ASSUMPTION SCHOOL PASSI CITY, ILOILO, INC.
Saligumba Street, Passi City, Iloilo
Government Recognition No. 49 s. 2005
Tel. # 311-6263/5245
ASPCI, a home where you can be your best
February 23, 2022
Good Day!
We, the Grade 12 Senior Highschool Students of STEM Strand of Pope Paul VI section from
Assumption School Passi City, Iloilo, Inc., with the members: Kaye Ann Cocjin, Kreisha Kate Panizal, Angel
Zyla Prado, and James Bernard Sacueza are currently working on our research study entitled “An Assessment
of Passinhons’ Healthy Lifestyle,” in partial accomplishment for our subject Practical Research 2 as required. A
constructed survey questionnaire will be utilized in the said research.
In line with this, we would like to request for your knowledge and assistance in validating and approving
the corresponding questionnaires to meet all requirements for conduction prior to administering it to the
respondents of this survey, knowing your encounter in handling research and education. We included here the
survey questionnaires with specified characters on the table, and with legends and directions for answering.
Attached herewith is the statement of the problem for validating the appropriateness of the questionnaire in
measuring the desired data for the problem.
We will be very pleased to hear your remarks and suggestions for the refinement of our research
instrument. We are hoping that our request would justify your positive response, and it would be exceptionally
valued. Thank you for your cooperation and generosity. God Bless!
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To the respondents:
We would like to ask for your time in responding to this survey which aims to assess the healthy
lifestyle of the Passinhons. We will be needing these data to accomplish our requirements for our subject,
Practical Research 2, at Assumption School Passi City, Iloilo, Inc. Your identity and private information will
remain confidential. Much thanks to you for your generous time and cooperation.
Sincerely,
The Researchers
QUESTIONNAIRE
(Adapted from BMC Public Health (2014) by Darviri et al.)
Part I: Personal Data Sheet
Name (optional): ____________________________________________________________________
Gender: ____ male ____ female Marital Status: ____ Unmarried ____ Married
Age: ___ 20 to 25 y.o. ____ 26 to 30 y.o. _____ 31 to 40 y.o. _____41 y.o. and above
Educational Attainment: ____ Secondary or Lower ____ Tertiary
Smoking: _____ Yes _____ No Disease/Ailment: _____ Yes _____ No
Weight in kg: ______________ Height in meter: ________________
Rate your health on a scale from 1 to 10, in which 10 denoted excellent health: _________
Sleep Quality (SQ)
• Are you satisfied with your sleep?
___ Not at all (0) ___ Little (1) ___Moderate (2) ___Very (3) ___Very much (4)
• Do you take any drug in order to sleep? ___ Yes (-1) ___ No (0)
• Do you fall asleep easily? ___ Never (0) ___Sometimes (1) ___Often (2) ___Always (3)
• Do you feel restful after awakening?
___ Never (0) ___Sometimes (1) ___Often (2) ___Always (3)
Directions: The following are statements about you. Please indicate if you agree with the statements by
checking the corresponding column applicable to you using the rating scale below. Express your opinion by
being honest and sincere in answering the questionnaire.
Legend: 1 - Strongly Disagree
2 - Disagree
3 - Neither Agree nor Disagree
4 - Agree
5 - Strongly Agree
(For the validators, please fill up the second table on the right and refer to the legend below to
evaluate/validate each statement:
Kindly put a check mark (✓) after the item if it is appropriate (A); Not appropriate (NA); Appropriate but
needs revisions (ANR).
Part II-A. Dietary Healthy Choices
A
N
Statement 1 2 3 4 5 A N Remarks
A
R
1. I am careful about how much food I put
on my plate.
2. I check the food labels before buying a
product.
3. I calculate the calories of my meals.
4. I limit fat in my meals.
5. I consider every ingredient that I add on
my food.
6. I make sure to consume enough nutrients
in a day.
7. I eat whole-wheat products.
8. I drink enough amount of water every day.
Part II-B. Dietary Harm Avoidance
A
N
Statement 1 2 3 4 5 A N Remarks
A
R
1. I avoid eating packaged- or fast-food
2. I avoid soft drinks and/or acidic
beverages.
3. I avoid eating when stressed or
disappointed.
4. I avoid binge eating when you are out
with friends.
Part II-C. Daily Routine
A
N
Statement 1 2 3 4 5 A N Remarks
A
R
1. I eat my meals at the same time each day.
2. I am careful about not skipping a meal
each day.
3. I eat a healthy breakfast.
4. I sleep at the same time each day.
5. I follow a scheduled program for my
daily activities.
Part II-D. Organized Physical Exercise
A
N
Statement 1 2 3 4 5 A N Remarks
A
R
1. I practice aerobic exercise for 20 or more
minute at least 3 times per week.
2. I exercise in an organized manner.
3. I create or follow a fitness/workout
routine.
Part II-E. Social and Mental Balance
A
N
Statement 1 2 3 4 5 A N Remarks
A
R
1. I share my personal problems or worries
with others.
2. I concentrate on positive thoughts during
difficulties.
3. I empty my brain of thoughts or the next
day’s program during bedtime.
4. I care about meeting and discussing with
my family on a daily basis
5. I balance my time between work, personal
life and leisure.
Comments:
Suggestion:
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Sincerely yours, Noted by:
KREISHA KATE D. PANIZAL LEOPOLDO II L. MAGBANUA
Research Leader Research Teacher
JOLENA YANSON
Research Adviser
Approved by:
LENNON RENDON
Research Validator
Statement of the Problem
This study entitled “An Assessment of Passinhons’ Healthy Lifestyle” aims to determine and compare
the extents of the Passinhons’ healthy lifestyle based on their Dietary Healthy Choices, Dietary Harm
Avoidance, Daily Routine, Organized Physical Exercise, and Social and Mental Balance when grouped
according to gender, marital status, age, educational attainment, smoker or not, and with and without
disease/ailment. This study aims as well to determine if there are relationships that exist between these data to
the different variables such the respondents’ Body Mass Index (BMI), Sleep Quality, Perceived Stress Scale,
and Health Assessment.
Specifically, it will seek answers for the following questions:
1. What is the extent of the Passinhons’ healthy lifestyle (Dietary Healthy Choices, Dietary Harm
Avoidance, Daily Routine, Organized Physical Exercise, and Social and Mental Balance) when grouped
as a whole and according to:
a. Gender?
b. Marital status?
c. Age?
d. Educational attainment?
e. Smoking status?
f. Disease/ailment status?
2. What is the Passinhon respondents’ Body Mass Index (BMI), Sleep Quality, Perceived Stress Scale, and
Health Assessment?
3. Is there a significant difference among and between the extents of the Passinhons’ healthy lifestyle
(Dietary Healthy Choices, Dietary Harm Avoidance, Daily Routine, Organized Physical Exercise, and
Social and Mental Balance) when grouped according to:
a. Gender?
b. Marital status?
c. Age?
d. Educational attainment?
e. Smoking status?
f. Disease/ailment status?
4. Is there a significant relationship that exist between the extent of Passinhon respondents’ total healthy
lifestyle to their:
a. Body Mass Index (BMI)?
b. Sleep Quality?
c. Perceived Stress Scale?
d. Health Assessment?
