Republic of the Philippines
\ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija
COLLEGE OF ARCHITECTURE
Research Participation and Consent
Do you voluntarily agree to participate in this study and consent to the use of your responses for academic research purposes
only?(Sumasang-ayon ka ba na boluntaryong lumahok sa pag-aaral na ito at payagan ang paggamit ng iyong mga sagot para
lamangsalayuning pang-akademiko?)
Your participation is completely voluntary, and all responses will be treated with the strictest confidentiality in compliance with
the Data Privacy Act of 2012 (RA 10173). Only I, the researcher, will have access to the gathered data, and no personally
identifiable information will be disclosed in the final study.
__ YES ___ NO
Part 1. Demographic Profile: Please fill in the blanks.
Name: (optional)
Address: (optional)
Age of the Respondent: (optional)
Sex of the Respondent: (optional)
City/ Municipality: (optional)
For Cancer Patient
1. What design features or spaces would make your treatment experience more comfortable?
(Anong mga bagay o puwesto sa loob ng kwarto ang magpapagaan ng loob mo habang nagpapagamot?)
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2. How important are factors like lighting, privacy, and accessibility for you?
(Gaano ba kahalaga para sa 'yo 'yung tamang ilaw, 'yung may sarili kang privacy, o 'yung madali lang puntahan 'yung lugar?
Bakit ito mahalaga?)
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3. What support services (counseling, waiting areas, recreation) would you like to see in the center?
(Bukod sa gamot, anong mga tulong ang gusto mong makita dito? Tulad ng may makakausap nang masinsinan, komportableng
waiting area, o mga pampalibang?)
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4. How helpful would it be if the facility also provided community programs like education or livelihood support? Why?
(Nakakatulong kaya kung mayroon ding mga programa dito para sa komunidad, tulad ng mga seminar o tulong pangkabuhayan?
Bakit?)
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5. What would make you feel more emotionally supported during your treatment?
(Ano sa tingin mo ang magpaparamdam sayo na may karamay ka, lalo na habang ikaw ay sumasailalim sa mag gagamot?)
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Republic of the Philippines
\ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija
COLLEGE OF ARCHITECTURE
Research Participation and Consent
Do you voluntarily agree to participate in this study and consent to the use of your responses for academic research purposes
only?(Sumasang-ayon ka ba na boluntaryong lumahok sa pag-aaral na ito at payagan ang paggamit ng iyong mga sagot para
lamangsalayuning pang-akademiko?)
Your participation is completely voluntary, and all responses will be treated with the strictest confidentiality in compliance with
the Data Privacy Act of 2012 (RA 10173). Only I, the researcher, will have access to the gathered data, and no personally
identifiable information will be disclosed in the final study.
__ YES ___ NO
Part 1. Demographic Profile: Please fill in the blanks.
Name: (optional)
Address: (optional)
Age of the Respondent: (optional)
Sex of the Respondent: (optional)
City/ Municipality: (optional)
For Dialysis Patient
1. What environment helps you feel more relaxed during dialysis?
(Anong klaseng kapaligiran ang nagpapagaan ng pakiramdam mo habang naka-dialysis?)
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2. What spaces or services (rest area, canteen, prayer room, etc.) do you wish were available near the treatment area?
(Anong mga lugar o serbisyo ang sana ay malapit lang sa paggagamutan? Tulad ng pahingahan, canteen, o chapel?)
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3. How important is accessibility for elderly or mobility-impaired patients?
(Para sa 'yo, gaano kahalaga na ang lugar ay accessible para sa mga matatanda o 'yung mga may kapansanan?)
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4. Would you participate in health education or support programs if they were offered in the facility?
(Sasali ka ba kung magkaroon ng mga health education o mga support programs dito sa facility?)
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5. What improvements would make your overall treatment experience better?
(Sa tingin mo, anong mga pagbabago ang magpapagaan sa karanasan mo sa pagpapagamot dito?)
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Republic of the Philippines
\ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija
COLLEGE OF ARCHITECTURE
Research Participation and Consent
Do you voluntarily agree to participate in this study and consent to the use of your responses for academic research purposes
only?(Sumasang-ayon ka ba na boluntaryong lumahok sa pag-aaral na ito at payagan ang paggamit ng iyong mga sagot para
lamangsalayuning pang-akademiko?)
Your participation is completely voluntary, and all responses will be treated with the strictest confidentiality in compliance with
the Data Privacy Act of 2012 (RA 10173). Only I, the researcher, will have access to the gathered data, and no personally
identifiable information will be disclosed in the final study.
__ YES ___ NO
Part 1. Demographic Profile: Please fill in the blanks.
Name: (optional)
Address: (optional)
Age of the Respondent: (optional)
Sex of the Respondent: (optional)
City/ Municipality: (optional)
For Barangay Health Workers (BHW)
1. Can you describe your role in assisting patients with chronic illnesses such as cancer and kidney disease?
(Paano mo tinutulungan 'yung mga pasyente sa barangay n'yo na may malulubhang sakit tulad ng cancer at sa bato?)
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2. What common issues do patients in your barangay experience when seeking treatment?
(Ano 'yung mga karaniwang problema ng mga pasyente sa inyo pag naghahanap sila ng gamot o pagpapagamot?)
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3. What are the challenges in linking patients from the barangay to larger healthcare facilities?
(Ano 'yung mga kadalasang challenges pag ini-refer n'yo 'yung pasyente papunta sa mas malalaking health center o ospital?)
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4. How could coordination between local health units and major hospitals be improved?
( Paano 'yung proseso n'yo ng pakikipag-ugnayan sa city health office o sa mga ospital kapag kailangan ng espesyalista ang
pasyente?)
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5. How can a community-based healthcare facility support local health education and outreach?
(Paano ba mas magagampanan ng isang health center dito sa komunidad ang pagpapalaganap ng tamang kaalaman sa
kalusugan?)
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6. What suggestions do you have to make the center more effective and accessible to the public?
(May mga suhestyon ka ba kung paano mas magiging epektibo ang serbisyo ng center at mas madali itong mapuntahan ng mga
tao?)
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Republic of the Philippines
\ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija
COLLEGE OF ARCHITECTURE
Research Participation and Consent
Do you voluntarily agree to participate in this study and consent to the use of your responses for academic research purposes
only?(Sumasang-ayon ka ba na boluntaryong lumahok sa pag-aaral na ito at payagan ang paggamit ng iyong mga sagot para
lamangsalayuning pang-akademiko?)
Your participation is completely voluntary, and all responses will be treated with the strictest confidentiality in compliance with
the Data Privacy Act of 2012 (RA 10173). Only I, the researcher, will have access to the gathered data, and no personally
identifiable information will be disclosed in the final study.
__ YES ___ NO
Part 1. Demographic Profile: Please fill in the blanks.
Name: (optional)
Address: (optional)
Age of the Respondent: (optional)
Sex of the Respondent: (optional)
City/ Municipality: (optional)
For Medical Professionals
1. What are the most common issues faced by dialysis and cancer patients in existing facilities?
(Base sa nakikita n'yo, ano 'yung mga pinaka-karaniwang reklamo o problema ng inyong mga pasyente ng dialysis at cancer sa
mga pasilidad ngayon?)
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2. What design features or spaces do you consider essential for patient care and staff efficiency?
(Para sa inyo, anong mga disenyo o espasyo ang talagang kailangan para sa maayos na pag-aalaga ng pasyente at para mas
mabilis ang galaw ng staff?)
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3. How can the center incorporate community-oriented programs to improve healthcare delivery?
(Paano ba maaring isama ng isang health center ang mga programang pang-komunidad para mas lalong gumanda ang
serbisyong medikal?)
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4. What recommendations can you give to ensure that the proposed facility promotes holistic healing, addressing physical,
emotional, and social well-being?
(Ano ang mairerekomenda n'yo para siguraduhin na ang bagong pasilidad ay tutulong hindi lang sa pisikal na pangangatawan,
kundi pati na rin sa emosyonal at sosyal na kalagayan ng pasyente?)
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Republic of the Philippines
\ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija
COLLEGE OF ARCHITECTURE
Research Participation and Consent
Do you voluntarily agree to participate in this study and consent to the use of your responses for academic research purposes
only?(Sumasang-ayon ka ba na boluntaryong lumahok sa pag-aaral na ito at payagan ang paggamit ng iyong mga sagot para
lamangsalayuning pang-akademiko?)
Your participation is completely voluntary, and all responses will be treated with the strictest confidentiality in compliance with
the Data Privacy Act of 2012 (RA 10173). Only I, the researcher, will have access to the gathered data, and no personally
identifiable information will be disclosed in the final study.
__ YES ___ NO
Part 1. Demographic Profile: Please fill in the blanks.
Name: (optional)
Address: (optional)
Age of the Respondent: (optional)
Sex of the Respondent: (optional)
City/ Municipality: (optional)
For Local Government Officials
1. What are the current challenges faced by the city in providing accessible and specialized healthcare services for cancer and
dialysis patients? (Ano po 'yung mga pangunahing hamon sa pagbibigay ng serbisyong pangkalusugan para sa mga pasyente ng
cancer at dialysis dito?
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2. What steps or programs are currently being implemented by the city government to improve healthcare accessibility for
residents?( Anong mga hakbang o programa ang kasalukuyang isinasagawa ng lungsod para mas maging accessible ang
healthcare para sa mga residente?)
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3. How can the proposed healthcare facility collaborate with barangay health units to strengthen early detection and preventive
healthcare programs?(Paano po magtutulungan ang proposed na health facility at ang mga barangay health unit para mas
mapalakas ang mga programa para sa maagang pag-check at pag-iwas sa sakit?)
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4. What are your recommendations to ensure that the project promotes inclusive, equitable, and community-centered
healthcare?(Ano po ang inyong mungkahi para masiguro na ang proyektong ito ay para sa lahat, patas, at nakatuon talaga sa
pangangailangan ng komunidad?)
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5. In what ways can the proposed facility integrate with existing community health programs to strengthen early detection,
education, and public awareness?(Paano mas isasama ng proposed na pasilidad ang mga umiiral nang health program sa
komunidad para mas maisaayos po ang early detection, edukasyon, at pagpapalaganap ng impormasyon sa publiko patungkol sa
cancer at dialysis?)
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Republic of the Philippines
\ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY
Cabanatuan City, Nueva Ecija
COLLEGE OF ARCHITECTURE
Research Participation and Consent
Do you voluntarily agree to participate in this study and consent to the use of your responses for academic research purposes
only?(Sumasang-ayon ka ba na boluntaryong lumahok sa pag-aaral na ito at payagan ang paggamit ng iyong mga sagot para
lamangsalayuning pang-akademiko?)
Your participation is completely voluntary, and all responses will be treated with the strictest confidentiality in compliance with
the Data Privacy Act of 2012 (RA 10173). Only I, the researcher, will have access to the gathered data, and no personally
identifiable information will be disclosed in the final study.
__ YES ___ NO
Part 1. Demographic Profile: Please fill in the blanks.
Name: (optional)
Address: (optional)
Age of the Respondent: (optional)
Sex of the Respondent: (optional)
City/ Municipality: (optional)
For Family Members of Patients
1. As a family member, what is the most challenging part for you when accompanying your loved one for their treatment?
(Bilang kapamilya, ano ang pinakamahirap na bahagi para sa iyo habang inaasikaso ang iyong mahal sa buhay na
nagpapagamot?)
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2. What kind of support or information do you, as a caregiver, often need but find hard to get?
(Anong klaseng tulong o impormasyon ang kailangan mo bilang tagapag-alaga, na mahirap hanapin?)
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3. How can the design of the facility (like waiting areas, information desks, or cafeterias) be improved to better support family
members?
(Paano pa kaya mapapaganda ang disenyo ng pasilidad (tulad ng waiting area, information desk, o kainan) para mas maging
komportable ang mga kapamilya?)
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4. Would you be interested in joining family support groups or educational sessions on how to care for your loved one? What
topics would be most helpful?
(Gusto mo ba sanang sumali sa mga grupo ng suporta o sa mga sesyon na magtuturo kung paano alagaan ang iyong mahal sa
buhay? Anong mga paksa ang pinakakailangan mo?)
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5. What suggestions do you have to make you and your family feel more supported and less stressed during appointments?
(Mayroon ka bang suhestyon para maramdaman mong suportado ka at hindi masyadong mabigatan tuwing may appointment?)
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