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    DE LA SALLE HEALTH SCIENCES INSTITUTE COLLEGE OF MEDICINEDEPARTMENT OF FAMILY AND COMMUNITY MEDICINE

    CM2 SY 2011-2012

    OUTPUT 6: DATA COLLECTION TOOL (REVISED)

    SUBMITTED ON:

    OCTOBER 13, 2011

    SUBMITTED TO:

    DR. JOVILIA M. ABONG

    SUBMITTED BY:

    GROUP 1A

    ARCAIRA, JOSHUA A.

    ABAD, MARY RAINA ANGELI

    ANCHETA, JONATHAN B.

    BASUL, CHARINE

    CARAVEO, JULIEN NICOLE

    CRUZ, SPICA

    ESPINOZA, FAITH KRISTINE

    GARCIA, RAY WILSON

    KALALO, GERARD MICHAEL

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    OUTPUT 6: DATA COLLECTION TOOL (REVISED)I. Group 1A, Dr. Jovilia M. Abong

    II. Research Question: Among second year high school students with allergic rhinitis of selected schoolsin Dasmarias, Cavite, will exposure to air-conditioned school rooms affect the severity of theirallergic rhinitis?

    General Objective: To determine if the exposure to the air-conditioning system affects the severityof allergic rhinitis in second year high school students of selected schools in Dasmarias, Cavite.

    Specific Objectives:1. To identify the prevalence of allergic rhinitis among second year high school students of selected schools in of Dasmarias, Cavite based on their exposure to air-conditioned rooms.2. To identify the prevalence of allergic rhinitis among second year high school students of selected schools in Dasmarias, Cavite based on their exposure to non-air-conditioned

    classrooms.3. To determine the severity of allergic rhinitis according to ARIA classifications.4. To identify the risk factors of allergic rhinitis present in the classroom or school, such as thepresence of molds, chalk dust, house dust, and cockroaches.5. Compare the severity of allergic rhinitis in students who are exposed to air-conditionedclassrooms and those who are not exposed to air-conditioned classrooms.

    III. Research Design: Cross-Sectional Study

    IV. Variables/ Data to be Collected :

    In this study, we will determine if the presence of an air-conditioning system will affect the severity of astudents Allergic Rhinitis in their classroom environment. In doing so, we will observe each classro ombeing studied, screen for those who have Allergic Rhinitis and administer a questionnaire to evaluateones Allergic Rhinitis. By doing so, the following information will be collected:

    1.) Prevalence of Allergic Rhinitis in air-conditioned classrooms2.) Prevalence of Allergic Rhinitis in non air-conditioned classrooms3.) Classroom Conditions (such as presence of molds, cockroaches, house dust and chalk dust)4.) Severity of each students Allergic Rhinitis according to ARIA classification

    V. Methods to be used in Collecting Data and Reason for Choosing the particular Method over the

    other Methods:

    The methods to be used in data collection would be 2 questionnaires and 1 checklist, specifically:

    1. ISAAC Questionnaire for screening the presence or absence of allergic rhinitis.2. ARIA Questionnaire for determining severity of a students allergic rhinitis. 3. Checklist for checking of classroom conditions such as molds, cockroaches, house

    dust and chalk dust.

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    Our group chose to use questionnaires and checklists as methods of collecting data for our study. Theresearchers prefer questionnaire and observation over the review of records because the data that we arecollecting are not written in records. We also chose them over the interview because having aquestionnaire or checklist is more efficient, it is standardized and it provides anonymity (equality). Therespondents are not also influenced by the interviewer or researcher unlike in the interview. The focus

    group discussion is not included among the data collection methods chosen because it is similar to aninterview but it is done with a group of respondents. Focus group discussion is also used to collect datafor perceptions, feelings, insights, manner of thinking and factors that affect complex behaviour and isalso used for large scale study both of which are not part of the scope of the study.

    The researchers chose these methods because we deem it more necessary that those directlyexposed to our variables (i.e. students and teachers) be the ones to provide sufficient information for thestudy. Also, the students (who have allergic rhinitis) are the ones more knowledgeable on the effects of environmental factors and room conditions to the exacerbation of their allergic rhinitis, if there are any.Moreover, the researchers are also going to use checklists to check the conditions in and out of theclassroom. The checklists will be used by the researchers themselves to prevent the occurrence of bias in

    process of data collection because if these were administered to the teachers for checking, they might notanswer honestly and truthfully about their classroom conditions.

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    VI. Data Collection Tools:

    1. ISAAC QUESTIONNAIRE FOR SCREENING STUDENTS

    Study Instruments for 13/14 year olds

    Instructions for Completing Questionnaire and Demographic Questions (Section 7.1)

    On this sheet are questions about your name, school, and birth dates. Please write your answers to thesequestions in the space provided.

    All other questions require you to tick your answer in a box. If you make a mistake, put a cross in the boxand tick the correct answer. Tick only one option unless otherwise instructed.

    ___________________________________________________________________________________

    SCHOOL:

    TODAYS DATE:Day Month Year

    YOUR NAME:

    YOUR AGE: years

    YOUR DATE OF BIRTH:Day Month Year

    (Tick all your answers for the rest of the questionnaire)

    Are you: MALE FEMALE

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    Core Questionnaire for Allergic Rhinitis (Section 7.3)

    All questions are about problems which occur when you DO NOT have a cold or the flu.

    1 Have you ever had a problem with sneezing, or a runny, orblocked nose when you DID NOT have a cold or the flu?

    YesNo

    IF YOU HAVE ANSWERED NO PLEASE SKIP TO QUESTION 4.

    2 In the past 12 months, have you had a problem with sneezing,or a runny, or blocked nose when you DID NOT have a coldor the flu?

    YesNo

    IF YOU HAVE ANSWERED NO PLEASE SKIP TO QUESTION 4.

    3 In the past 12 months, has this nose problem beenaccompanied by itchy-watery eyes?

    YesNo

    4 Have you ever had hay fever? YesNo

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    2. CHECKLIST FOR CLASSROOM CONDITIONS

    Checklist for the presence of MOLDS (http://www.moldunit.com/mold-detection.html)

    Yes No 1. Presence of water leaks coming from either rain or air-conditioning units apparent on

    the ceiling, walls and pipes or stagnant water.Yes No 2. Wet cellulose materials such as paper, cardboard, ceiling tiles and wood products.Yes No 3. Appearance of a cottony, velvety, granular or leathery like dirt (in any shade of color)

    near or within the area where there are water leaks.Yes No 4. Inspect walls, under carpeting, under cabinets and air ducts for hidden molds.

    Checklist for the presence of COCKROACHES (http://www.ehow.com/how_7744440_tell-roaches.html) (http://www.roebourne.wa.gov.au/Assets/environment/hs-0025%20cockroach%20management.pdf)

    Yes No 1. Presence of dripping faucets and bathrooms.Yes No 2. Presence of eggs of roaches, dead roaches, insect parts or feces (black gritty substance,

    pepper-like) under the cabinets or behind walls and appliances, and sight of cockroachesthemselves.

    Yes No 3. Evidence of holes from chewing such as paper and cardboards.

    Checklist for the presence of HOUSE DUST

    Yes No 1. Presence of curtains, pillows, carpetsYes No 2. Presence of dust when you touch or rub with your hand the materials mentioned

    above.Yes No 2. Presence of dust above the tables, chairs, window sills, and the floor.

    Checklist for the presence of CHALK DUST

    Yes No 1. Presence of chalk (for writing on the board) and specify if it is dustless or not.Yes No 2. Presence of chalk dust in corners of the board and on the board eraser.Yes No 3. Presence of a wet rag for cleaning the chalk board.Yes No 4. Presence of a box for cleaning the board eraser.

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    3. ARIA QUESTIONNAIRE

    1. What symptoms do you have?(Answer Yes for any of the symptoms listed below that apply. Answer No for all that do not.)

    Watery runny nose Yes No

    Sneezing (especially violent and in bouts) Yes No Nasal obstruction (feeling of being unable to breathe through your nose) Yes No Itchy nose Yes No Watery, red, itchy eyes Yes No

    2. How long do your symptoms last?(Answer Yes or No for each time frame below.)

    More than four days a week Yes No More than four weeks in a row Yes No

    3. How do your symptoms affect you?(Answer Yes for any of the symptoms listed below that apply. Answer No for all that do not.)

    My symptoms disturb my sleep. Yes No My symptoms restrict my daily activities (sports, leisure, etc.) Yes No My symptoms restrict my participation in school or work. Yes No My symptoms are troublesome to me. Yes No

    4. How much do your symptoms bother you?(On a scale of 0 to 10, with 0 being Not at all and 10 as Very much, indicate how much your symptoms bother you Tick onlyone.)

    0 4 8 1 5 9 2 6 10 3 7