KALINGA STATE UNIVERSITY

COLLEGE OF HEALTH AND NATURAL SCIENCES

Bachelor of Science in Midwifery
Chapter I
This chapter presents the introduction, conceptual framework, objectives of the
study, objectives of the study, hypothesis, scope and limitation, importance of the
study, and the definition of terms.

Background of Study

Maternal immunization is a crucial public health tactic, and it is a maternal

vaccination, which shields expectant mothers and their babies from a range of
diseases that can be avoided. Health agencies including the World Health
Organization (WHO), and the Department of Health (DOH) advise vaccinations
against tetanus, diphtheria, pertussis (Tdap), and influenza during pregnancy to
lower maternal and newborn morbidity and mortality. But despite the advantages,
a lot of expectant mothers, particularly those living in poor and rural areas,
continue to receive insufficient vaccinations because of obstacles like
misconceptions, ingrained cultural views, and restricted access to medical care.
One such remote locality with poor rates of maternal immunization is Cagaluan,
Pasil. The purpose of this study is to find out how pregnant women in Cagaluan
feel about maternal immunization in terms of knowledge, acceptance, and
attitudes.

Maternal immunization is the process where in pregnant women are

vaccinated against major infectious diseases to protect both the mother and her
unborn child. It is advised to have vaccinations against diseases including Tdap
and Influenza to lower the risk of contracting these illnesses. Many expectant
mothers still do not obtain these immunizations even though they are readily
available for a variety of reasons, such as misinformation, lack of awareness, and
practical difficulties. To increase vaccination rates, especially in remote and
underserved areas, it is essential to comprehend the degree of awareness,
acceptability, and attitudes toward these vaccines. To aid enhance healthcare
delivery in Cagaluan, Pasil, this research aims to investigate these issues.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
Maternal vaccination has gained recognition as a vital intervention for
enhancing the health of expectant mothers and newborns on a worldwide scale.
The successful implementation of maternal immunization programs has resulted
in significant reductions in infant mortality rates in high-income countries,
according to WHO studies (2020). However, uptake is still uneven in low- and
middle-income nations due to obstacles like cultural norms, vaccination
hesitancy, and disinformation. International research highlights the value of
public health programs and community involvement in raising immunization rates
among expectant mothers. WHO is still pushing for more immunization
campaigns to target vulnerable groups in neglected areas of the world.

Maternal immunization is one of the main focuses of the Department of

Health's (DOH) mother and child health initiatives in the Philippines. According to
the DOH (2021), vaccination rates have increased in urban regions, but vaccine
distribution and uptake remain exceedingly difficult in rural areas. Research by
Navarro, Delos Santos, and Lim (2022) show that vaccination hesitancy must be
addressed with more comprehensive teaching efforts, particularly for expectant
mothers living in rural areas. Additionally, the DOH has taken steps to improve
maternal immunization access; nonetheless, obstacles like logistical problems
and cultural attitudes still exist. These difficulties highlight the necessity of
targeted initiatives to increase the number of pregnant women who receive
vaccinations.

Maternal immunization rates vary throughout the Cordillera Administrative

Region (CAR), which includes Region 2. Rural and isolated areas have lower
uptake than urban centers. According to regional health reports (2022),
immunization initiatives in these locations are still hampered by a lack of access
to healthcare facilities and false information. Research carried out in the Central
African Republic has demonstrated the efficacy of health education and outreach
initiatives in enhancing pregnant women's acceptance of vaccines. To address

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
the deeply ingrained cultural beliefs that affect the health decisions made by
indigenous groups, however, consistent efforts are needed. Currently,
community-based maternal immunization efforts are being strengthened through
strong collaboration between local governments and health agencies.

Maternal immunization rates in Kalinga continue to be poor because of

social, cultural, and geographic issues. Pregnant women's poor immunization
rates are partly caused by inadequate access to healthcare facilities in distant
locations, despite the availability of vaccines, according to provincial health data
(2021). According to Ramos, Villanueva, and Pascual (2021), this problem is
further exacerbated by traditional beliefs and distrust against modern medicine.
As their data makes clear, more must be done to promote vaccine uptake in rural
areas like Kalinga, even though education efforts have improved things in some
places. Through focused health campaigns and collaborations with local leaders,
the provincial health office has started to address these obstacles.

Maternal vaccination poses considerable problems in Barangay Cagaluan,

Pasil Kalinga. Despite efforts made by healthcare professionals to emphasize the
necessity of these immunizations, local health statistics from 2022 show that a
limited number of pregnant women receive the recommended doses. It is
challenging to provide regular immunization services in the barangay due to its
rural location, cultural differences, and lack of healthcare infrastructure.
According to research by Ramos et al. (2021), when local leaders supported
health efforts, vaccination acceptability increased in similar barangay health
education programs. These results imply that the obstacles to maternal
immunization in the Cagaluan may be addressed with a tailored strategy.

Conducting research on maternal immunization to understand, to

measure, and examine the level of knowledge, acceptance, and attitudes
towards maternal immunization, specifically Tdap and influenza vaccines among
pregnant women residing in Cagaluan, Pasil. To enhance mother and newborn

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
health outcomes in this community, this research intends to identify the barriers
to immunization and use that information to guide health policies and develop
targeted treatments. The finding helps healthcare providers to address
misconceptions, improve vaccine rates and identifying the key factors
contributing to these challenges they encounter in accessing vaccination
services. Ultimately, this study aims to enhance the overall health outcomes for
mothers and newborns and support the development of a more informed
immunized community.

CONCEPTUAL FRAMEWORK

Pregnant women's opinions and acceptance of vaccines are significantly

influenced by their level of knowledge regarding maternal immunization.
Individuals with greater knowledge about vaccines tend to have more favorable
attitudes toward immunization, which increases their willingness to get
vaccinated (Dube et al., 2013). To understand these factors better, the Health
Belief Model (HBM) will be used as the guiding framework, as it is highly relevant
in public health and effective in exploring individual perceptions and behaviors
regarding health interventions (Rosenstock, 1974). The HBM focuses on how
people assess their risk of illness, perceive the severity of its consequences, and
believe in the benefits of preventive actions such as vaccination. This model will
help explain the factors influencing pregnant women’s knowledge, acceptance,
and attitudes toward vaccines like Tdap and influenza, providing insight into how
perceptions and beliefs may affect their decision to get vaccinated.

Knowledge about maternal immunization plays a pivotal role in whether a

pregnant woman accepts or rejects vaccines. Healthcare providers are
considered the most trusted source of information about the safety and benefits
of vaccines, (Omer et al., 2009). Clear, evidence-based recommendations from
healthcare providers help women understand the importance of vaccination for
both maternal and fetal health (Kirkpatrick et al., 2018). Public health campaigns

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
and informational programs also significantly contribute to raising general
awareness, although they are most effective when combined with personalized
counseling (Boyer et al., 2017). Socio-demographic factors, such as education,
socio-economic status, and health literacy, further influence how well women
understand maternal immunization (Vanderpool et al., 2020; Leung et al., 2020).
Women with higher education levels and better healthcare access are generally
more knowledgeable about the benefits of vaccination.

Attitudes toward maternal immunization are shaped by knowledge, trust in

healthcare providers, and cultural beliefs. Women who are well-informed about
the safety and efficacy of vaccines tend to have more positive attitudes toward
immunization (Omer et al., 2009). However, cultural norms or religious beliefs
can influence attitudes and may foster skepticism about vaccines (SAGE, 2014).

Acceptance of maternal immunization is closely tied to both knowledge

and attitudes. Pregnant women who understand the benefits and safety of
vaccines and have positive attitudes toward immunization are more likely to
accept the vaccines recommended to them (Gharpure et al., 2020). Healthcare
provider recommendations are one of the most influential factors in promoting
vaccine acceptance, as strong, clear recommendations significantly increase
vaccine uptake (Kirkpatrick et al., 2018). Practical barriers, such as access to
vaccines, cost, and convenience, can also affect acceptance. Even well-informed
and positive women may hesitate if vaccines are not easily accessible or
affordable (Sharma et al., 2020). Additionally, social influence plays a role in
vaccine acceptance, with women who see family members or peers accepting
vaccination being more likely to follow suit (Liu et al., 2020). Overall, the
relationship between knowledge, attitude, and acceptance is complex and
interconnected, with each factor influencing the others in the decision-making
process for maternal immunization. This framework will serve as a guide for
interpreting data and developing recommendations aimed at improving

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
immunization uptake in Cagaluan, Pasil, where increasing knowledge and
addressing attitude-related concerns can significantly enhance vaccine
acceptance and maternal immunization rates.

INDEPENDENT VARIABLES

To determine the demographic

factors that affect the level of
knowledge, acceptance and
attitudes of the respondents
To provide evidence-based DEPENDENT VARIABLES
recommendations for improving
maternal immunization programs The level of knowledge,
and interventions based on the acceptance and attitude on
finding related knowledge, maternal immunization among
acceptance and attitudes among pregnant women at Cagaluan,
pregnant. Pasil.

To determine the level of

knowledge, acceptance and
attitudes of the respondents in
terms of immunization.

MODERATOR VARIABLES

Age
Religion
Educational attainment

Figure 1. Paradigm of the study

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
This study illustrates the relationship between independent, dependent,
and moderating variables. The independent variables, knowledge on maternal
immunization, acceptance of vaccination, and attitude toward vaccination, are
essential factors influencing maternal immunization practices. According to Glanz
et al. (2015), these variables are significant predictors of health behaviors,
particularly in vaccine uptake.

The dependent variable is the level of knowledge, acceptance, and

attitude on maternal immunization among pregnant women in Cagaluan, Pasil.
This variable reflects the outcome of the participants' interaction with vaccination-
related information, their perceptions, and their acceptance of vaccines.

To capture the complexities of these relationships, moderating variables

are also considered. These include demographic factors (e.g., age, educational
attainment, and parity). Studies have shown that demographic characteristics
significantly impact knowledge and acceptance of maternal immunization (Wilson
et al., 2021).

This framework provides a structured approach to analyze the interplay

between these variables and identifies critical factors that influence maternal
immunization behaviors in the study area.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
OBJECTIVES OF THE STUDY

The general objective of the study is to assess the level of knowledge,

acceptance, and attitudes towards maternal immunization among pregnant
women.

Specific objectives:

1. To determine the demographic factors that affect the level of knowledge,

acceptance and attitudes of the respondents
2. To provide on evidence-based recommendations for improving maternal
immunization programs and interventions based on the finding related
knowledge, acceptance and attitudes among pregnant.
3. To determine the level of knowledge, acceptance and attitudes of the
respondents in terms of immunization.

HYPOTHESIS

H₀: states that there is no significant relationship between the level of

knowledge, acceptance, and attitudes of pregnant women toward maternal
immunization and their demographic characteristics, such as age, educational
attainment, socioeconomic status, and parity.

H₁: posits that there is a significant relationship between the level of knowledge,
acceptance, and attitudes of pregnant women toward maternal immunization and
their demographic characteristics, such as age, educational attainment,
socioeconomic status, and parity.

These hypotheses will serve as a basis for identifying whether specific

demographic variables significantly influence the knowledge, acceptance, and
attitudes of pregnant women in this community toward maternal immunization.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
SCOPE and DELIMITATION of the STUDY

The study aims to assess the level of knowledge, acceptance and attitude
towards maternal immunization among pregnant women in Cagaluan, Pasil. The
research will be conducted at the Barangay Cagaluan and will involve pregnant
women.

The study will be limited in generalizability focus on solely on pregnant

women currently residing in Cagaluan. The research will specifically address
maternal immunizations, including influenza and Tdap (tetanus, diphtheria)
vaccines. Other vaccines not recommended during pregnancy will not be
included in the study.

Importance of study

This research is vital in addressing the level knowledge, acceptance and

attitudes of pregnant women in Cagaluan, Pasil, towards maternal immunization,
specifically focusing on the Tdap and influenza vaccines.

Mothers: The result of this study will help them to gain the importance of
immunization. It also furnishes them to possible keys in improving their
knowledge, acceptance and attitudes towards immunization.

Community: The study will help improve maternal and infant health by
identifying gaps in knowledge, acceptance and attitude of maternal immunization.
This can prevent serious diseases, protect and support better healthcare in
Cagaluan, Pasil.

Local health: This can help local health authorities and policymakers develop
targeted strategies to address concerns. By identifying the challenges, barriers
from getting vaccinated, such as limited healthcare access, cultural beliefs and
mis information often hesitancy against vaccine uptake.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
Healthcare Professionals: The results will give healthcare professionals crucial
information they can use to better inform and counsel pregnant mothers about
the benefits and safety of vaccinations. This may result in higher immunization
rates. Additionally, the findings will assist BHW and healthcare professionals in
developing more successful communication plans and initiatives that highlight the
value of maternal vaccinations. The research will guide in enhancing overall
health and well-being of mothers and baby in the community.

The future researcher: The result of the study can be reference material in
similar undertaking they will be interested pursuing about the the level
knowledge, acceptance and attitudes on maternal immunization among pregnant
women.

DEFINITION OF TERMS

Acceptance- The degree to which pregnant women are willing to receive

recommended vaccines and follow immunization guidelines.

Access to healthcare- The degree to which individuals can obtain necessary

health services, which may include availability, affordability, and ease of
accessing vaccinations and healthcare providers.

Attitude- The overall emotional and psychological stance of pregnant women

towards maternal immunization.

Influenza Vaccine- A vaccine that protect against influenza virus, which can
cause severe illness in pregnant women in their infants. The vaccine
recommended for pregnant women to reduce the risk of complication from
influenza during pregnancy.

Level of Knowledge- The degree of understanding and information that pregnant

women possess regarding maternal immunization.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
Maternal Immunization- The practice of administering vaccines to pregnant
women to protect both the mother and the newborn from infectious disease.
Common vaccine include influenza and Tdap.

Pregnant -Refer to a respondent carrying one or more offspring in her womb or

uterus.

Tdap Vaccine- A combination vaccine that protects against three diseases:

tetanus, diphtheria, and pertussis. The Tdap vaccine recommended during
pregnancy to help protect infant from pertussis, a potentially severe respiratory
illness.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
CHAPTER II

REVIEW OF RELATED LITERATURE

Maternal Immunization of mothers is an essential public health measure,

especially when it comes to lowering global rates of morbidity and mortality
among mothers and newborns. Maternal immunization programs significantly
reduced influenza and pertussis in pregnant women and newborns across
several nations, according to a study by Wilson et al. (2019). This improved the
health of expectant mothers and the outcome of their babies. Nunes and Madhi's
(2018) research highlights global success stories from low-income settings and
highlights the immunological benefits of maternal vaccinations for both the
mother and child. Healy and Rench (2020) looked at the global acceptance of
maternal immunization in another study, demonstrating how pregnant women's
attitudes and knowledge affect vaccine uptake.

Maternal immunization has improved public health on a national level.

Cruz et al. (2021) conducted a study in the Philippines and found that
immunization programs run by the government greatly enhanced the health of
pregnant mothers and their babies, particularly in rural areas. An associated
study by Santos and Reyes (2020) examined pregnant women’s acceptance of
vaccines and found that uptake was trending upward because of better
educational initiatives. Similarly, increased immunization efforts have led to a
notable decline in newborn illnesses including pertussis, according to
Department of Health data from 2019.

Maternal immunization programs differ in efficacy among regions because

of socioeconomic conditions and the availability of healthcare. In their 2020
study, Garcia et al. Examined the impacts of maternal vaccination in the Northern
Luzon region and discovered a direct relationship between vaccine acceptance
and healthcare access. According to a study conducted in the Visayas region by
Ramos (2018), maternal immunization coverage was higher in urban areas than

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
rural areas. Mendoza and Ilagan (2019) found in another study that while
localized health campaigns increased immunization rates; they also highlighted
the importance of culturally appropriate methods.

Although there has been little local study on maternal immunization in

Cagaluan Pasil, a few small-scale studies shed light on its impacts. In remote
villages in Northern Luzon, including Cagaluan Pasil, research by Dela Cruz
(2022) discovered that although vaccination awareness was high, actual vaccine
uptake varied because of logistical difficulties. The Pasil Municipal Health Office
(2021) released another local health report that indicated that mother
immunization rates were rising, they were still falling short of national goals.
Santos and Valdez (2020) conducted a community survey which revealed that
decisions regarding maternal immunization in the area were still impacted by
traditional beliefs and misconceptions.

Maternal immunization programs have demonstrated noteworthy benefits

on a global scale. Pregnancy-related vaccination significantly lowers infant
mortality and disease incidence globally, especially in low- and middle-income
nations, claim Eberhardt and Blencowe (2019). Jamison et al. (2020) conducted
a thorough review and discovered that vaccination during pregnancy has a
positive impact on the long-term health of both mothers and their unborn
children. Palache and de Jong (2021) showed in another international study that
routine healthcare integration of maternal vaccinations has improved public
health outcomes in numerous countries.

In the Philippines, studies have highlighted the impact of maternal

immunization on reducing neonatal and maternal mortality. According to a
nationwide study by Cruz et al. (2019), maternal health outcomes have improved
because of vaccinations, particularly those for tetanus and influenza. Infant
infectious disease rates were shown to be correlated with maternal immunization,
according to a different study by Torres and Santos (2020). Maternal

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
immunization programs have been essential to the nation’s success in reaching
its maternal health objectives, according to the National Health Institute (2020),
especially in underprivileged areas.

Regional disparities in results are caused by factors such as vaccine

accessibility and healthcare infrastructure. Flores et al. (2018) conducted studies
in the Ilocos region and found that maternal immunization reduced infant
morbidity, but uneven access to healthcare was a barrier to the program’s
general effectiveness. Castro and Reyes (2019) conducted a regional analysis in
the Bicol region and found that greater vaccination rates in regions with better
healthcare facilities related to improved maternal health outcomes. Ramos
(2021) conducted study in the Cagayan Valley and found that vaccination uptake
and health outcomes were much enhanced by educational programs.

Local Studies conducted locally in Cagaluan Pasil show a combination of

favorable and difficult results. Although the region still lags in meeting national
standards, a study by the Pasil Municipal Health Office (2022) observed gains in
maternal health following the introduction of vaccination programs. According to
a local study by Valdez (2020), despite a rise in vaccine awareness, logistical
and cultural obstacles still stand in the way of the best possible health outcomes.
In a similar vein, Ramos (2019) discovered that increased vaccination coverage
and improved newborn health required ongoing community participation.

Knowledge, Attitudes, and Practices (KAP) on Maternal Immunization

Maternal vaccination practices, attitudes, and knowledge vary throughout

the world. Misinformation continues to be a significant obstacle to adoption of
maternal vaccinations, despite an increase in awareness of these shots (Larson
et al., 2020). Similar findings were made by Paterson and MacDonald (2021),
who discovered that a pregnant woman’s propensity to accept vaccinations is
strongly influenced by her educational attainment. Socio-cultural factors have

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
been highlighted by Larson et al. (2018) as key predictors of maternal
vaccination uptake in a global assessment.

Maternal immunization practices, attitudes, and knowledge have improved

in the Philippines. According to a nationwide poll conducted in 2019 by Cruz and
Torres, government-led educational initiatives have improved public awareness
of the advantages of maternal vaccinations. According to Reyes (2020), pregnant
women in urban areas had more favorable opinions regarding vaccination than
pregnant women in rural areas. While knowledge levels were typically good,
there were still gaps in practice, especially in distant populations, according to a
study by Dela Cruz and Santos (2018).

Studies indicate variations in KAP associated with maternal vaccination at

the regional level. According to Flores (2019), women in Central Luzon
possessed a high degree of vaccination awareness, but obtaining vaccines was
difficult because of a lack of healthcare providers. A study by Valdez (2021)
revealed that although vaccination awareness was typically high in the Cordillera
Administrative Region, cultural attitudes occasionally inhibited vaccination
uptake. According to Ramos (2018), regional health initiatives were essential in
enhancing maternal immunization behaviour and awareness in Northern Luzon.

Locally, traditional beliefs and educational outreach have an impact on

maternal immunization practices, attitudes, and knowledge in Cagaluan Pasil.
According to a study by Santos and Valdez (2020), many pregnant women in the
area still adhere to customs that occasionally disagree with current medical
recommendations, even though healthcare staff have enhanced the distribution
of knowledge. According to a community study conducted in 2021 by the Pasil
Municipal Health Office, local perceptions of the safety of vaccines posed a major
obstacle to increased vaccination rates. Dela Cruz (2022) also discovered that
family recommendations and firsthand experience had a significant impact on
vaccination decisions.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
Maternal immunization is also influenced by the healthcare system,
socioeconomic position, cultural norms, and the involvement of medical
professionals. Research suggests that in both urban and rural settings,
healthcare accessibility is a significant factor in determining the uptake of
vaccines (Garcia, 2020). Additionally, especially in rural areas, logistical
difficulties and financial limitations frequently prohibit expectant mothers from
receiving vaccinations (Flores, 2019). A pregnant woman’s decision to vaccinate
can be influenced by the advice of healthcare providers, who also have a big say
in the matter (Ramos, 2021)

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
CHAPTER III
METHODOLOGY
This chapter presents the methods of the research, which includes the locale of
the study, research design, sampling procedure, respondent/informant of the
study, instrumentation, data collection procedure, and the appropriate data
analysis.
The Locale of the Study
The study will be conducted in Barangay Cagaluan, located in the
municipality of Pasil. The area was chosen to evaluate the knowledge,
acceptance and attitude of pregnant women towards Tdap and influenza vaccine.

Research design

This research study will use quantitative, descriptive research design,

which provides relatively complete data of the study. The researcher will choose
the design to accumulate enough information on the study's objectives quickly,
opted to identify and assess the level of knowledge attitude and acceptance on
maternal immunization among pregnant women at Cagaluan, Pasil.

Sampling Procedure

The researchers will be acquire a simple random sampling. The

participants in this study will be the pregnant women residing in Cagaluan, Pasil.
This method will help assess their knowledge, acceptance, and attitude towards
maternal immunization specifically the Tdap and influenza vaccine. Prior to data
collection, informed consent will be obtained from each participant, ensuring they
understand the study’s purpose and procedure and voluntarily agree to
participate.

Respondents/Informants of the study

The respondents of this study will be the pregnant women residing in
Cagaluan, Pasil, who met the inclusion criteria: currently pregnant, residing in the

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
barangay, and willing to participate. Pregnant women were selected as
respondents because they are the primary focus of maternal immunization
program, and their knowledge, acceptance, and attitudes towards vaccine
directly impact the success of these programs. Participants were recruited
through local healthcare facilities, such as the barangay health center.

Instrumentation

To get appropriate data, researcher utilize a survey questionnaire modified

from related research. To gather information about their demographic profiles
and the knowledge, acceptance, and attitudes on maternal immunization,
specifically focusing on the Tdap and influenza vaccines among pregnant women
residing in Cagaluan, Pasil. The questionnaire will be divided into 4 parts.

Table 1 the profile of the respondents

Table 2 is a survey questionnaire about knowledge on maternal immunization

Table 3 is a survey questionnaire about acceptance on maternal immunization.

Table 4 is a survey questionnaire about attitude towards maternal immunization.

In determining the level of knowledge, acceptance, and attitude of the

respondent, a five-point Likert scale will be adopted to Likert R., 1932.

Scale Range Description

5 4.21-5.00 Strongly Agree

4 3.41-4.20 Agree

3 2.61-3.40 Neutral

2 1.81-2.60 Disagree

1 1.00-1.80 Strongly Disagree

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
Validity and Reliability of Instrumentation

The survey questionnaire will be presented to the Research council for

approval before the administration of Researcher’s survey. Corrections and
suggestions were incorporated. The indicator of the questionnaire will be based
on the Level knowledge, acceptance and attitude on maternal immunization
among pregnant women towards Tdap and influenza vaccine. The survey
questionnaire will be adopted necessary changes and modifications were made
by the researcher based on the objective of the study. The questionnaires are
adopted from the World health organization (WHO) 2023, Centers for disease
prevention (CDC) 2023, Brown et al.,2020, and Smith et al., 2021.

Data Gathering Procedures

The permit for conducting the study will be secured and signed by the
college dean. The data will gather via survey questionnaire. Before gaining
participants' consent, the researcher will send a letter requesting permission to
carry out the study to the necessary boards. After authorization of access to
participants, a letter of invitation will be distributed and will verbally ask
permission. Within this letter of invitation there will be a short explanation that will
comprise the aims of the study, briefly what participation will entail, the rights of
the participants, a discussion on confidentiality, and the names of the researcher
to allow participants to clarify any queries. With this letter of invitation, the
researcher will distribute the questionnaire with a consent form, which the
participant must read and approve of taking part in the study. Participants will be
given enough time to respond, and then the researcher collected the survey
questionnaires.

Their participation in the study will be voluntary, and participants had the
right to withdraw. After that, the researcher collected it prospectively to ensure
validity, reliability and as well as confidentiality of answers from the respondents.
The researcher made sure that the respondents' personal information will be kept

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
confidential and that the ethical consideration of confidentiality and privacy
remained throughout the data gathering process. After the respondents take the
questionnaires, the papers will check, be tallied, interpreted, and statistically
analyzed by an expert.

Data Analysis

Frequency and percentage distribution will be used in summarizing the

profile of respondents. Weighted means are derived and used to determine the
level of knowledge, acceptance and attitude of the respondents on maternal
immunization.

Frequency. This was used to determine the number of responses on the

identified information need in the study.

Percentage. This will be used to determine the number of respondents in relation

to the total population of the study.

Ranking. This was used to record the data into their rank ordering from largest to
smallest.

Weighted Mean. This was used to quantify the responses of the respondents
along the different indicators and variables.

Formula:  x w = WiFi/N

Where:

 x w = Weighted Mean

WiFi = Summation of weighted frequencies

N = Number of responses

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
References

Abrevaya, J., & Wagner, S. (2020). The influence of healthcare communication

on maternal immunization. Maternal and Child Health Journal,
24(5), 103- 110.

Ames, H. M. R., Glenton, C., & Lewin, S. (2019). Parents' and informal
caregivers' views and experiences of communication about routine
childhood vaccination: A synthesis of qualitative evidence.
Cochrane Database of Systematic Reviews.

Boyer, C. H., Patrick, D. L., & Getz, K. A. (2017). Increasing vaccine knowledge
and acceptance through public health campaigns and personalized
counseling. Vaccine, 35(33), 4238-4245.

Cruz, J., & Torres, R. (20 19). Maternal Immunization Awareness in the
Philippines. Journal of National Health, 20(2), 45-56.

Danchin, M. H., Biezen, R., Manski-Nankervis, J. A. E., Kaufman, J., & Leask, J.
(2021). Preparing the public for COVID-19 vaccines: How can
general practitioners build vaccine confidence and optimize uptake
for themselves and their patients? Australian Journal of General
Practice, 50(8), 494-499.

Dela Cruz, M. (2022). Maternal Immunization in rural Northern Luzon: A case

study. Journal of Local Health, 15(1), 22-30.

Frew, P. M., Saint-Victor, D. S., Owens, L. E., & Omer, S. B. (2019).

Socioecological and message framing factors influencing maternal
influenza immunization among minority women. Vaccine, 37(1), 18-24.

Garcia, L. (2020). Healthcare Access and Maternal Vaccination in the

Philippines. Health and Society Journal, 18(3), 77-85.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
Garcia, P., & Ramos, T. (2021). Improving Maternal Immunization Rates in Rural
Communities: A case Study in CAR. Journal of Public Health in the
Philippines, 18(2), 123-130.

Gauld, N. J., Braganza, C. S., & Babalola, C. O. (2021). Enhancing maternal

vaccination through midwife-led immunization promotion. Journal of
Midwifery & Women's Health, 66(1), 58-66.

Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health Behaviour: Research,
and Practice (5th ed.) Jossey-Bass

Godongwana, M., Myburgh, N., Adedini, S A., Cutland, C., & Radebe, N. (2021).
Knowledge and Attitudes towards maternal immunization:
Perspective from Pregnant and Non-Pregnant Mothers, Healthcare Providers,
Community and Leaders in a selected urban setting in South Africa.
Heliyon, 7(1).

Healy, C., & Rench, M. (2020). Global Acceptance of Maternal Vaccines:

Knowledge and Attitudes. Vaccine Journal, 33(2), 113-119.

Healy, C. M., Rench, M,a., Montesinos D. P., N& Swaim, L. S (2015). Knowledge
and attitudes of pregnant women and their providers toward
recommendations for immunization during pregnancy. Vaccine, 33(41),
5445-5451.

Kirkpatrick, D., Abbott, S., & Omer, S. B. (2018). Understanding the role of
healthcare provider recommendations in maternal vaccination uptake.
Human Vaccines & Immunotherapeutics, 14(10), 2349-2356.

Kilich, E., Dada, S., Francis, M. R., Tarrant, M., & Booy, R. (2020). Factors that
influence vaccination decision-making among pregnant women: A
systematic review and meta-analysis. PLOS One, 15(7), e0234827.

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COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
Lutz, C. S., Carr, W., Cohn, A., & Rodriguez, L. (2020). Understanding barriers
and motivators for maternal immunization: Perspectives from
providers and patients. American Journal of Preventive Medicine,
58(2), 167-175.

Larson, H. J., Paterson, P., & MacDonald, N. E. (2021). Cultural factors and
Maternal Immunization Uptake Worldwide. International Journal of
Public Health, 40(4), 102-110.

Leung, A. K., Lee, M. L., & Chu, H. M. (2020). The impact of health literacy on
maternal immunization knowledge. Journal of Community Health,
45(4), 785-791.

Navarro, J., Delos Santos, M., & Lim, S. (2022). Implementation of WHO Baby-
Friendly Hospital Initiative Protocols in Regional Hospitals in the
Philippines. Philippine Journal of Health, 25(3), 45-59.

Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, R. L., & Halsey, N. A.
(2009). Vaccine refusal, mandatory immunization, and the risks of
vaccine-preventable diseases. The New England Journal of
Medicine, 360(19), 1981-1988.

Pasil Municipal Health Office. (2021). Maternal immunization practices in

Cagaluan Pasil: Annual report. Local Public Health Journal, 12(2), 35-48.

Patel, S., Vilaj, M., & Thompson, R. (2018). Addressing Global Challenges to
Maternal Immunization: A Review of Barriers and Strategies.
Vaccine Journal, 36(24), 3456-3462.
https://doi.org/10.1016/j.vaccine.2018.03.042

Ramos, A., Villanueva, G., & Pascual, E. (2021). Maternal Employment and
Breastfeeding rates: A Study in Luzon’s Rural Hospitals.
International Journal of Maternal Health, 32(1), 67-75.

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COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
Ramos, E. (2021). Educational Initiatives for Maternal Immunization in Northern
Luzon. Journal of Health Education, 14(1), 50-60.

Rosenstock, I.M (1974) Historical Origins of Health Belief Model: Decade Later.
Heath Education Monographs, 2(4), 328-335

Sharma, M., Marshall, A., & Landry, A. (2020). Practical barriers and challenges
to vaccine acceptance among pregnant women. Journal of
Vaccination Research, 44(2), 198-204.

SAGE. (2014). Global vaccine safety initiative: WHO Strategic Advisory Group of
Experts. World Health Organization.

Valdez, T., & Santos, F. (2020). Influence of Local Beliefs on Maternal

Immunization in Rural Communities. Community Health Journal, 16(2),
44-58.

Vanderpool, R. C., Glover, S. H., & O'Rourke, J. M. (2020). Maternal

immunization knowledge: The role of socio-demographic characteristics.
Public Health Reports, 135(3), 435-441.

Villanueva, G., & Pascual, E. (2021). Cultural Practices and Maternal Health in
Kalinga: Understanding Barriers to Maternal Immunization. Philippine
Journal of Indigenous Health Studies, 14(1), 25-32.

Wilson, C., Graham, J., & Bennett, P. (2019). Vaccine Hesitancy in Low-income
Countries: A Systematic Review of the Literature. Journal of Global Public
Health, 12(7), 223-236. https://doi.org/10.1080/17441692.2019.1565267

World Health Organization. (2020). Maternal Immunization and Antenatal care:

Global Status Report. WHO Publications.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery

SURVEY QUESTIONNAIRE

The questionnaire aims to gather information on your knowledge,

acceptance, and attitudes towards maternal immunization, specifically the Tdap
and Influenza vaccine. Your responses are confidential and will only be used for
research purposes.

Name
(optional):

Date of interview:

Direction: Put a check in the box of your corresponding bracket.

TABLE I. Demographic Respondent’s Profile

a. Age: (put a check in the box of your corresponding bracket)

O 15-20 years old O 21-25 years old
O 26-30 years old O 31-35 years old
O 36 and above
b. Marital status
O single
O married
O widowed
c. Educational attainment
O Elementary Graduate O Elementary level
O Highschool Graduate O Highschool level
O College Graduate O College level
O Vocational
d. Occupation status

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
O unemployed O casual
O self-employed O none
O contractual O permanent employment
e. Family Monthly Income (check the bracket)
O Below 5,000 O 20,000 - 30, 000
O 5,000 - 10, 000 O 30,000 - 40, 000
O 10,000 - 20,000 O 50,000 and above
f. Religion
O Catholic
O Free believers
g. Length of Residency
O 0–5years O 6-10 years
O 11-15 years O 16 and above
h. Number of pregnancies (including current)
O 1(first pregnancy) O 2-3
O 4-5 O 6 or more
i. Trimester of current pregnancy
O first trimester (1-12 weeks)
O second trimester (13-27 weeks)
O third trimester (28 weeks and above)

Direction: Please put a check (/) to your corresponding answer on the proper
column

(5) Strongly Agree

(4) Agree

(3) Neutral

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery
(2) Disagree

(1) Strongly Disagree

TABLE II. knowledge on maternal immunization

INDICATORS SA A N D SD

5 4 3 2 1

1. The Tdap vaccine is recommended

during every pregnancy to protect
newborns from whooping cough.

2. Influenza vaccine is safe to receive

during pregnancy.

3. Maternal immunization helps protect

both the mother and baby from vaccine-
preventable disease.

4.The Tdap vaccine usually administered

during the third trimester of pregnancy.

5. It is unnecessary to receive the flu

vaccine if you have been vaccinated in
previous years.

6. Is it commonly known that the Tdap

vaccine is recommended during the third
trimester of pregnancy.

7. Are Tdap and influenza vaccine part of

the international guidelines for pregnant
women.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery

TABLE III: Acceptance of maternal immunization.

INDICATORS SA A N D SD

5 4 2 2 1

1. The respondent is willing to receive the

Tdap vaccine during pregnancy.

2. The respondent is willing to receive the

flu vaccine during pregnancy.

3. The respondent trust the information

provided by health care professional/BHW
about maternal immunization.

4.My family supports my decision to

receive vaccine during pregnancy.

5. The respondent is willing to get

vaccinated even if I experienced minor
side effect.

6. The respondent is open to maternal

immunization despite cultural or religious
belief.

7. The respondent feels motivated to get

vaccinated after hearing about its
importance from peers/family.

8.Do you believe that vaccines are

compatible with your cultural or practices
beliefs.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery

TABLE IV: Attitudes towards maternal immunization.

INDICATORS SA A N D SD

5 4 3 2 1

1. The respondent concerned about the

side effect of vaccine during pregnancy.

2. The respondent feel confident in the

safety of vaccines recommended during
pregnancy.

3. Receiving vaccines during pregnancy is

unnecessary if you are healthy.

4.The respondent believe getting

vaccinated during pregnancy is a
responsible choice for my baby’s health.

5. The respondent would recommend

maternal immunization to other pregnant
women.

6. The respondent believe that lack of

information is the biggest barrier to
maternal vaccine acceptance.

7. The respondent believe that more

awareness campaigns are needed to
address vaccine hesitancy.

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery

LEVEL OF KNOWLEDGE, ACCEPTANCE AND ATTITUDE, ON

MATERNAL IMMUNIZATION AMONG PREGNANT WOMEN IN
CAGALUAN, PASIL

An Undergraduate Thesis Presented to the Faculty of the

College of Health and Natural Science in Kalinga State University

Bulanao, Tabuk City, Kalinga

In Partial Fulfillment of the requirements for the Degree of

Bachelor of Science in Midwifery

Jayhanne B. Bagni

December 2024

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 KALINGA STATE UNIVERSITY
COLLEGE OF HEALTH AND NATURAL SCIENCES
Bachelor of Science in Midwifery

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