

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5- Very effective 4- Mostly effective 3- Moderately effective 2- Least effective 1- Not effective
3.) When was your first visit to avail prenatal check-up in the Barangay Candau-ay

Health Center in the presence of public health nurse? ______ a. A week after the missed period ______ b. After confirmation of pregnancy ______ c. Within first trimester of pregnancy ______ d. Within second trimester of pregnancy ______ e. Within third trimester of pregnancy

4.) How often do you submit yourself to prenatal program in the presence of public

health nurse?. Unsa ka sige ang imong pag pa check-up?( Check ug usa nga labing duol sa imung tubag.

_____ a. I always submit myself to prenatal check-up Sige ko ug pa prenatal check-up

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DIN EN ISO 9001 2N: 09 100 98572

ST. PAUL UNIVERSITY DUMAGUETE (St. Paul University System) P.O. Box 12 6200 Dumaguete City Philippines

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_____ b. I used to but I stopped. Specify the reason for the discontinuation in availing the service. Tig pa-check up ko sa una pero ni undang na ko. Isulat ang rason sa pag-undang nimo sa pagpaprenatal. ______________________________________________________________

_____ c. Ive tried once before but I didnt continue. Specify the reason for the discontinuation. Nakasulay ko ug ka usa pero wala ko ni padayon. Isulat ang rason sa pag-undang. ________________________________________________________________

_____ d. I never tried. Specify the reason for not complying. Wala jud ko ka sulay. Isulat ang rason sa wala pagpacheckup.______________________________________________________________ Proceed to number 3 if your answer is a or b.

5.) Indicate the number of times that you have submitted yourself to pre-natal check-

up in the space provided for each trimester in the presence of public health nurse. Isulat og ika-pila ka nakapa-prenatal sa gihatag nga lugar sa ilalom.

PAASCU ACCREDITED

DIN EN ISO 9001 2N: 09 100 98572

ST. PAUL UNIVERSITY DUMAGUETE (St. Paul University System) P.O. Box 12 6200 Dumaguete City Philippines

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_____First Trimester (Una hantod sa ika-tulo nga bulan) _____Second Trimester (Ika-upat hantod sa ika-unom ka bulan) _____Third Trimester (Ika-pito hantod ika-siyam ka bulan Answer the question below. Check the blank that correspond to your answer. Tubaga ang pangutana sa ubos. Markahi ug check ang blanko nga mutunong sa imong tubag.

6.) What are the services have you availed during your visits to the center in the presence of public health nurse? Check all that applies. ______ a. weight taking ______ b. height taking ______ c. BP monitoring ______ d. Physical Examination ______ e. 30+ tablets of ferrous sulphate with folic Acid per visit ______ g. TT injections ______ h. Leopolds maneuver ______ i. Health Teachings

PAASCU ACCREDITED

DIN EN ISO 9001 2N: 09 100 98572

ST. PAUL UNIVERSITY DUMAGUETE (St. Paul University System) P.O. Box 12 6200 Dumaguete City Philippines

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______ j. Dental Check-up referral ______ k. Laboratory Exam referral

Scale: 7-10 times - Always 5-6 times Often 3-4 times Seldom 1-2 times Sometimes 0 times Never

7.) What are the factors affecting the degree of compliance to prenatal check-up among pregnant women ? Check all that applies. Unsa ang panan-aw nimo sanaka impluwensya sa pagimplementar sa pagpaprenatal. ______a. Presence of a Public Health Nurse (Adunay nars) ______b. Midwife/BHW

PAASCU ACCREDITED

DIN EN ISO 9001 2N: 09 100 98572

ST. PAUL UNIVERSITY DUMAGUETE (St. Paul University System) P.O. Box 12 6200 Dumaguete City Philippines

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______c. Government support (suporta sa gobyerno) ______d. social support networks () ______e. Educational attainment ______f. physical environment ______g. employment and working condition ______h. personal behaviour and coping skills ______e .Others (please specify) ________________________________

PAASCU ACCREDITED

DIN EN ISO 9001 2N: 09 100 98572