St. Scholastica’s College Tacloban Inc.
Maharlika Highway, Brgy. Campetic, Palo, Leyte 6501
COLLEGE OF NURSING
RESEARCH SURVEY QUESTIONNAIRE
This questionnaire is designed to assess the level of knowledge and perception on
the use of herbal medicine among residents of Barangay Lima, Pastrana, Leyte. Your
responses will remain confidential and used for academic purposes only. The
questionnaire consists of three sections: (1) demographic profile, (2) knowledge of herbal
medicine, and (3) perception of herbal medicine. Please answer all questions honestly.
Thank you for your participation.
Part I: Demographic Profile
Please provide the following information:
1. Age: ( ) 18 to 29, ( ) 30 to 59, ( ) 60+
2. Sex: ( ) Male ( ) Female
3. Martial Status: ( ) Single ( ) Married ( ) Divorced ( ) Widowed ( ) Separated
( ) Unknown
4. Religion: ____
Part II: Knowledge on Herbal Medicine
IIA. Please indicate if you are familiar with the following ten DOH-approved herbal
medicines: (Check all that apply)
( ) Akapulko
( ) Ampalaya
( ) Bawang (garlic)
( ) Bayabas (guava)
( ) Lagundi
( ) Niyog-Niyogan
( ) Pansit-Pansitan (ulasimang bato)
( ) Sambong
( ) Tsaang Gubat
( ) Yerba Buena (peppermint)
( ) Others: ___________
IIB. Knowledge on the medicinal purpose of herbal medicine
Statement Very Moderately Slightly Not
Aware (4) Aware (3) Aware (2) Aware (1)
1. Akapulko can be used to
treat skin problems caused
by fungi such as ringworm,
athlete's foot, and scabies.
2. Ampalaya can be used to
lower blood sugar levels
and help manage diabetes.
3. Bawang can be used to
lower cholesterol and
relieve a toothache.
4. Bayabas can be used to
treat diarrhea, swollen
gums, and to clean wounds.
5. Lagundi can be used to
treat coughs.
6. Niyog-niyogan can be
used to remove parasitic
worms from the stomach.
7. Pansit-Pansitan can be
used to relieve gout and
lower uric acid levels.
8. Sambong can be used to
get rid of excess fluid,
lessen swelling, and help
break down kidney stones.
9. Tsaang Gubat can be used
to treat diarrhea and
stomachache.
10. Yerba buena can be used
to relieve pain, such as
headaches and toothaches.
IIC. Knowledge on the preparation of herbal medicine
Statements Very Moderately Slightly Not
Aware (4) Aware (3) Aware (2) Aware (1)
1. Akapulko
Preparation: The leaves are
grinded and applied on the
skin.
2. Ampalaya
Preparation: The leaves may
be eaten as a salad or as an
ingredient in meals. It may
also be boiled with 2 glasses
of water until only half the
water is left.
3. Bawang
Preparation: The garlic bulbs
are soaked in vinegar, grilled
or fried in oil.
4. Bayabas
Preparation: The leaves are
boiled in water for cleaning
wounds or drinking.
5. Lagundi
Preparation: The leaves are
crushed and then boiled with
2 cups of water until only
half the water is left.
6. Niyog-niyogan
Preparation: The seeds are
taken out and eaten.
7. Pansit-Pansitan
Preparation: The leaves can
be eaten raw as a salad. The
leaves may also be boiled
with 2 glasses of water until
only half the water is left.
8. Sambong
Preparation: The leaves are
minced and boiled with 2
glasses of water until only
half the water is left. It is
then strained, and the
remaining water is for
drinking.
9. Tsaang Gubat
Preparation: The leaves are
chopped and boiled with 1
glass of water until only half
the water is left. It is then
strained, and the remaining
water is for drinking.
10. Yerba buena
Preparation: The leaves are
grinded and then boiled with
2 glasses of water until only
half the water is left. It is
then strained, and the
remaining water is for
drinking.
Part III. Perception of herbal medicine according to its use
IIIA. Effectiveness
Statement Strongly Agree Disagree Strongly
Agree (4) (3) (2) Disagree (1)
1. Herbal medicine is effective in
treating common illnesses such
as cough and colds.
2. Herbal medicine is effective
in managing chronic conditions
such as hypertension or diabetes.
3. The effects of herbal medicine
are mostly due to people’s
beliefs and not its properties.
4. Herbal medicine provides
noticeable relief for minor health
issues.
5. While herbal medicines work,
they don’t work as effectively as
pharmaceutical drugs.
6. Herbal medicine is effective in
preventing illness, not just
treating symptoms.
7. The effects of herbal medicine
are consistent and dependable.
8. The benefits of herbal
medicines are supported by
scientific research.
9. I have experienced health
improvements from herbal
medicine.
10. I have seen others (e.g.
family, friends) improve after
using herbal medicine.
IIIB. Safety
Statement Strongly Agree Disagree Strongly
Agree (4) (3) (2) Disagree (1)
1. Herbal medicine is generally
safe to use.
2. Herbal medicine have fewer
side effects than
pharmaceutical drugs.
3. Herbal medicine can still pose
a health risk or danger if
people use it incorrectly.
4. I feel comfortable
recommending herbal
medicine because I believe it
is safe.
5. Using large amounts of herbal
medicine without limit can
lead to harmful effects.
6. Herbal medicine has a lower
risk of causing allergic
reactions.
7. Herbal medicine can be used
by people of all age groups
when taken properly.
8. Herbal medicine is safer than
pharmaceutical drugs.
9. I have used herbal medicine
and did not experience any
harmful side effects.
10. I have seen others (e.g. family,
friends) use herbal medicine
safely without any problems.
IIIC. Accessibility
Statement Strongly Agree Disagree Strongly
agree (4) (3) (2) disagree (1)
1. Herbal medicine is generally
easy to find and obtain.
2. Herbal medicine is more
affordable and cost-effective than
pharmaceutical drugs.
3. People who live in cities may
still have trouble accessing herbal
medicine.
4. The variety and wide selection
of herbal medicine options allows
me to choose what works best for
me.
5. I or my community sometimes
experience a lack of herbal
medicine due to seasons or storms.
6. I or my community actively
plant herbal medicines.
7. I know where to find herbal
medicine even when I am
travelling.
8. I can find many herbal
medicines that address different
health concerns.
9. I have received herbal medicine
from people (e.g. family, friends,
community leaders).
10. I have given people (e.g.
family, friends) herbal medicine.