ASSENT FORM

This assent form is for the students who are invited to participate in the survey on the
knowledge, attitudes and practices on type 2 diabetes mellitus prevention among high school
students in Manila.
Project Title:
Institution:
Investigators:

Knowledge, Attitudes and Practices on Type 2 Diabetes Mellitus

Prevention among High School Students in Manila
College of Public Health, University of the Philippines Manila
Gladys Larissa V. Armada, Lily Jane D.M. Calata,
Paul Jeremiah K. Co, Ann Renette R. Uy

Purpose of the study:

We are 4th year BS Public Health students in the University of the Philippines Manila
conducting a study entitled Knowledge, Attitudes and Practices on Type 2 Diabetes Mellitus
Prevention among High School Students in Manila, with the general objective of determining
the knowledge, attitudes, and practices of high school students in Manila on type 2 diabetes
mellitus
Only a limited number of studies on T2DM among adolescents exists, and none has
been done yet regarding their knowledge, attitudes and practices on T2DM prevention in the
Philippines. Describing these will provide baseline data for the development of prevention and
lifestyle modification programs specific for adolescents, of which none exist at the moment.
Such programs would increase their awareness on diabetes, lower their risk and preventing
further incidence of T2DM.
Conduct of the study:
The study design is descriptive cross-sectional with a multi-stage sampling design. A
self-administered questionnaire will be given after consent from the parent and assent from the
student are obtained. On the day of the survey, only students who have signed their assent
forms and brought their parents signed informed consent forms will be given the
questionnaires. Prior to this, a letter to the principals of the chosen schools were sent asking for
the participation of their students in the study.
Selection of participants:
958 high school students in Manila will be asked to participate in the study and answer the selfadministered questionnaire. Stratification of the population will be done by school, then by year
level, followed by clustering per section will be applied in choosing the participants. The whole
class will be the prospective participants of the study.

Voluntary participation from the study:

Participation is completely voluntary and students may not take part in the study should they
choose not to.
Duration of participation:
Answering the questionnaire will only take at most 15 minutes of the time of the participant.
Responsibility of the participant:
The participant is to answer the questionnaire truthfully and completely.
Anonymity and confidentiality:
With the tool being a questionnaire, issues regarding anonymity and confidentiality will be
addressed by not including personal information except for age, sex, year level, family history of
diabetes, and whether or not they were diagnosed as diabetics. As such, researchers will have
no means of identifying the participant. Only code numbers will be assigned and indicated in the
questionnaire and will be done prior to the researchers giving them out. The researchers will be
solely and completely responsible in handing out the questionnaire to the students. Likewise,
they will provide a box and instruct the students to fold their completed questionnaires and put
in the box. This process ensures that only the researchers will have access to the
questionnaires throughout the study and that researchers wont be able to pinpoint the individual
who answered the particular questionnaire. The teachers, although inside the classroom, may
only assist in maintaining order of the class and will by no means take part in the administration
of the questionnaire.
Risks and inconveniences:
There are no risks and social harms upon participating in the study. Inconvenience is also at a
minimal level as answering the questionnaire will only take at most 15 minutes of their time.
Benefits:
This study will bring about benefits to the participants for both in the short and the long term
manner. By simply answering the questionnaire, awareness on the subject, type 2 diabetes
mellitus, would increase. Health promotion and education materials on T2DM will likewise be
handed out upon completion of the survey, improving their knowledge, attitudes and practices
on T2DM prevention. As for the long term benefit, answering the questionnaire honestly and
completely would make the study more significant and reliable. Should the DOH and the local
school administration choose to utilize the results, the first prevention programs targeting
adolescents would be developed and would be able to address what are specifically lacking in
the knowledge, attitudes and practices of adolescents regarding type 2 diabetes mellitus
prevention.
Compensation:
There will be no financial considerations upon participation to the study.

Provision for injury or related illness:

No injury or related illness will occur from participating in the study.
Sharing of results:
The results of the study will be presented to the principals of the participating schools.
Contact person/s:
For more details on the research and rights of the participant, you may contact Gladys Armada
through 09062344509 or gladysarmada@yahoo.com
This proposal has been reviewed and approved by the College of Public Health Review Ethics
Board and the UP Manila Research Ethics Board. For further questions or concerns, you may
contact us through:
Name

Contact number

Email address

Gladys Larissa Armada

09062344509

gladysarmada@yahoo.com

Lily Jane Calata

09277592835

psalms_261@yahoo.com

Paul Jeremiah Co

09228548575

paulkhoco@yahoo.com

Ann Renette Uy

09064805326

uyrenette@yahoo.com

If you wish to find about more about your rights as a research participant, you may contact:
Dr. Jacinto Blas V. Mantaring III
Chair, UPMREB
2nd Floor Paz Mendoza Building, College of Medicine, UP Manila
547 Pedro Gil Street, Ermita, 1000 Manila
Telephone: +63 2 522-2684
Email: upmreb@post.upm.edu.ph
We, the investigators, have explained and provided the information needed in deciding to
participate in the study. I confirm that everything stated in this consent form is true and valid.

Gladys Larissa Armada

Paul Jeremiah Co

Lily Jane Calata

Ann Renette Uy

Noted by:

Eleanor C. Castillo, DrPH

Group Adviser
09228001655
annilovecastillo@yahoo.com

Original Copy
ASSENT FORM
I have read and understood the foregoing information. I have had the opportunity to
consider and ask questions about it and these have been answered to my satisfaction. I
have received a copy of this informed consent form. I consent voluntarily to participate
in this study.
Participants signature:
________________________
Name of participant

_______________________
Signature of participant

_________
Date

Participants Copy
ASSENT FORM
I have read and understood the foregoing information. I have had the opportunity to
consider and ask questions about it and these have been answered to my satisfaction. I
have received a copy of this informed consent form. I consent voluntarily to participate
in this study.
Participants signature:
________________________
Name of participant

_______________________
Signature of participant

_________
Date

INFORMED CONSENT FORM FOR PARENTS (IN ENGLISH)

This informed consent form is for the parents of the students invited to participate in the survey
on the knowledge, attitudes and practices on type 2 diabetes mellitus prevention among high
school students in Manila.
Project Title:
Institution:
Investigators:

Knowledge, Attitudes and Practices on Type 2 Diabetes Mellitus

Prevention among High School Students in Manila
College of Public Health, University of the Philippines Manila
Gladys Larissa V. Armada, Lily Jane D.M. Calata,
Paul Jeremiah K. Co, Ann Renette R. Uy

Purpose of the study:

We are 4th year BS Public Health students in the University of the Philippines Manila
conducting a study entitled Knowledge, Attitudes and Practices on Type 2 Diabetes Mellitus
Prevention among High School Students in Manila, with the general objective of determining
the knowledge, attitudes, and practices of high school students in Manila on type 2 diabetes
mellitus.
Only a limited number of studies on T2DM among adolescents exists, and none has
been done yet regarding their knowledge, attitudes and practices on T2DM prevention in the
Philippines. Describing these will provide baseline data for the development of prevention and
lifestyle modification programs specific for adolescents, of which none exist at the moment.
Such programs would increase their awareness on diabetes, lower their risk and preventing
further incidence of T2DM.
Conduct of the study:
The study design is descriptive cross-sectional with a multi-stage sampling design. A
self-administered questionnaire will be given after consent from the parent and assent from the
student are obtained. On the day of the survey, only students who have signed their assent
forms and brought their parents signed informed consent forms will be given the
questionnaires. Prior to this, a letter to the principals of the chosen schools were sent asking for
the participation of their students in the study.
Selection of participants:
958 high school students in Manila will be asked to participate in the study and answer the selfadministered questionnaire. Stratification of the population will be done by school, then by year
level, followed by clustering per section will be applied in choosing the participants. The whole
class will be the prospective participants of the study.

Voluntary participation from the study:

Participation is completely voluntary and students may not take part in the study should they
choose not to.
Duration of participation:
Answering the questionnaire will only take at most 15 minutes of the time of the participant.
Responsibility of the participant:
The participant is to answer the questionnaire truthfully and completely.
Anonymity and confidentiality:
With the tool being a questionnaire, issues regarding anonymity and confidentiality will be
addressed by not including personal information except for age, sex, year level, family history of
diabetes, and whether or not they were diagnosed as diabetics. As such, researchers will have
no means of identifying the participant. Only code numbers will be assigned and indicated in the
questionnaire and will be done prior to the researchers giving them out. The researchers will be
solely and completely responsible in handing out the questionnaire to the students. Likewise,
researchers will provide a box and instruct the students to fold their completed questionnaires
and put in the box. This process ensures that only the researchers will have access to the
questionnaires throughout the study and that researchers wont be able to pinpoint the individual
who answered the particular questionnaire. The teachers, although inside the classroom, may
only assist in maintaining order of the class and will by no means take part in the administration
of the questionnaire.
Risks and inconveniences:
There are no risks and social harms upon participating in the study. Inconvenience is also at a
minimal level as answering the questionnaire will only take at most 15 minutes of their time.
Benefits:
This study will bring about benefits to the participants for both in the short and the long term
manner. By simply answering the questionnaire, awareness on the subject, type 2 diabetes
mellitus, would increase. Health promotion and education materials on T2DM will likewise be
handed out upon completion of the survey, improving their knowledge, attitudes and practices
on T2DM prevention. As for the long term benefit, answering the questionnaire honestly and
completely would make the study more significant and reliable. Should the DOH and the local
school administration choose to utilize the results, the first prevention programs targeting
adolescents would be developed and would be able to address what are specifically lacking in
the knowledge, attitudes and practices of adolescents regarding type 2 diabetes mellitus
prevention.
Compensation:
There will be no financial considerations upon participation to the study.

Provision for injury or related illness:

No injury or related illness will occur from participating in the study.
Sharing of results:
The results of the study will be presented to the principals of the participating schools.
Contact person/s:
For more details on the research and rights of the participant, you may contact Gladys Armada
through 09062344509 or gladysarmada@yahoo.com
This proposal has been reviewed and approved by the College of Public Health Review Ethics
Board and the UP Manila Research Ethics Board. For further questions or concerns, you may
contact us through:
Name

Contact number

Email address

Gladys Larissa Armada

09062344509

gladysarmada@yahoo.com

Lily Jane Calata

09277592835

psalms_261@yahoo.com

Paul Jeremiah Co

09228548575

paulkhoco@yahoo.com

Ann Renette Uy

09064805326

uyrenette@yahoo.com

If you wish to find about more about your rights as a research participant, you may contact:
Dr. Jacinto Blas V. Mantaring III
Chair, UPMREB
2nd Floor Paz Mendoza Building, College of Medicine, UP Manila
547 Pedro Gil Street, Ermita, 1000 Manila
Telephone: +63 2 522-2684
Email: upmreb@post.upm.edu.ph
We, the investigators, have explained and provided the information needed in deciding to
participate in the study. I confirm that everything stated in this consent form is true and valid.

Gladys Larissa Armada

Paul Jeremiah Co

Lily Jane Calata

Ann Renette Uy

Noted by:

Eleanor C. Castillo, DrPH

Group Adviser
09228001655
annilovecastillo@yahoo.com

Original Copy
CONSENT FORM
I have read and understood the foregoing information. I have had the opportunity to
consider and ask questions about it and these have been answered to my satisfaction. I
have received a copy of this informed consent form. I consent voluntarily to let my child
participate in this study.
Parent/Guardians signature:
________________________
Name of parent/guardian

_______________________
Signature of parent/guardian

_____________
Date

Parent/Guardians Copy
CONSENT FORM
I have read and understood the foregoing information. I have had the opportunity to
consider and ask questions about it and these have been answered to my satisfaction. I
have received a copy of this informed consent form. I consent voluntarily to let my child
participate in this study.
Parent/Guardians signature:
________________________
Name of parent/guardian

_______________________
Signature of parent/guardian

_____________
Date

INFORMED CONSENT FORM PARA SA MGA MAGULANG (FILIPINO)

Ang kasulatan ng pahintulot na ito ay para sa mga magulang ng mga estudyante na

inimbita para sumali sa sarbey tungkol sa kaalaman, ugali, at kasanayan ng mga
estudyante sa hayskul ukol sa pagpigil ng type 2 diabetes mellitus (T2DM).
Project Title:

Institusyon:
Tagapagsaliksik:

Knowledge, Attitudes and Practices on Type 2 Diabetes

Mellitus Prevention among High School Students in
Manila
College of Public Health, University of the Philippines
Manila
Gladys Larissa V. Armada, Lily Jane D.M. Calata,
Paul Jeremiah K. Co, Ann Renette R. Uy

Layunin ng pag-aaral:
Kami ay mag-aaral ng BS Public health sa ika-apat na taon sa Unibersidad ng
Pilipinas Manila na gumagawa ng isang pag-aaral na may pamagat na Knowledge,
Attitudes, and Practices on Type 2 Diabetes Mellitus Prevention among High School
Students in Manila. Ang pangkalahatang layunin ng pag-aaral na ito ay ang mabatid
ang kaalaman, ugali, at mga gawain ng mga estudyante mula sa hayskul ukol sa
pag-iwas sa type 2 diabetes mellitus.
Kaunti lamang ang mga pag-aaral ukol sa T2DM sa mga tinedyer at wala pang pagaaral na ginagawa ukol sa kanilang kaalaman, ugali, at kasanayan ukol sa pagpigil
ng type 2 diabetes mellitus. Ang pagbatid sa mga ito ay magbibigay ng baseline data
para sa pagbuo ng mga programa sa pagpigil ng T2DM sa mga tinedyer. Ang mga
itoy makakadagdag sa kamalayan ng mga tinedyer ukol sa diabetes, makakababa
ng kanilang peligro sa T2DM at makakapigil sa pagrami ng mayroong T2DM.
Pamamaraan ng pag-aaral:
Ang disenyo ng pag-aaral ay descriptive cross-sectional na may multi-stage sampling
design. Ang pag-aaral na ito ay gagamit ang isang self-administered na
palatanungan na ibibigay matapos mahingi ang pagsang-ayon ng magulang at ng
estudyante. Sa araw ng sarbey, tanging ang mga estudyante lamang na pinirmahan
ang kanilang assent form at dala ang pirmadong consent form ng kanilang magulang
ang bibigyan ng palatanungan. Bago ang lahat ng ito, ang mga punong-guro ay
padadalhan ng sulat na nanghihihingi ng partisipasyon ng kanilang paaralan. Ang
palatanungan ay masasagot sa ilalim ng 15 minutos.

Pagpili ng mga kalahok:

958 na estudyante mula sa mga hayskul sa Maynila ay pipiliin upang lumahok sa

pag-aaral. Sila ay pagbubuklurin ayon sa kanilang paaralan at baitang. Pipiliin ang
klase na lalahok sa pag-aaral, at lahat ng estudyante nito ay aanyayahang magigng
kalahok.
Kusang-loob na pagsali sa pag-aaral:
Kusang-loob ang pagsali at may karapatang tumanggi lumahok ang mga estudyante
Tagal ng partisipasyon:
Ang pagsagot sa palatanungan ay hindi lalagpas sa 15 minuto.
Tungkulin ng kalahok:
Ang kalahok ay kinakailangang kumpleto at tapat na sagutin ang palatanungan.
Anonymity at ang pagkakompidensyal:
Dahil isang palatanungan ang gagamitin, ang mga isyu ukol sa pagiging
kompidensyal ng pag-aaral ay maiiwasan sa hindi pagkuha ng personal na
impormasyon, maliban sa edad, kasarian, baiting, kung may kapamilyang mayroong
diabetes at kung sila mismo ay diabetic ayon sa doktor. Hindi hihigin ng mga
mananaliksik ang pangalan sa palatanungan kayay walang paraan ang mga
mananaliksik para malaman kung sino ang sumagot nito. Mga code numbers lamang
ang gagamitin at ilalagay sa palatanungan, na gagawin bago pa man ipasagot ang
mga ito. Tanging ang mga tagapagsaliksik ang maaaring magbigay ng palatanungan
sa mga estudyanteSila rin ay ay magdadala ng kahon kung saan ilalagay ng mga
estudyante ang nasagutan nilang palatanungan matapos itong tupiin. Sa ganitong
paraan, nasisigurado na hindi makikila ng mga mananaliksik ang mga sumagot at
tanging ang mga mananaliksik lamang ang maaaring makabasa ng palatanungan.
Ang mga guro ay walang bahagi sa sarbey ngunit ay naroon upang panatilihin ang
katiwasayan ng klase.
Mga Panganib at Kaabalahan:
Walang panganib sa pagsali sa pag-aaral. Ang kaabalahan ay kaunti lamang dahil
15 minuto lamang ang pagsagot sa palatanungan.
Mga Pakinabang:
Ang pag-aaral na ito ay may agaran at pangmatagalan na benepisyo sa mga lalahok.
Sa pagsagot ng palatanungan, madadagdagan ang kamalayan ukol sa T2DM. Mga
gamit sa health promotion and education sa T2DM ay ibibigay pagkatapos ng sarbey
at ito ay makakapagpalaganap ng kanilang mga kaalaman, ugali, at ginagawa para
sa pagpigil ng T2DM. Ang pangmatagalang pakinabang nito ay ang pagiging
makabuluhan at ang kahalagahan ng pag-aaral kung sasagutin nang matapat at
kumpleto ang palatanungan. Kung gagamitin ng DOH at ng lokal na administrasyon
ng paaralan ang resulta ng pag-aaral, ang mga unang programa ukol sa pagpigil ng
T2DM ay magagawa at matutugunan nito ang mga ispesipikong kakulangan ng mga
estudyante ukol sa kaalaman, ugali, at ginagawa ukol sa pagpigil ng T2DM.
Gantimpala:
Walang konsiderasyong pinansyal ang pagsali sa pag-aaral.

Pantustos sa pahamak o pagkasakit:

Walang pahamak o pagkasakit ang makukuha sa pagsali sa pag-aaral.
Pamamahagi ng resulta:
Ang mga resulta ay ipepresenta sa mga punong-guro ng mga eskwelahang lumahok
sa pag-aaral.
Contact person/s:
Para makahingi pa ng detalye tungkol sa pagsasaliksik at sa karapatan ng mga
kalahok, maaaring kausapin si Gladys Armada sa 09062344509 o
gladysarmada@yahoo.com. Ang panukalang ito ay sinuri at binigyan ng pahintulot
ng College of Public Health Review Ethics Board at ng UP Manila Research Ethics
Board (UPMREB). Para sa karagdagang kaalaman o mga tanong, maaari kaming
kausapin sa:
Pangalan

Contact number

Email address

Gladys Larissa Armada

09062344509

gladysarmada@yahoo.com

Lily Jane Calata

09277592835

psalms_261@yahoo.com

Paul Jeremiah Co

09228548575

paulkhoco@yahoo.com

Ann Renette Uy

09064805326

uyrenette@yahoo.com

Para sa karagdagang kaalaman ukol sa iyong karapatan bilang kalahok, maaaring

kausapin si:
Dr. Jacinto Blas V. Mantaring III
Chair, UPMREB
2nd Floor Paz Mendoza Building, College of Medicine, UP Manila
547 Pedro Gil Street, Ermita, 1000 Manila
Telephone: +63 2 522-2684
Email: upmreb@post.upm.edu.ph
Kami, ang mga tagapagsaliksik, ay nakapagpaliwanag at nakapagbigay ng
impormasyon na kailangan upang makadesisyong sumali sa pag-aaral.
Kinukumpirma kong totoo at mabisa ang lahat nang nakalaan sa consent form na ito.
Gladys Larissa Armada

Paul Jeremiah Co

Lily Jane Calata

Ann Renette Uy

Noted by:
Eleanor C. Castillo, DrPH
Group Adviser
09228001655
annilovecastillo@yahoo.com

Kopya ng Mananaliksik
KASULATAN NG PAHINTULOT
Nabasa ko at lubos na nauunawaan ang mga bagay na nakasaad sa kasulatang ito. Nagkaroon
ako ng pagkakataong magtanong ukol dito at ang mga ito ay sapat na nasagot. Nakatanggap
ako ng kopya nitong kasulatan ng pahintulot. Sumasangayon ako at pumapayag na maging
bahagi ang aking anak sa pag-aaral na ito.
Lagda ng Magulang o Tagapag-alaga
_________________________________
Pangalan ng Magulang o Tagapag-alaga

____________________________
Lagda ng Magulang o Tapag-alaga

_________
Petsa

Kopya ng Magulang o Tagapag-alaga

KASULATAN NG PAHINTULOT
Nabasa ko at lubos na nauunawaan ang mga bagay na nakasaad sa kasulatang ito. Nagkaroon
ako ng pagkakataong magtanong ukol dito at ang mga ito ay sapat na nasagot. Nakatanggap
ako ng kopya nitong kasulatan ng pahintulot. Sumasangayon ako at pumapayag na maging
bahagi ang aking anak sa pag-aaral na ito.
Lagda ng Magulang o Tagapag-alaga
_________________________________
Pangalan ng Magulang o Tagapag-alaga

____________________________
Lagda ng Magulang o Tapag-alaga

_________
Petsa