ABSTRACT

Low childhood immunization rates are a national healthcare

concern. Many children are at increased risk for preventable childhood illnesses
because of under-immunization, thus increasing the burden on healthcare
workers and families and increasing healthcare costs and decreasing quality of
life. This study aims to identify predictors that contribute to non-compliance with
vaccination schedules and thus will aid healthcare workers in identifying children
who are at-risk for under-immunization and help nurses recognize factors that
could help increase compliance rates. Through a descriptive design, researchers
will be interviewing parents of young children at local health departments such as
Barangay Health Center, in order to find common reasons for non compliance
and what factors that could potentially increase compliance in these parents.
Data will be calculated through descriptive statistics, recognizing trends in
various factors. Ethical considerations would be taken to uphold confidentiality
and decrease bias in this study.

CHAPTER I
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INTRODUCTION

A. BACKGROUND OF THE STUDY

Of all the child survival interventions, immunization has generally had the
greatest success thus far. For immunization programs to succeed, they must
instill some new attitudes and some new knowledge, but their success does not
depend on parents learning and repeating new procedures, as the other child
survival interventions generally do. This means that the behavioral issues are
less complex. Certainly this fact is related to immunization's relative success to
date.
Nevertheless, as health planners proceed to think about further extending
and also sustaining gains made thus far; it becomes increasingly important for us
to focus attention on understanding and influencing the behavior of community
members whose children have not yet been fully immunized.
In relation to the research study, families having children with partial
immunization or even no immunization at all should acquire the behavior of
compliance. Compliance is a cooperative performance and adherence to
prescribed therapy as recorded in the clinic record at a given period and that
compliance criteria included among other things frequency of keeping clinic
appointments. According to, compliance is the clients physical presence at the
health unit or hospital on the appointment day to receive the prescribed care. In
the context of this study, the term compliance is defined or conceptualized as
receiving the required number of doses of vaccines at the appropriate age.
Most common reasons for partial and non-immunization were lack of
knowledge about childhood immunization schedule and where to sources for it.
Other reasons include lack of awareness about health benefits of immunization.
This is an indication that health workers should intensify their efforts in
educating mothers on benefits of immunization. Study on compliance rates have
found that parents sited non-compliance as being due mainly to childs illness,
procrastination and lack of knowledge about immunization and where to obtain
services. Also, non-minority children with parents of higher socio-economical
background were far more likely to have complete immunization.
Failing to vaccinate is a failure to protect the interests of those who are
most vulnerable. Children, whether they are immunized or not, are particularly
vulnerable members of society, dependent on their parents to make decisions
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about their health. Hence children are most likely to be injured by an increase in
vaccination noncompliance. When parents fail to immunize their children, they
not only expose their own children to a greater risk of disease, but they also
place others in the community at heightened risk. Vaccine Preventable
diseases will contribute more to infant morbidity and mortality. Parents must play
their vital roles in complying with immunization for the protection of their children
against diseases.
B. STATEMENT OF THE PROBLEM
This study aims to identify specific behavioral factors that affect parental
non-compliance to childrens immunization. More specifically, the study aims to
answer the following questions:
1. What are the specific behavioral factors leading to parental noncompliance to immunization of children?
2. How can a home-based teaching interaction address the non-compliance
behaviors of parents towards childhood immunization?
3. What are the outcomes or benefits derived from the home-based teaching
interaction?
C. SIGNIFICANCE OF THE STUDY
The study is deemed significant for the following reasons:

This study helped identify factors which affects parental non-compliance

regarding EPI (Expanded Program on Immunization)
This study helped identify which factors are carried out most by the
residents of Barangay Sta. Catalina.
This study directly addressed the MDG ( Millennium Development Goal)
number 4 : Reduce Child Mortality
This study provided an insight to the service or application of the EPI
(Expanded Program on Immunization) in the health care system of
Barangay Sta. Catalina

D. SCOPE AND DELIMITATIONS OF THE STUDY

This study is a Descriptive Research based on a Qualitative Research
approach wherein it is particularly concerned with parental behavior and attitude
towards compliance on completion of vaccine immunization in children.
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This study aimed to identify factors that affect parental compliance among
15 randomly selected respondents who are residing at Barangay Sta. Catalina
Martha drive, Zamboanga City.
The inclusion criterion for the parent or guardians participation in this study
were as follows:

A resident of Barangay Sta. Catalina (Martha Drive)

At least 18 years old and above.
Have a child or children between 9 mos to below 4 years old with
incomplete immunization.

E. OPERATIONAL DEFINITION OF TERMS

Immunization - is the process whereby a person is made immune or

resistant to an infectious disease, typically by the administration of a
vaccine, known as Immunogen.

Expanded Program on Immunization - is a World Health Organization

Program with the goal to make vaccines available to all children
throughout the world.

MDG 4: Reduce Child Mortality - is a Millennium Development Goal that

was set by the World Health Organization that has been adopted by the
Department of Health in the Philippines that aims to reduce by two-thirds,
between the years 1990 and 2015, the under-five child mortality rate.

Compliance - a patients readiness to conform or agree to abide by a

certain recommended sequence of treatment.

Noncompliance - is the failure or refusal of a patient to comply. A refusal

or failure to conform by the contractual agreement taken upon with the
researchers.

Enabling factors - are defined as factors or conditions that make it

possible or easier for an individual and or population to change their
behavior or their environment.

Predisposing factors - are factors or conditions that make somebody

favorable to become susceptible to a certain disease or disorder.
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Purposive sampling - is a non-representative subset of some larger

population, and is constructed to serve a very specific need or purpose.

Descriptive Research - It attempts to describe and explain conditions of

the present by using many subjects and questionnaires to fully describe a
phenomenon. Survey research design /survey methodology is one of
the most popular for dissertation research. There are many
advantages.

CHAPTER II
REVIEW OF RELATED LITERATURE

Immunization
Each year, millions of children die from diseases that are preventable with readily
available vaccines. These diseases include measles, meningitis caused by
Haemophilus influenza type B (Hib), diphtheria, tetanus, pertussis, yellow fever, polio
and Hepatitis B. New vaccines against other illnesses, such as pneumonia and diarrhea
caused by rotativirus, have been developed and are now more widely used.
Immunization is the process whereby a person is made immune or resistant to an
infectious disease, typically by the administration of a vaccine. Vaccines stimulate the
bodys own immune system to protect the person against subsequent infection or
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disease and it is a way of creating immunity to certain diseases by using small amounts
of a killed or weakened microorganism that causes the particular disease.
Immunization also protects children from these deadly diseases. All children
have the right to this protection.
Early protection through immunization is critical. The immunizations in the childs
first and second years are especially important. It is also essential that pregnant women
are immunized against tetanus to protect themselves as well as their newborns. It is
safe to immunize a child who has a minor illness or a disability or is suffering from
malnutrition. In the Philippines, all public health centers offer free immunization all year
long for the recommended vaccines shown in Table 1 below. In addition, the
Department of Health conducts an outreach immunization program twice a year, in
order to boost immunization coverage amongst children. UNICEF supports the
Department of Health in the procurement of vaccines used in its immunization program.
Vaccines keep children alive and healthy by protecting them against disease.
Immunization is especially important for the hardest to reach families as it can also be a
bridge to other life-saving care for mothers and children in isolated communities such
as child nutritional screening, anti-malarial mosquito nets, vitamin A supplements and
de-worming tablets. Immunization is one of the most successful and cost-effective
public health investments we can make for future generations.
www.unicef.org/.../Facts_for_Life_-_IMMUNIZATION_Brochure.pdf

Table 1 Immunization Schedule for Infants in the Philippines

Age
Antigen

BCG

At
6
10
14
9
birth weeks weeks weeks months

12
months

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HepB

DPT HepB Hib

OPV

Rotavirus

Measles
MMR

X
X

http://www.philvaccine.org/vaccination-schedules/childhood-immunization schedule

Concept of Compliance
Compliance is cooperative performance and adherence to prescribed therapy as
recorded in the clinic record at a given period and that compliance criteria included
among other things frequency of keeping clinic appointments. According to, compliance
is the clients physical presence at the health unit or hospital on the appointment day to
receive the prescribed care. In the context of this study, the term compliance is defined
or conceptualized as receiving the required number of doses of vaccines at the
appropriate age as shown on the immunization schedule table and recorded in the
childs record card.
Nursing Research Principles and Methods 7 th Edition, by Denise F. Polit and Cheryl
Beck, page 124

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Presidential Decree No. 996 September 16, 1976

State that immunization is compulsory for infants and children below eight (8)
years of old against immunizable diseases.
http://www.gov.ph/1976/09/16/presidential-decree-no-996-s-1976/

Factors Affecting Low Compliance of Immunization

Predisposing factors:

Family Structure
a. Large family having difficulty in attending each of their children needs.
b. Busy in attending other needs, daily living needs or activities, rather
than complying with the immunization.

Education
a. Lack of knowledge about kinds of vaccines and how vaccination works.
b. Lack of knowledge about schedules and repeat doses.

Culture and Beliefs

a. Some families have different beliefs regarding immunization.

Location: Immunization
a. Immunization site is too far away.
b. Road or path to clinic is hazardous or impassable after rain or rainy
season.

Availability
a. Immunization services are scheduled at a time that conflicts with other
duties.
b. Not adequately informed of the immunization schedule.
c. Arrival of vaccinators is unpredictable (e.g., due to weather or
distance)
d. Vaccines not in supply (or staff wont open new vial)
e. Some vaccines systematically not used on certain days of the week.

Enabling Factors:

Employment
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a. Parents are too busy attending to their work, to the point they forgot to
attend their children needs including their immunization.
Income
a. Parents could not afford the vaccines.

http://pdf.usaid.gov/pdf_docs/PNABG749.pdf
Complications that may occur if a child wont be immunized:

Diseases that are almost unknown would stage a comeback.

More children would get sick or infected and may eventually die to certain
diseases or serious complications.
Children are at greater risk of having one of the vaccine-preventable diseases
such as Hepatitis B, Tuberculosis, Polio, Measles, etc.

CONCEPTUAL FRAMEWORK
Following the basic phases of the nursing process, the concept behind our
framework is the Community nursing process and is as follows: In the assessment
phase, the researchers conducted an informal interview with the participants that will
enable the researchers to identify the factors affecting the immunization compliance.
Upon analyzing the data, the researcher group has planned with the local Barangay
officials and health personnel the most appropriate interventions that would address the
needs of the residents. Health teaching programs were conducted among the residents
in the area. This was to enforce awareness about the importance and advantages of
immunization and to encourage the residents to utilize the Health Center more
frequently than the usual. The respondents were evaluated right after the end of each
session of Health teaching as to how they have able to comprehend the health teaching
done.
As shown in our framework above, there is relevance between the variables in
which implies the identification of the specific determinants that contributes to low
compliance of immunization status of a child making them susceptible to these certain
vaccine preventable diseases; in which explains the process of increasing their
compliance through information dissemination regarding consequences of not

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complying to immunization wherein it could influence their readiness to take their

children to immunization centers.

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CHAPTER III
METHODOLOGY

Methodology is a framework that outlines the methods that are followed for
research. This chapter, therefore, discussed the population of the study, sampling
procedures used and the tools used in order to achieve the planned objectives of the
study. The researchers also described the research design that was chosen for the
purpose of this study and discussed the methods used to analyze the data. Lastly, the
ethical issues that were followed in the process are also discussed.

A. RESEARCH PROCESS
The researchers sought permission and approval to collect the necessary data
for the research advisers and the midwife of Sta. Catalina Health Center. The
researchers gather data through interview. The researcher chose open-ended
interviews as it allows participants to discuss their opinions, views and experiences fully
in detail whereas a set interview with closed ended questions may inhibit them to
express their full opinions and feelings. With the use of semi-structured interviews the
researcher prepared a topic guide or a certain amount of questions to be covered with
each participant. The researchers determined the factors of parental non-compliant
parents that affect the vaccination of children ages 1 to 2 years of age.

B. RESEARCH DESIGN
The research design use in this study is based on a qualitative approach which is
Descriptive research. This research design aimed to recognize specific factors
influencing parental noncompliance to childrens ages 12 months to 2 years of age in
immunization, ways to improve compliance rate and preventing the possible
complications of children who are partially immunized.

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C. RESEARCH SETTING
This study was conducted at Martha drive Barangay Sta. Catalina, Zamboanga
City.

D. RESEARCH SUBJECT
The subjects included in the sample were the parents of the said partially
immunized children. The researchers conducted an interview with parents having
children ages 12mos to 2 years of age with incomplete immunization. Their perceptions
and attitudes served as a source of information.

E. SAMPLING DESIGN
Sampling is a method of selecting experimental units from a population so that
we can make decision about the population.
Sampling design is a design, or a working plan, that specifies the population
frame, sample size, sample selection, and estimation method in detail. Objective of the
sampling design is to know the characteristic of the population.
Purposive Convenience Design was utilized for it is appropriate for this
research.

The Inclusion Criteria:

A resident of Barangay Sta. Catalina Martha drive

At least 18 years old and above.
Have a child or children between 9 months to below 4 years old with
incomplete immunization
.

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F. ETHICAL CONSIDERATIONS
All potential subjects were presented with a consent form which described the
type of study being done, the purpose of the study, and the subjects rights as a
participant in the study, including the right to confidentiality and the right to withdraw
from the study at any time. Names will not be included in any of the findings and will
only be used for the consent form. All information gathered from the survey tool would
be burned or shredded after the completion of the research study.

G. RESEARCH INSTRUMENT
To collect information regarding the factors influencing parental compliance in
Barangay Sta, Catalina, the researchers used questionnaire checklist as research tool.

H. RELIABILITY AND VALIDITY

RELIABILITY OF THE DATA DURING DATA COLLECTION - In order to ensure
that data obtained/collected are accurate, discussion and
interview
with
the
residents will be documented through the use of cameras
(photographs).
VALIDITY - The tool validity used in this research is face validity. The study
utilized a survey questionnaire in data gathering. The survey Questionnaire contains six
questions, which would be verbally or descriptively be answered by the respondent(s),
consisted of questions that are related to different behavioral factors of the clients
regarding Partial compliance to childhood immunization. The question sought to find out
specific behavioral factors affecting parental non-compliance to immunization of children
of the Barangay residents of Sta. Catalina, Martha Drive.

Table 2 Data Triangulation

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RESEARCH
QUESTIONS
1. What are the specific behavioral factors
leading to parental non-compliance to
immunization of children?

SOURCES OF
DATA

Review of Documents
Data or information gathered from
the one on one discussion with the
respondents
References from the internet
Research books

2. How can a home-based teaching

interaction address the non-compliance
behaviors of parents towards childhood
immunization?

Data gathered from the respondents

3. What are the outcomes or benefits

derived from the home-based teaching
interaction?

Data gathered from the respondents

during the one on one discussion

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CHAPTER IV
This chapter presents the data analysis and data tabulation of the previous chapter.

A. DATA ANALYSIS
Figure 1. Behavioral Factors Leading To Parental Non-Compliance To
Immunization of Children

Figure 1.1 Regularity in utilization of the services in the Health Center.

The data shows that among the fifteen (15) respondents, fifteen (15) or all
of them utilized the Health Center, Particularly during Consultations.

Figure 1.2 What are the reasons why your children have incomplete
immunization

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Although 15 out of 15 respondents regularly go to the health center to

seek health care, we the researchers deemed it significant to identify what
particular reasons the respondents have as to why they do not comply to
have their children completely immunized by the means of further
assessing them by asking WHY; The data shows one common reason as
to their low compliance, Is because
of their lack of knowledge with
regards to the importance of compliance to immunization.

These are other reasons as to why they cannot comply: (1) there was no
more stocks of the vaccines needed to be given to their children due to
expiration of the vaccines in relation to the siege that took place late last
year (2) OTHER REASONS such us there is no one will be left in the
house/ with the other children that they have (3) Employment they do not
have enough time because they have to work to earn back what they have
lost during the siege.

Figure 1.3 Evaluation of their knowledge or perception with regards to the

importance of compliance to immunization.

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The data shows that 8 out of the 15 families (respondents) know something about
Immunization. Some even mentioned that Immunization is good for the health of
their children while others, 7 out 15 submit their children to being vaccinated without
knowing what reason there is, to why they need to do this.

Figure 2. Comparison of childrens immunization status

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There are a total number of 28 children out of the 15 Family (Respondents)

that we gathered.

As shown in the figure above, there is a large number of Partially

Immunized Children amongst the Respondents, more so there is a total
figure of 24 children who are Partially Immunized out the total 28 children
there is in the study, and there are a total of 4 children who has 0 Vaccine
Immunization given to them.

Figure 3. Most common vaccines not given (regardless of dosage) and

number of children under each category

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 As shown in the Figure there are six (6) types of Vaccines in the Expanded

Program on Immunization that are supposedly to be received by the

children. We the researchers consolidated the data gathered from the
respondent with regards to the vaccines that were missed out by their
child/children; in this figure it the missed out Vaccine Immunization follows
this order: (1) Measles Mumps Rubella (MMR) is the top most Vaccine on
the list 25 out of 28 children has yet to the Vaccination, next to it (2)
Measles with 23 out of 28 (3) Pentavalent vaccine 21 out of 28 (4) Oral
Polio Vaccine (OPV) with 10 out of 28 (5) Bacillus Calmette Guerin (BCG)
and Hepa B with 4 out of 28 children.

CHAPTER V
SUMMARY, CONCLUSION AND RECOMMENDATION

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This chapter presented the summarization of the previous chapter, as well

as the conclusion that can be derived from the gathered and collected data.
Recommendations for actions as well as further studies are also included in this
chapter.

SUMMARY
This paper has given account of the number of children who are
incompletely immunized of Martha Drive, Sta. Catalina.
This study shows that 86% of the children in Barangay Sta. Catalina
Martha Drive are partially immunized. It was also shown that most of the respondents or
families dont comply to their childrens immunization status was due to the lack of
knowledge about the importance of immunization and there was no more stocks of the
vaccines needed to be given to their children due to expiration of the vaccines in
relation to the siege that took place late last year.
Based on the datas that we gathered and for the findings made, the
researchers decided to conduct a home-based teaching interaction to substantiate their
lack of knowledge about the importance of immunization. The researchers found out
that the intervention given to the respondents was effective when the researchers
evaluated their response.

CONCLUSION
There are several factors affecting the low compliance of parents to
immunization status of their children. Those factors include, insufficient knowledge
regarding immunization, large family having difficulty in attending each of their children
needs, busy in attending other needs, daily living needs or activities rather than
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complying with the immunization, some families have different beliefs regarding
immunization, Immunization site is too far away, immunization services are scheduled at
a time that conflicts with other duties, not adequately informed of the immunization
schedule, some vaccines systematically not used on certain days of the week, parents
are too busy attending to their work to the point they forgot to attend their children
needs including their immunization. Among the factors mentioned, lack of knowledge to
the importance of immunization and availability of vaccines are the reasons why parents
in Barangay Sta. Catalina Martha drive has low compliance to immunization.

RECOMMENDATION

The researchers of this study recommend improvement of campaign using local

area dialect so that parents can fully understand the importance of Immunization to
their children that will maximize compliance.

It is further recommended that the barangay health officer to monitor compliance of

parents to fully Immunize their children.

It is recommended that future researchers will create an enhanced program to

increase compliance of parents to fully immunize their children.

The researchers suggest that the compliant parents should annually immunized
their children

Based upon the results of the data gathered, most of the children who are partially
immunized are at risk of having certain diseases like MMR, Measles and DPT. Data
showed above indicates that MMR, Measles and DPT were among the vaccines
which the children mostly missed. We the researchers, would likely suggest that
they should comply on these certain vaccines for it will serve as a protection in
reducing the risks of acquiring these certain diseases.

QUESTIONNAIRE CHECKLIST

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Respondents Name: _________________________ Age: _____ Gender: ______

Family Number: ______
Civil Status: ______________
Educational Status: _________________________ Occupation: ______________
Address: ______________________________________________

Child/Childrens Name:

NAME

AGE

IMMUNIZATION STATUS

COMPLETE

INCOMPLETE
(PLS. INDICATE VACCINES
RECEIVED)

1. Do you utilize the services in the Health Center regularly?

a.
b.

yes
If no, what are the reasons?

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
2. What are the reasons why your children have incomplete immunization?

Not available
Culture and Belief
Lack of knowledge about immunization
Location of home to the health center
Family Structure
Income
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Employment
Other reasons ______________________

3. Can you tell me as briefly as you can on the importance of immunization?

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

REFERENCES:
Nursing Research Principles and Methods 7 th Edition, by Denise F. Polit and Cheryl
Beck, page 124
http://en.wikipedia.org/wiki/Action_research
http://en.wikipedia.org/wiki/Millennium_Development_Goals
www.unicef.org/.../Facts_for_Life_-_IMMUNIZATION_Brochure.pdf
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http://www.philvaccine.org/vaccination-schedules/childhood-immunization schedule
http://www.gov.ph/1976/09/16/presidential-decree-no-996-s-1976/
http://pdf.usaid.gov/pdf_docs/PNABG749.pdf

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