Copar2

Mindanao State University Iligan Institute of Technology COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR)

Age: 4045

4650

5155

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Moth er Fath er Educational Attainment: Mother Father Elem. Grad. High School College Grad. Masterals PHD’s Blood Type: Mother Father A B AB O Income: Mother Father 5000 below 600010000 11000 above Civil Status: O Married O Widow O Separated Residential Status O Permanent O Temporary Type O O O

of House Unit: Single detach Apartment/Condo Multiple dwelling units

Ownership of dwelling unit: O owned

Materials Used: O concrete O wood O mixed wood/concrete Tenure of Lot: O owned O rented O occupying free with consent O occupying free without consent Family Planning: 1. Have you used any Methods of FP? O yes O no 2. If any, what are these methods? A. B. C. D. E. 3. Are you contented with the methods you are using? O yes O no 4. If not, what are the reasons? A. B. C. D. E. 5. What are the reasons why you have stopped using methods of FP? A. B. C. D. 6. What is the participation of your husband in FP? A. B. C. D. E. F. 7. Are you given knowledge

O rented O occupying free with consent O occupying free without consent

8. Where did you get that information? A. B. C. D. E. F. 9. How many children would you want to have? A. B. 10.How many years is the spacing do you want to have? A. B. Maternal and child Health Care: 1. Have you undergo prenatal before this pregnancy? O yes O no 2. How many times have you visited the health center? O once O twice O many O none 3. What are the reasons why you haven’t visited the health care center? A. B. C. D. E. 4. Have you been given tetanus toxoid injection? A. B. C. 5. Did you take Vit. A this pregnancy or the previous one? O yes O no 6. In other week, have you used iodized salt? O yes O no

about FP and responsible parenthood before marriage? O yes O no 10.Have you take Vit. A one month after giving birth? O yes O no 11.Have you been given Ferrous Sulfate after giving birth? O yes O no 12.Are you given enough knowledge about methods of Family Planning? O yes O no 13.Are you given enough information about this? O yes O no 14.What are the foods you take the previous days? 15. Go food Grow Glow food food A. A. A. B.

B.

B.

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C.

C.

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D.

D.

E.

E.

E.

F.

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F.

In the previous years, do you know anyone who died during pregnancy, upon giving birth or six weeks after giving birth? O yes O no 16.Have you experienced being sick? A. B. C. 17. Do you have a child six months and below? What is the milk used? A. B. C. 18.The previous six months, has the baby been weighed

7. This or the previous pregnancies have you gone to a dentist? O yes O no 8. Have you been examined by a doctor in this or the previous pregnancy? O yes O no 9. Have you been examined by a Health Worker (doctor, nurse, midwife) for six weeks after giving birth? O yes O no

2.

3.

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G. H. I. J. What symptoms do you know of from this sickness? A. B. C. D. E. F. G. From where do we get these kind of sickness? A. B. C. D. E. What effects do you know of that you can get from this kind of sickness? A. B. C. D. E. F. What methods do you know to avoid STD/RTI/HIV/AIDS? A. B. C. D.

Adolescent Reproductive Health 1. In the previous years, is there any family member

(5 years and below)? O yes O no 19.Has the baby been given Vit. A? O yes O no STD/RTI/HIV/AIDS 1. What kind of sickness do you know of that is from a girl or boy that is in your purok? A. B. C. D. E. F. 2. Have it been examined in the health center? O yes O no 3. What medications do he/she is taking? O Antifungal Ointment O Antibiotics O Caladryl O Harax 4. From where did he/she have the medicine? O doctor O pharmacy Cardiovascular 1. Is there any family member who has high blood pressure, heart problems, diabetes? O yes O no 2. Have it been examined in the health center? O yes O no 3. What medicines are being taken? O Insulin O ACE inhibitor O Diamicron O Aspirin O Adalat O Betaloc 4. Is there any family member who has cough for two weeks or more? O yes O no 5. What are your actions regarding this condition? A. B.

who marries at the age of 18 and below? O yes O no 2. In the previous years, is there any family member that got pregnant at the age of 18 and below? O yes O no 3. In the previous years, is there any family member that experienced miscarriage? O yes O no 4. Do you talk about sexuality? O yes O no Integumentary 1. Is there any family member who has skin problems that takes long time to heal? O yes O no Community Involvement/Participation 1. What are the organizations in your barangay? A. B. C. D. E. 2. Are you a member of this Organization? O yes O no 3. Do you contribute something to the society? O yes O no Information, Education and Communication 1. From where do you get information regarding services for good health? A. B. C. D. E. 2. What kind of information do you usually hear? A. B. C. D. E. 3. Does this give big change

C. 6. Has he/she take medicines for the lungs? O yes O no 7. If taking, what medicine? O Solmux O Robitusin 8. From where does is come from? O doctor O pharmacy 9. How many months do he/she takes the medicine? A. B. C. D. 10.Does phlegm been examined? O yes O no

4. The sanitary control encourages the owners to let their employees secure a health certificate before they let them work? O yes O no 5. If the answer is no, what are the reasons? A. B. C. D. 6. If your answer is yes in question 4, how many workers have a certificate? A. B. C. 7. How often do you get your workers to be examined by the personnel of the City Health Office? A. B. C. D. E. 8. Do you have Sanitary Permit to operate this kind of business? O yes O no 9. If your answer is no, what

regarding your insight about good health? O yes O no Environment Sanitation 1. What kind of CR are you using? A. B. C. D. E. 2. How do you dispose your garbage? A. B. C. D. E. F. G. 3. Is your place reached by NAWASA? O yes O no If no, A. B. C. D. 16.What are the problems that you see in your community that you want to be solved? O Garbage O Curfew Hours O Stagnant Water O Early Pregnancy O Noise Pollution O Air Pollution O Water Supply O Drainage O Sanitation O Malnutrition O Overpopulation O Road Construction O Traffic Signs O Water Pollution O Information Dissemination O Peace O Parking Space

are the reasons? A. B. C. D. 10.Has the personnel attended the “Food Handlers Class”? O yes O no 11.If yes, who are among them? A. B. C. 12.If no, what is the reason? A. B. C. D. 13.How do you keep the excess food that has been served to the customers? A. B. C. D. 14.Do you have pets? O yes O no 15.Does the dog been given anti-rabies? O yes O no