KWESTIYONEYR

Appendix A
Questionnaire on the Use of Complementary and Alternative Medicine and Perceived

Severity of Disease of Cardiovascular Disease Outpatients in Philippine General Hospital
Greetings! We are undergraduate students from the College of Public Health,

UP Manila, and we are conducting a study regarding the use of
complementary and alternative medicine among cardiovascular disease
patients in the Philippine General Hospital. The information that you will
provide will be kept strictly confidential. Answering this questionnaire is fully
up to you. You may opt to stop answering this questionnaire at any point.
Should you willingly participate in our study by answering this questionnaire,
we implore you to answer each question as honestly, accurately, and
completely as you can. We will be happy to answer any question you may
have. Thank you for your time.
Identification No. _______
DEMOGRAPHIC DATA
Age: ________
*Edad:________
Marital Status:
*Marital Status:
Sex: Male
Female
Kasarian: Lalaki
Babae
Single
Married
Separated
Widowed/Widower
Hindi pa kasal Kasal
Hiwalay
Biyudo/Biyuda
Highest educational attainment:

None
Elementary
High school
College Postgraduate
*Pinakamataas na naabot na lebel ng edukasyon
Hindi nakapagaral
Elementarya High school
Kolehiyo
Postgradweyt
Employment status:
*Estado ng Trabaho:
Employed
Not employed
Kasalukuyang may trabaho
Walang trabaho
Monthly income:
Less than P 2000 /month
P 2001 to P 5000 /month

P 5001 to P 10000 /month
More than P 10000 /month
*Buwanang Sweldo
Kulang sa P 2000 /month
P 2001 to P 5000 /month
P 5001 to P 10000 /month
Higit sa P 10000 /month
CONVENTIONAL CVD TREATMENT
Type of cardiovascular disease:
stroke
heart attack
hypertension
Uri ng cardiovascular na sakit
stroke
heart attack
hypertension
How long have you had this disease? _
_
*Gaano
na
katagal
ang
inyong
sakit?
____________________________________________
How long have you been receiving any treatment for this disease? _
_
*Gaano na katagal ang inyong paggamit ng gamut o lunas sa sakit?
___________________
Below is a table with the common treatment methods prescribed by doctors
for treating CVDs. Please fill in with your information as accurately as
possible.
Prescribed
Did your Have
Treatment
doctor
Price
you?
you Frequency
you used treatmen currently
prescribe it in the t
this
of Are
to past?
(pls. using/tak
indicate
in Pesos
ing it?
(pls.
indicate
how
many
times you use

it
per
per
day/week/mo
month)
_
nth)
ACE inhibitors
Aldosterone
_
_
Inhibitors
Angiotensin II
Receptor
Blocker (ARBs)
_
_
Beta-Blockers
Calcium
Channel
Blockers
Cholesterol-
Lowering
_
_
Drugs
_
_
Digoxin
_
_
Diuretics
Inotropic
_
_
Therapy
Potassium or
Magnesium
supplements
_
_
Vasodilators
_
_
Warfarin
Antiplatelet
_
_
agents
Digitalis
_
_
medications
How did you come to know of the existing CAM treatments for CVD?
Health personnel of health center / hospital

Health personnel outside of a health center / hospital
Friends
Family members
CAM practitioner
Mass Media (TV, newspaper, radio, magazines, etc.)
People from your church or religious group
Other patients
Others || pls specify: _
_
Have you used any treatment other than the ones prescribed by your doctor?
Yes
No
Below are CAM treatments usually used by CVD patients. If you have taken
any of them in the past, or are currently using them, please indicate the
price you spend for each treatment per month.
*Ang mga sumusunod ay mga uri ng CAM na ginagamit ng mga pasyenteng
may CVD. Kung mayroon sa mga sumusunod ang nagamit na sa nakaraan o
kasulukuyang ginagamit, maari lamang na isulat ang presyo nito kada
buwan.
Are there other types of complementary and alternative medicine that you
know/used but is not listed above? Yes
No
If yes, please specify the name of the treatment and how much you
spent/spend per month:
Name
of
treatment
1.
CAM Price
spent
per
month
2.
3.
*Mayroon bang uri ng CAM na iyong ginamit o ginagamit na hindi nakalista?
Yes
No
Kung mayroon, maaari bang isulat ang lunas na ito at ang presyong
kaakibat.
Pangalan ng CAM
Presyo kada buwan
1.
2.
3.
How long have you been using complementary and alternative medicine?
less than 1 year
1 year
more than 1 year
*Gaano katagal ka ng gumagamit ng CAM?
kulang sa isang taon
isang taon
higit sa isang taon
How do you use your CAM and prescribed treatment as your treatment
progresses?
Use both CAM and prescribed treatment at the same time
Use CAM instead of prescribed treatment
Use prescribed treatment instead of CAM
*Paano niyo ginagamit ang CAM at ang gamut o lunas na inireseta sa inyo ng
doctor?
Ginagamit ang pareho ng sabay
Ginagamit ang CAM kaysa iniresata ng doctor
Ginagamit ang inireseta ng doktor kaysa CAM
What are your reasons for deciding to use CAM?
You were disappointed that conventional treatment is not working
for you.
Conventional treatment is too toxic or mutilating.
Conventional treatment is too mechanistic / technological and lacks
human touch.
Conventional treatment is expensive.
You are just trying everything that can help.
Others || pls specify: _
_
_
_
_
_
*Anu-ano ang iyong mga rason sa paggamit ng CAM?
Hindi ka masaya sa resulta ng lunas na inereseta sa iyo ng doctor
Ang inereseta ng doktor ay hindi nakakabuti sa kalusugan ng

pasyente
Ang inereseta ng doktor ay masyadong mekanikal at teknikal
gamitin.
Ang inereseta ng doktor ay masyadong mahal.
Nais mo lamang masubukan lahat ng paraan na pwedeng
makatulong sa sakit.
Iba pang dahilan :
________________________________________________
________________________________________________
________________________________________________
________________________________________________
What benefits are you hoping to get from the CAM that you are using for your
CVD?
It will directly treat/cure your CVD.
It will boost your bodys ability to cure the CVD.
It will relieve symptoms of the conventional treatment which you are
receiving.
It will relieve the symptoms of CVD.
It will improve your psychological/emotional well-being.
It is your way of doing everything you can to fight the CVD.
It will improve your physical well-being.
Others || pls specify:_
_
_
_
_
_
*Anu-anong mga benepisyo ang iyong inaasahan sa paggamit ng CAM para
sa iyong CVD?
Gagaling ako sa aking CVD.
Mapapalakas nito ang aking katawan para gumaling sa CVD
Mababawasan nito ang mga sintomas na kaakibat ng paggamit na
mga ineresetang gamot.
Mababawasan nito ang mga sintomas ng CVD.
Mapagbubuti nito ang aking mental na kalagayan.
Ito ang aking paraan para labanan ang CVD.
Mapagbubuti nito ang aking pisikal na kalagayan.
Iba pa: ________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Have you obtained any particular benefit from the CAM treatment(s) that you
used for CVD?
Yes || pls specify: _
No
*May nakamtan ka na bang magandang benepisyo sa paggamit ng CAM para

sa CVD?
Oo || isulat : ____________________________________________________
Wala
Did you experience any unwanted effect from the CAM treatment(s) that you
have used for CVD?
Yes || pls specify: _
_
No
*Mayroon ka na bang naranasang hindi kanais-nais na epekto ng paggamit
ng CAM para sa CVD?
Oo || isulat : ____________________________________________________
Wala
How satisfied are you with the performance of the CAM you have used for
CVD?
Not satisfied
Satisfied
Very satisfied
*Gaano ka ka-kuntento sa mga epekto ng CAM na iyong ginagamit para sa
iyong CVD?
Hindi kuntento
Sapat
Kuntento

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Appendix A

Questionnaire on the Use of Complementary and Alternative Medicine and Perceived

Greetings! We are undergraduate students from the College of Public Health,

Highest educational attainment:

P 2001 to P 5000 /month

Did your Have

you used treatmen currently

times you use

Health personnel of health center / hospital

Presyo kada buwan

Ang inereseta ng doktor ay hindi nakakabuti sa kalusugan ng

*May nakamtan ka na bang magandang benepisyo sa paggamit ng CAM para

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