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School Health Program, Health Status, and Academic Performance of Pupils in the Province of Capiz

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CHAPTER 1
INTRODUCTION
This chapter deals with the background and rationale of the study, statement of the problem, theoretical and conceptual frameworks, significance of the study, and its scope and delimitations. It includes a review of related literature, both foreign and local, synthesis, and the conceptual and operational definition of some terms used in the study. Background and Rationale of the Study The School Health Nursing Program (SHNP)is an integral part of the total school program. The philosophy of the School Health Nursing Program is consistent with the socio-economic, cultural and political philosophy of the people. Therefore, health and nutrition education are aligned with their democratic way of life. The School Health Nursing Program is a health service offered by the DepEd for elementary school children in the province of Capiz. School nurses visit schools throughout the year to provide children with the opportunity to have their health checked; provide information and advice about healthy behaviors and link children and families to community-based health and wellbeing services. This program is designed to identify children with potential health-related learning difficulties and to respond to health concerns and observations about the child's health and wellbeing. Other activities offered by the program may include formal and informal health education and health promotion to the school community. The School Health Nursing Program plays a key role in reducing negative health outcomes and risk taking behaviors among pupils. Its focus is on prevention of ill health and problem behaviors by ensuring coordination between the school and the community based health and support services (Harmon, et. al. 2005). The School Health Nursing Program supports the school community in addressing contemporary health and social issues facing children and provides appropriate primary health care through professional clinical nursing, including assessment, care, and referral procedure and establishes collaborative working relationships among school nurses, school personnel and community health workers to assist young children. It is a free service offered by the DepEd to all schoolchildren in the province.
School nurses visit schools throughout the year to provide children with the opportunity to have a health assessment, provide information and advice about healthy behaviors and link children and families to community-based health and wellbeing services. It is also designed to identify children with potential health-related learning difficulties and to respond to parents’ concerns and observations about their child's health and wellbeing (Ruiz and Giking, 2013). The five components of the SHNP are Nutrition Education, Health Instruction, Healthful School Living, School-Community Coordination, and Referral Procedure. Nutrition Education covers the nutritional status of the children through appraisal and screening procedure while Health Instruction covers the health status of the pupils. On the other hand, healthful school living pertains to the provision of wholesome and safe environment, harmonious interrelationship and organization of a healthful school day. The health and nutrition services determine the total health and nutrition status of the children through screening tests and physical examination. The School-Community Coordination for Health and Nutrition is a coordinated endeavor to link the school with the home and the community so that there is an effective carry-over of health and nutrition habits and practices learned in the school to the home and community. The referral procedure as a component of the SHNP embraces requests made to a health or social care agencies regarding assistance for action on the health concerns of the pupils (Cuevas, et., al. 2007). The school nurse has the responsibility for providing leadership in the areas of school health nursing practice, school health policy, and school health programs. As a school nurse, one of his/her major roles is to know the pupils’ learning environment and how this affects their behavior. Technical assistance is available on a number of topics such as school health program planning, implementation and evaluation, education programs and related services for children with special health care needs, school health records, medication administration, and emergency services (Cuevas, et., al. 2007). The researcher, being a nurse, would like to find out the extent to which the pupils in the public and private elementary schools are benefited by the nursing services of the DepEd in terms of the five components of the Public Health Nursing Program. In addition, the researcher would like to find out the impact of the program on the health status of the pupils and their academic performance.
General Objective of the Study This study aims to investigate the School Health Nursing Program and its relation to the health status and academic performance of the pupils in public and private elementary school pupils in the province of Capiz for school year 2015-2016. The specific questions this study seeks to answer are: 1. What are the socio-demographic characteristics of the pupils in terms of sex, age, grade level, educational attainment of parents, employment status of parents, estimated monthly family income, and type of school? 2. What is the extent of implementation of the School Health Nursing Program In terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure when the respondents are taken as a whole and when they are grouped according to their socio-demographic characteristics? 3. What is the level of health status of the pupils in public and private elementary schools when the respondents are taken as a whole and when they are grouped according to their socio-demographic characteristics? 4. What is the level of academic performance of the respondents when taken as a whole and when they are grouped according to their socio-demographic characteristics? 5. What is the effect of the School Health Program on the health status and academic performance of the elementary school pupils? 6. Is there a significant difference in the extent of implementation of the School Health Nursing Program In terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure when the respondents are taken as a whole and when they are grouped according to their socio-demographic characteristics? 7. Is there a significant difference in the level of health status of the respondents when the respondents are taken as a whole and when they are grouped according to their socio-demographic characteristics? 8. Is there a significant difference in the level of academic performance of the respondents when the respondents are taken as a whole and when they are grouped according to their socio-demographic characteristics? 9. Is there a significant relationship between the implementation of the school health nursing program to the health status and academic performance of the respondents?
Hypotheses of the Study The hypotheses of the study are: 1. There is no significant difference in the extent of implementation of the School Health Nursing Program In terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure when the respondents are taken as a whole and when they are grouped according to their socio-demographic characteristics. 2. There is no significant difference in the level of health status of the respondents when the respondents are taken as a whole and when they are grouped according to their socio-demographic characteristics. 3. There is no significant difference in the level of academic performance of the respondents when the respondents are taken as a whole and when they are grouped according to their socio-demographic characteristics. 4. There is no significant relationship between the implementation of the school health nursing program to the health status and academic performance of the respondents.
Theoretical Framework This study is based on the theory of Moscato, et al.al. (2004) on the school nursing program. This theory states that school nursing as an integral part of any school system provides a variety of services such as providing health and sex education within schools, carrying out developmental screening, undertaking health interviews and administering immunization programmers. These duties are discharged by the school nurse. The provisions of health care, education and the health of the family have increased the need and demand for school health services. The components of the school heath nursing program are nutrition education, health instruction, healthful school living, school-community coordination, and referral system(Cuevas, et., al. 2007). New paradigms are evolving for school health services as school systems develop comprehensive school health programs to address the diverse and complex health problems of today's pupils and students. In addition to health issues, schools must cope with problems caused by homelessness, divorce, remarriage, poverty, substance abuse, and violence. The school nurse has a central management role in the implementation of the school health services program for all children and youth in the school. Ideally, the school nurse collaborates with primary care physicians, specialists, and local public health and social service agencies to ensure a full spectrum of effective and quality service that sustain children, youth, and their families. All school health services are delivered in the overall context of the child, the family, and the child's overall health plan (DepEd Health and Nutrition Manual, 2006).
Conceptual Framework The schematic diagram on Figure 1 reflects the conceptual framework of this study. INDEPENDENT MODERATING DEPENDENT VARIABLES VARIABLES VARIABLES
Socio-Demographic Characteristics Sex
Age
Grade Level
Educational Attainment of Parents

Employment status of Parents

Estimated Monthly Family Income

Type of School
School Health
Nursing Programs

Nutrition education

Health Instruction

Healthful School Living

School-Community Coordination

Referral Procedure

Health Status

Academic Performance

Figure1. Schematic Diagram Showing the Framework of the Study
Conceptual Framework This study used the conceptual framework advocated by Passarelli (2010) that the goals of a school health nursing program relates directly to the health service component to ensure access to primary health care. It provides a system for dealing with crisis medical situations, and provides adequate health care needs that affect the health status and educational achievement of pupils. The independent variables of the study are the socio-demographic characteristics of the pupils such as sex, age, grade level, educational attainment of parents, employment status of parents, estimated monthly family income and type of school. The independent variables influence or affect the dependent variables. It is assumed to be the cause. In this study, the dependent variables are level of health status of the pupils in public and private elementary schools and level of academic performance of the respondents which are assumed to be the effect. There are moderating variables which are the School Health Nursing Programs. Its indicators are nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure. The moderating variables sort of modify the effect or influence of the independent variables on the dependent variables. Figure 1 reflects the schematic diagram of the conceptual framework of the study. Significance of the Study The findings of this study will benefit the following: DepEd Officials. The findings of this study may serve as benchmark data which the officials of the DepEd may use in enhancing the School Health Nursing Program in order to maximize its benefits for the pupils in both public and private elementary schools in the province of Capiz. Principals and Head Teachers. Results of this study may be used by principals in public and private schools in planning strategies to improve the delivery of health service to the pupils so that they may be able to upgrade their academic performance. Health Personnel of the Schools in the Province. Findings of this study may be used as baseline information which will be used by health personnel in the province to align their health activities and programs for the efficient and effective delivery of health services in the province. Personnel of the Rural Health Units. The schools are establishing linkages of the rural health units of the province. In view of this, the personnel of the rural health units in the province may use the findings of this study to strengthen the linkage between the health personnel of the municipalities and the different elementary schools in the province. Stakeholders of the Elementary Schools. Other stakeholders of the public and private schools may use the results of the study in planning and redesigning their civic and health activities to help in achieving the goals and objectives of the School Health Nursing Program in the province. Teachers. Teachers are mandated by law to support the school health nursing program. They play an important role in the efficient and effective implementation of the program. Findings of this study will provide teachers with insights on their contributions in realizing the goals and objectives of the program. This will inspire them to exert extra efforts in helping realizing the goads of the program. Parents. The results of this study will provide information to parents which will help them understand the role they play in the health education of their children. They can help their children in establishing a healthy lifestyle. Pupils/Students. The pupils/students as direct beneficiaries of the schools health program may benefit from the results of this study through the efficient and effective implementation of the school health nursing program. This will redound to improved health status and improved academic performance of the pupils/students. Future Researchers. Findings of this study may be used by future researchers who would like to conduct researchers on the efficient and effective implementation of the school health nursing program in the elementary schools. They may enrich their researches on this issue by using qualitative and quantitative methods.
Scope and Delimitations of the Study This study pertains to the extent of the Implementation of School Health Nursing Programs and its relation to the health status and academic performance of the pupils in public and private elementary schools in the province of Capiz. The socio-demographic characteristics of the pupils are limited to sex, age, grade level, educational attainment of parents, employment status of parents, estimated monthly family income and type of school. Similarly, the indicators of the extent of implementation of the School Health Nursing Program are limited to nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure. The level of health status and academic performance of the pupils in public and private schools were manifested by the respondents themselves based on their answers in the questionnaires. The respondents of this study are1,197public and 190private elementary school pupils. A total of 1,387 respondents. A validated researcher-made questionnaire was used to gather the needed data to answer the specific questions of the study.
Review of Related Literature The review of related literature focuses on the implementation of the School Health Nursing Program. Discussions of the topics are categorized into conceptual literature, both local and foreign studies on the school health nursing programs in the elementary schools. It ends with a synthesis. A. Foreign Literature The school nurse has a crucial role in the provision of comprehensive health services to children and youth. Increasing numbers of pupils enter schools with chronic health conditions that require management during the school day. This policy statement describes the role of the school nurse in serving as a team member in providing preventive services, early identification of problems, interventions, and referrals to foster health and educational success (Davies, et., al 2008). To optimally care for children, preparation, ongoing education, and appropriate staffing levels of school nurses are important factors for success. School nurses have overarching roles they have to fulfill in providing health services to pupils and students. Responsibilities include assessment and treatment within the scope of professional nursing practice, communication with parents, referral to physicians, and provision or supervision of prescribed nursing care. The school nurses are responsible for management of the school health plan and communication about the plan to all appropriate school personnel. They have a unique role in providing school health services for children with special health needs, including children with chronic illnesses and disabilities of various degrees of severity. Children with special health needs are included in the regular school classroom setting as authorized by laws (Davies, et., al 2008). As a leader of the school health team, the school nurse must assess the pupils/student's health status, identify health problems that may create a barrier to educational progress, and develop a health care plan for management of the problems in the school setting. The school nurses ensure that the student's individualized health care plan is part of the individualized education plan. When appropriate the plan is developed and implemented with full team participation, which includes the pupil/student, teaches, family, and a physician (Penn, 2008).
The school nurse helps promote a healthy school environment. He/She provides for the physical and emotional safety of the school community by monitoring immunizations, ensuring appropriate exclusion for infectious illnesses, and reporting communicable diseases as required by law. In addition, the school nurse provides for the safety of the environment by participating in environmental safety monitoring (playgrounds, indoor air quality, and potential hazards). The school nurse also participates in the implementation of a plan for prevention and management of school violence, bullying, disasters, and terrorism events. In addition, the school nurse may also coordinate with school counselors in developing plans to enhance the health of the children. In addition, if a school determines that drug testing is a part of its program, school nurses should be included in school district and community planning, implementation, and ongoing evaluation of this testing program (Muhi, 2009).
The school health and nutrition program is an integral part of the school program. It embraces four major components namely: health and nutrition instruction, health and nutrition services, healthful and nutrition living, and school-community coordination for health and nutrition. These components are implemented through various programs and projects that are interested and supportive to one another. To ensure a functional school health and nutrition program, the school health and nutrition personnel, school administrators, supervisors, and teacher should have a working knowledge of the philosophy of health and nutrition education, the matrix of its goals and purposes as noted hereunder: the philosophy of health and nutrition education should be consistent with the socioeconomic, cultural, and political philosophy of the people. Therefore health and nutrition education should reflect their democratic ways of life, the learner being helped, is composed of body and mind, which is indivisible and interrelated, hence his education should be holistic in approach, the individual dignity and worth must be respected, he/she has intelligence, and therefore, should be given a chance to solve his/her problems, individuals differ, hence, individual differences should be taken into account, and he/she has freedom of the will but should be guided to choose and decide for the betterment of his/her own health (Del Rosso, 2009).
The supervision in public health nursing, mentioning time, competency and cooperation with clients. The interview with nurses about their perceptions of supervision in 13 public health nursing showed the nurses did their best to discharge their duties efficiently (Tveiten, 2006).
Both nurses and parents at local clinics and carried out observations with the intention of examining normality and deviation and to look closer at what public health nurses see and do not see in mother and child relationships. The fact that almost 100% of families avail of public health nursing services can, according to Neumann, show their unique and specific knowledge of children, child health and family circumstances in their districts. The public health nursing trusted status in communities can put them in a position to reach and help many parents and families, but their focus on the concept of normality can influence their approach; making it difficult for public health nurses to discover children who are victims of abuse and deficient parental care (Neumann, 2007).
In the study of Jentoft (2005), health clinics for young people. The purpose of her study was to find out how adolescents perceive the service. The study showed that the young people trusted both the service and the health professionals working there. Trust was the analytical focus of the study .
Young people’s perspectives of mental health revealed the importance of the school nurse and showed that trust, respect, authenticity and respectability as well as continuity and accessibility were important for health promoting mental health dialogues (Tinnfält, 2008). Based on the identified gap in public health preparedness competencies for PHNs, especially in mass casualty and disaster response, Polivka et al. (2008) developed 25 public health nursing competencies for public health surge events related to disaster. These are consistent with the public health emergency preparedness competencies sponsored by HRSA and with general educational competencies for RNs, but move beyond the generic clinical level of training for disaster surge into PHN-specific training on building and sustaining effective population-focused care delivery during disaster. They are tailored specifically to the knowledge needs and processes that will be encountered by PHNs during disaster surge. Stanley, et al. (2008) noted the lack of specific, competency-based educational training for PHNs in disaster surge that had been developed or evaluated for effectiveness.
Using the competencies developed by Polivka et al. (2008), Stanley et al. (2008) developed a series of competency-based educational training modules specific to the needs of PHNs in disaster surge. The course was developed and presented as The Public Health Nursing Surge Curriculum with its Explore Surge Trail Guide and Hiking Workshop. This curriculum was developed for public health nurses by nurses and nursing educators, and provides discipline-specific training for PHNs. The 25 disaster surge competencies for PHNs were presented under and linked to the three phases of emergency response: Preparedness, Response, and Recovery.
The educational offering is designed to reduce the dissonance that PHNs sometimes feel about their unique practice in light of traditional clinical approaches to emergency or disaster incidents. It provides the means for PHNs to 7 integrate consistency of thought about their role in disaster nursing” (pg. 173). The educational offering is a blended learning approach that entails 12 independent, self learning modules or ‘‘mileposts’’ in the form of the online Explore Surge Trail Guide, in combination with a 6-hour face-to-face interactive classroom Hiking Workshop session. The Public Health Nursing Surge Curriculum provides 50 hours of nursing continuing education and activity-based learning experiences, including an in-classroom seminar (Stanley, et. al., 2008). The curriculum’s use of a blended learning methodology enables public health nurses to master individual competencies toward surge capability within the public health response system. The development of the Public Health Nursing Surge Curriculum used adult learning principles to include involving learners in planning and implementing the learning activities, cultivating self-direction in learners, and fostering a spirit of collaboration in the learning setting (Knowles, et. al. 2005).
Nutrition Education is any combination of educational strategies, accompanied by environmental supports, designed to facilitate voluntary adoption of food choices and other food- and nutrition-related behaviors conducive to health and well-being. Nutrition education is delivered through multiple venues and involves activities at the individual, community, and policy levels. Studies prove that following nutrition guidelines can prevent major non-communicable diseases. Nutrition education is committed to providing a practical nutritional education to pupils/students that allows them to be able to understand the importance of nutrition to their physical health. This goal is accomplished through nutritional lessons in health. There should be attempts to insert nutrition into all the curricula through a Nutrition Themes Program such as nutrition and healthful living, nutrition in the prevention of diseases, and nutrition for longer life span. In addition to a strong commitment to nutrition education, the nutrition program is charged with updating information about the results of nutrition research that can be applied to the nutrition of the pupils/students. This goal can be accomplished through a massive campaign with the involvement of the parents and the community (Wright and Leahey, 2005). According to Ross (2010), nutrition and its effects on academic performance. The results of her study revealed that school breakfast and lunch programs are not up to par with current United States Department of Agriculture standards and that USDA standards may not be utilizing the latest research about nutrition. Proper nutrition has a direct effect on student performance and behavior in school. The literature reviewed confirmed that nutrition has a direct effect on neurotransmitters which are important in sending messages from the body to the brain. Specific dietary components were shown to have negative effects on this system, many of which are commonplace in school-aged children’s daily eating. Unfortunately, school breakfast and lunch programs, in many cases, inhibit the body’s cognitive and energy potentials by not providing proper nutrition. The problem has also added to the obesity rate amongst American students, which also has added to the lower achievement in school. Socioeconomic status seems to be an indicator of food insufficiency, which is simply the lack of available food to a household. Food insufficiency has been shown to directly affect children’s cognitive development. What schools can do to improve upon existing nutritional conditions is to provide nutritious food in the canteen. Many schools across the nation have invested in nutrition by way of enhanced breakfast and lunch programs. Some have even gone so far as to grow fresh produce in school gardens. B. Local Literature In the Philippines, public health nurses take care of the health needs of pupils and students in school. It is the duty of the Health and Nutrition Center of the DepEd to safeguard the health and nutritional well-being of all pupils and students in the public schools. School health necessitates the development of policies and guidelines that insures effective delivery of health services to pupils and students in the public and private schools. The primary role of school nurse is to support learning on all levels of education so that the educational potential of the learners is not impaired by unmet health needs. They assist in providing learners in acquiring health knowledge and developing attitudes and practices conducive to healthful living. This is anchored on the belief that academic performance of learners and instructional outcomes are determined by their quality of health. School nursing is centered on the promotion of health and wellness of the pupils/students, and the teaching and non-teaching personnel of the schools. It assists them in making choices for a healthy lifestyle and focuses on issues such as prevention of drug abuse, teenage pregnancy, malnutrition, sexually transmitted diseases and communicable and non-communicable diseases (Cuevas et al, 2007). Education and health go hand in hand. Children need to be healthy to be fit for school. Sadly, too many children in the Philippines are afflicted by everyday ailments that impact largely on their physical and mental development and limit them from getting the most from their education. The majority of Filipino children very often suffers from worm infections, sever tooth decay and from infectious diseases. Toothaches have a huge impact on the quality of life of children and on their ability to learn. Diarrhea, stomachaches, and itchy skin infectious also contribute to poor participation and school absenteeism. Even the best education system cannot guarantee high academic performance when students are frequently ill or in pain Monse, at. al., (2011). However, many of these diseases and ailments are preventable. There are simple, scientifically proven interventions that greatly limit their occurrence and transmission. The key is good hygiene. The Essential Health Care Program (EHCP) for Filipino Children focuses on tree such interventions – daily handwashing with soap, daily toothbrushing with fluoride toothpaste, and biannual deworming. Handwashing with soap is regarded as more effective than any other single day health intervention, reducing the incidence of diarrhea by 42%to 47% and respiratory infections by up to 30%. Toothbrushing with fluoride is recognized by both the World Health Organization and FDI World Dental Federation as the most realistic way of reducing the burden of tooth decay in populations. Meanwhile, biannual deworming has been proven worldwide to reduce helminth infections by up to 30% resulting in improved nutrition and body weight. Essential Health Care Program (EHCP) is cost effective and can be easily implemented on a mass scale, even in under resourced communities. Through an existing, well-organized institution – the public school system. School is a second home to most children. Because of the country’s widespread poverty, the school is also often the only environment that is equipped with the resources to exposed children to healthy practices. By working closely with the Department of Education and Local Government Units (LGUs), we have incorporated EHCP into regular school activities that have the potential to significantly improve the health of Filipino children. The role of teachers is especially vital to the success of EHCP. Through their commitment to the program, they ensure that these interventions are correctly practiced by their students and become lifelong, healthy habits (Monse, et. al., 2011). The components of the School Health Nursing Program are nutrition education, health instruction, healthful school living, school-community coordination, and referral systems. These components are implemented through various programs and projects that are interrelated and supportive of one another. To insure a functional school health nursing program the goals and objectives should be consistent with the socio-economic, cultural and political philosophy of the people. Health and nutrition education should reflect the people’s democratic way of life (Santos 2012). The study examined the level of implementation of the School Health and Nutrition Program (SHNP) along its four components in public elementary schools. The implementation of the SHNP in public elementary schools has not been achieved to highest level for its four components in instruction, services, healthful school living and school community coordination. Assessment on the implementation of the SHNP did not differ among school principals, health personnel and selected pupils. A proposed scheme was presented by the researchers to help the school principals and health personnel in optimizing the implementation of SHNP. Strategies to address the problems encountered were formulated. Foremost were the employment of needed personnel and strategies to increase awareness about health and nutrition issues among the stakeholders (Ruiz and Guiking, 2013). In the public schools set up, the Philippines have a peculiar structure in the delivery of health and nutrition. Unlike in other countries where school health and nutrition services fall under the jurisdiction of its equivalent to the Department of Health (DOH), in the Philippines, the Department of Education (DepEd) has the sole responsibility for these services. The rationale is simple: the academic performance of a student directly correlates with his/her health and nutrition status. The healthier and nutritionally well-off a child is, the more receptive he/she is in the classroom. Another justification for DepEd to assume responsibility of health and nutrition in school is because it would enable better coordination among various players involved like school health personnel, principals, teachers, and parents. And more importantly, DepEd receives the biggest budget allocation from the national government, thus giving it more accountability to provide the basic services for all the students. Because of this experience, the government saw it best that the delivery of school health and nutrition services be a function of the DepEd and not of DOH. Thus, the responsibility is lodged on DepEd (Ilagan, 2007). Many of the diseases and malnutrition that impact school-age children are preventable and/or treatable. Schools offer a readily available infrastructure to reach children and since some treatments are inexpensive, SHN interventions are among the most cost-effective health interventions. SHN interventions also improve equity. Diseases and some forms of malnutrition affect the poor more than the non-poor. Children from poorer households are also less able to have access to or afford treatment. SHN interventions redress this inequity and unlike many educational interventions such as text-books, teacher training or others that may tend to benefit the highest achieving students the most (possibly increasing inequality in the education system), SHN benefits the poorest children more and helps those who are most disadvantaged the chance to take better advantage of their educational opportunities. The effects of health and nutrition on the academic performance of students. The problems facing Filipino children are considerable and are pressing these are directly related to health, nutrition, education, and protection. These four core threats to the optimum well-being of young children have implications in guaranteeing children’s rights to survival, protection, development and participation. The problems are closely linked and indicate an urgent need for an intensive and integrated effort to ensure the optimum development of young children . On the level of implementation of school health and nutrition program along its four components, the findings revealed that only health and nutrition education were rated as highly implemented while for health and nutrition services, healthful school living and school-community coordination were all rated as implemented. Our results agree with Babasa (2006) that the School Nutrition Program has brought moderate effects on the achievement of the pupils and it should be continuously implemented considering the pre-implementation and post-implementation so that actual effects may be quantified.
Nutrition Education The School Health and Nutrition Program is organized to help assure each child through his own effort and action to achieve the potential of which he is capable of from his educational opportunity, and thereby, contribute to the welfare of society. Public Health Nurses have the responsibility of promoting healthy nutrition. With nutrition counseling and health education, more pupils/students can be helped prevent the occurrence of major non-communication diseases. All health and nutrition personnel must be trained on the use of educational methods, approaches and media. They should be equipped with the basic communication skills. The work of nutrition educators takes place in schools, both government and non-agencies (Cuevas et al, 2007). Promoting healthy nutrition is the key to prevent many of the leading communicable diseases. Providing nutrition education to individuals and group whenever possible is an important responsibility of the nurse. This includes clients who are well, at risk, or even with disease. Target groups for nutrition education include mothers, food handlers and food service people. Educating persons in key positions to influence others like teachers, day care workers, community and civic leaders will also achieve a lot in pushing for lifestyle change. Sometimes providing nutrition education or counseling to individuals is not enough to promote healthy nutrition. The environment plays a major role in influencing nutrition related behavior, particularly in the availability and access to healthy food (Iligan, 2007). The Food and Nutrition Research Institute recommends the Nutritional Guidelines for Filipinos which aims to encourage the consumption if an adequate and well-balances diet and promote desirable food and nutrition practices on the general population. The guidelines also provide the general public with simple recommendation about proper diet and wholesome practices to promote good health for every individual and his/her family members. The guidelines are widely used by nutrition educators as framework and reference in educating the public on proper nutrition practices that can also correct or reduce risk of developing non-communicable disease. The school nurse plays a big role in motivating pupils/students to prevent unhealthy eating habits. She has the responsibility of increasing their knowledge and skills needed to engage in healthy activities that motivate them to maintain healthy behavior. In addition, she can encourage the pupils/students to practice activities that prevent non-communicable diseases such as aiming for ideal body weight, building healthy nutrition-related practices, and choosing food wisely. To maintain a healthy lifestyle, pupils/students should consume more vegetables, fruits, and root crops. They should eat a variety of foods every day (Cuevas, et,. al 2007).
Health Instruction Formal Teaching health and nutrition concepts messages are integrated in the different subject areas based on minimum learning competencies. Health instruction focuses on the promotion of health and wellness of the pupils/students. This augments the health instruction curriculum in basic education. Health instruction embraces such areas as wellness or the absence of non-communicable and communicable disease and overall health assessment of pupils/students.
Probably nothing can contribute as much to the improvement of the quality of health teaching in the schools. Such an issue considers the choice of one's objectives, the interests and needs of the pupils/students , the nature of the experiences involved in the learning process. In short, almost the entire school and community environment in which pupils and teachers function are involved in this area. This permits a broad approach to the subject of health and which is important for the pupils/students. Health teachers are generally in agreement that the traditional practice of measuring acquired knowledge, although involved in the process, is an inadequate and incomplete approach to evaluation in health instruction. Teachers and nurses always should determine the pupils/students’ health status. The pupil's health behavior should be noted and actual improvement in health habits should be appraised. In additions, the knowledge of the pupil/student should be tested. The ultimate goal of health instruction and that evaluation should include an appraisal of it.
Health instruction has been reluctant to try to measure the results of health education. To be sure it is not easy to isolate and describe quantitatively as factual knowledge. Perhaps, instead of thinking of habits, teachers might substitute the word "performance" because it may seem less formidable. Teachers evaluate performance regularly in music, art, drama, or physical activities-so why not in health. It certainly would not be difficult to determine the percentage of the class who volunteered for vaccine shots following a unit on poliomyelitis. Similarly, after the appropriate unit, it would not be difficult to determine those who dress properly for weather conditions within the limits of the willingness or economic ability of their parents to provide such necessities (Ruiz and Giking, 2012). In fact one of the measures of the success of health instruction in the school should be its impact on the behavior of parents. This impact may come indirectly through their children or directly from the school through parent-teacher contacts of various types. Cooperation of parents is essential if changes in health habits are to result, since most of these habits are learned and practiced previous to school attendance in the home environment. Certainly, many areas of behavior can be observed and recorded by one technique or another. Anecdotal records, surveys of student behavior, casual observations, and conferences with pupils/ students and parents can provide information on progress toward improved health habits and attitudes. Too often teachers teach health as a subject matter and then at the end of a period of time have to check back to find out what they have been teaching in order to prepare an examination. No other single procedure will improve the teaching in health, as much as establishing specific, crystal-clear objectives. This in turn makes for more specific teaching as the goals are more readily understood by both teacher and pupil. Evaluation is also relatively less complicated and the time-span involved in the learning process may be shortened. The learning is more functional and realistic as opposed to a vague outcome, such as better health to be realized in the future (Cuevas et al, 2007).
Healthful School Living
Healthful school living pertains to the provision of wholesome, and safe environment, harmonious interpersonal relationship and organization of a healthful school day. For a child to learn, observe and practice sound health and nutritional habits, a healthful school environment with adequate provision of facilities offers great opportunity to effect concrete application of theories learned in the classroom. A healthful environment serves as a good vehicle for acquiring knowledge pertaining to orderliness, safety, cleanliness and appreciation of beauty and the values of health and nutrition. It pertains to the provision of school environment suitable and conductive to learning. School safety and sanitation includes adequate lighting, proper ventilation, safe water supply, adequate and sanitary drinking, hand washing, tooth brushing and food washing facilities, ample space for building safe and clean school building, safe playground and apparatus, proper seating arrangement, safety from accident, hazards, freedom from noise and the provision of good drainage (Ruiz and Giking, 2013).
The objective of healthful school living are provide and environment conductive to optimum growth and development; educate school teachers and other school personnel to appreciate environmental factors and sanitary practices which will contribute to good health and nutrition and provide opportunities for pupils to internalize good health and nutrition values; maintain adequate sanitation in the school and provide means to carry over the values to the home to the community; promote wholesome interpersonal relationship through a healthful physical, mental, social and spiritual atmosphere.
The organization of a healthful school day is an aspect of healthful living which includes the healthful arrangement of daily school program for the development of the health and nutritional well being of the pupils and teachers alike. School-Community Coordination for Health and Nutrition It is a coordinated endeavor to link the school with the home and the community so that there is an effective carry-over of health and nutrition habits and practices learned in the school to the home and community (Cuevas et al, 2007). The following are to be coordinated: 1) the different activities of the components of the School Health and Nutrition Program, 2) objectives, standards, policies, agreements and other procedures, particularly changes in personnel and 3) the School Health and Nutrition Program with other existing community health and nutrition programs. How to coordinate the school-community agencies for health and nutrition: a) Coordinate/orient the head of the school on the specific roles, functions and responsibilities of different members of the School Health and Nutrition Program, b) Hold conference with parents and other members of the community, c) Have an organizational chart showing the flow of responsibility of different members, d) Recognize the valuable contribution of others, and e) Keep each member posted with the results or problems and issues met. 2. Organization of the School-Community Health and Nutrition Council The effective implementation of the School Health and Nutrition Program depends to a large measure on the functional coordination between the school and the community. It is therefore, imperative that the school and the community be organized for health and nutrition education. a) School-community council shall be organized The council shall be composed of the following agencies/organizations: 1) school, 2) rural health unit, 3) Parent-Teacher Association, 4) government and non-government health agencies, and 5) other professional, civic and religious organization The way people design communities can influence health. Decisions about zoning, community design and land use affect the daily choices people make, whether it is to drive or walk to the store, exercise, or buy healthy foods. Creating incentives can encourage developers to take health and livability into account when retrofitting old developments or building new ones. Healthy foods, such as fresh fruits and vegetables, which are accessible and affordable, are part of the equation. Encouraging schools and government agencies to buy local produce, providing fiscal incentives for locating grocery stores in all communities especially underserved urban or rural communities and setting school nutrition standards and school wellness policies can have a big impact on people’s health (Santos, 2012).
Referral Procedure Findings during health appraisal must be followed immediately b measures for correcting defects. Minor infection or ailments can be taken care of in the school clinic. If school physician is not available, the case may be referred to any of the following: Provincial Health Hospital, Rural Health Unit, Department of Social Welfare Development, Private Health Practitioner, and Other cooperating agencies/organizations (Cuevas et al, 2007).
Synthesis
The literature reviewed, both foreign and local, are similar to the present study for they dealt with the implementation of the School Health Nursing Program. Grade point average has been consistently linked to the health status of the pupils. The studies found that high standards of academic performance are the ultimate result of the general health and well-being of the child. The studies, both foreign and local showed that all societies are doing their best to implement the health nursing program.
However, the foreign and local studies differ in the respondents of the study, the setting of the study, research objectives, research variables, research instruments, and statistical tools used to answer the problems.
Definition of Terms The terms in the study are defined conceptually and operationally to facilitate better understanding.
Academic Performance. This is the real life application of understanding as evidenced by the students’ performance of authentic tasks (DepEd Order No. 73s. 2012). In this study, it refers to the grade point average of the pupils for two grading periods.

Age. This means part of the duration of a being or a thing which is between its beginning and any given time as the present age of a man (Good, 2008) As used in the study, it refers to the ages of the pupils in the elementary schools in the province of Capiz.
Educational Attainment. This means the highest level of schooling which a person has attended and completed successfully in an educational system (Quint et al, 2007). In this study, it refers to the highest degree that the respondents’ parents such as elementary, high school, and college.
Estimated Monthly Family Income. It means the remuneration of the work and services a person had provided to an employer; an office, corporation, company, agency, government, etc., (Good, 2008). In this study, it means the combined income of the respondents’ family.
Grade Level. This refers to the different division in the elementary or secondary schools such as Grade I, II, etc. (Good, 2008). In this study, it refers to the level in the elementary grades in Capiz to which the respondent belongs such as Grade I etc.
Health and Nutrition Service. These are procedures designed to determine the health and nutrition status of the school population with appropriate intervention (Cuevas, 2007). In this study, it means the process of providing school children with health and nutrition activities to enhance their academic performance through health and nutrition practices (Cuevas, 2007).
Healthful School Living. This pertains to the wholesome and safe environment and the practice of sound health and nutritional habits (Cuevas, 2007). In this study, it refers to the school environment that provides healthful facilities conducive to the efficient learning of the pupils. Health Status. This refers to the health (good or poor) of a person, group or population in a particular area, especially when compared to other areas or with national data (Segen’s Medical Dictionary, 2012). In this study, it refers to health conditions manifested by the respondents.
Employment Status. This refers to the usual or common l work of respondents’ father/mother in earning a living (Good, 2008). In his study it refers to any activity with which the respondents’ fathers/mothers are engaged to earn money for the family’s basic needs. Referral Systems. Is a method of involving the school and community in the issues and concerns health (Good, 2008). In this study, it means the cases of health problems that are brought to the attention of the school authorities and the health nurse.
School-Community Coordination for Health and Nutrition. This is a coordinated endeavor to link the school with the home and the community for a carry-over of learning from the school to the home (Cuevas, 2007). In this study, it means encouraging elementary pupils to practice health and nutrition that they have learned in the school to their homes. It refers also to the role of the school in the community not only as an educational system but also for civic actions.
School Health Program. This refers to the organization or learning experiences directed towards the development of favorable health and nutrition knowledge, attitudes and practices which may be formal or informal (Cuevas, 2007). In this study it means the coordinated efforts of the schools and the school health nurse to insure the health and well-being of the respondents. Sex. This refers to the sum of the characteristics that distinguish organisms on the basis of their reproductive function which is either of the two categories, male or female (Stedman, 2002). In this study, it is the condition or character of being female or male.

CHAPTER II
Methodology
The chapter includes the research design of the study, research participants and sampling procedures, instrument development, data gathering procedure, and data analysis and Interpretation procedure.
Research Design The research design used in the study is the descriptive method. This type of research, according (Reganit 2010), focuses on present conditions, the purpose of which is to find new truths. This method describes and interprets the conditions or relationships that prevail or trends that are developing. A descriptive study is a process involving collection of data to test hypothesis, to answer questions concerning the status of the subject of the investigation, and to report the way things and conditions are. On the other hand, correlation research sometimes referred to as associational research, attempts to investigate possible relationships among variables without trying to influence those variables. This type of research will be used by the researcher because he will find the relationship between the implementation of the nursing school health program and the academic performance of the respondents.

Research Participants and Sampling Procedure The participants of the study are public and private elementary school pupils in the province of Capiz. The respondents were the pupils from Capiz and Roxas city divisions that belong to the top three biggest schools in terms of enrolment for the current school year. n=t2PQd21+1Nt2PQd2-1 This study consists of a sample of 1387 respondents obtained from 14,196 pupils in the province of Capiz for school year 2015 - 2016. This was obtained using the Cochran’s formula: n=1.962(0.50)(0.50)(0.025)21+114,1961.962(0.50)(0.50)(0.025)2-1

n=1536.64001.1082

n=1,387

where: t2, n-1>30 1.96 Z1-2 tis the abscissa of the normal curve that cuts off an area of a at the tails with a = 0.05, and degrees of freedom n-1, P is the proportion in the target population estimated to have a particular characteristic. If there is no reasonable estimate, then use 50% Q = 1 – p d is the margin of error (set at 0.025) N is the total population N is the sample size | | Furthermore, the researcher used stratified random sampling because the population is too big to handle, thus dividing it subgroups called strata is necessary. Samples per stratum are then randomly selected from the subgroups. The process used is proportional allocation. This procedure chooses sample sizes proportional to the sizes of the different subgroups or strata. This was given by the formula: where ni = sample size for each elementary school n = total sample size Ni = size of subpopulation, i = 1, 2, ,…,p N = size of population

The respondents of 1,387 pupils in the public and private elementary schools in the province of Capiz for school year 2015-2016 were shown in Table 1.
Table 1
Distribution of the Respondents in Capiz Division
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Private Schools Enrolment Sample Percentage
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Pontevedra Christian School 169 17 36
Immaculate Heart of Mary Child Learning Center 157 15 32
Parish School of
St. Isidrore 157 15 32
-------------------------------------------------
Total 483 47 100
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Table 1.1
Distribution of the Respondents in Capiz Division
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Public Schools Enrolment Sample Percentage
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Dumarao ES 3,439 336 34
Pilar ES 3,397 332 34
Pontevedra ES 3,216 314 32
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Total 10,052 982 100
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Table 1.2

Distribution of the Respondents in Roxas City Division

-------------------------------------------------
Private Schools Enrolment Sample Percentage
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Filamer Christian University 594 58 41
Colegio de la Purisima Concepcion 436 43 30
College of St. John- Roxas 435 42 29
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Total 1,465 143 100
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Table 1.3
Distribution of the Respondents in Roxas City Division
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Public Schools Enrolment Sample Percentage
PMRMS South 819 80 37
Banica ES 695 68 32
PMRMS North 682 67 31
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Total 2,196 215 100
-------------------------------------------------

Table 1.4

Summary Table

------------------------------------------------- Schools Enrolment Sample Percentage

Public 15,516 1,197 86
Private 1,945 190 14

------------------------------------------------- TOTAL 17,461 1,387 100

Instrument Development The research instrument used in the study is a researcher-made survey questionnaire. The use of the questionnaire is appropriate according to Reganit (2010) when information to be secured is from varied and widely scattered sources and when it is possible to explain briefly the purpose of the survey. The questionnaire is used when the researcher cannot personally and readily see all the selected respondents or when there is no particular reason to see the respondents personally. The questionnaire consisted of four parts. Part I includes the socio- demographic characteristics of the respondents. There are eight indicators, namely: sex, age, grade level, educational attainment of parents, employment status of parents, estimated monthly family income and type of school. Part II deals with the level of Implementation of School health program that covers nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure. Part III is the level of health status and Part IV is the level of academic performance of the respondents.

The responses were scored as follows:
For Part II. Level of Implementation of School Health Program
Value Score Interval Verbal Interpretation Meaning
5 - 4.21- 5.00 Always - If the program is implemented at all times
4 - 3.41 – 4.20 Often - If the program is implemented most of the time 3 – 2.61 – 3.40 Occasionally - If the program is implemented on certain occasions
2 - 1.81 - 2.60 Seldom - If the program is implemented rarely
1- 1.00 – 1.80 Never - If the program is not Implemented at all
For Part III. Level of Health Status
Value Score Interval Verbal Interpretation Meaning
5 - 4.21- 5.00 Always - Significantly manifests the Behaviour or condition
4 - 3.41 – 4.20 Often - Regularly manifests the behavior or condition 3 – 2.61 – 3.40 Occasionally - Occasionally manifests the behavior or condition
2 - 1.81 - 2.60 Seldom - Hardly manifests the behavior or condition
1- 1.00 – 1.80 Never - No manifestations of the expected behavior or condition

For Part IV. Level of Academic Performance
Value Score Interval Verbal Interpretation Meaning
5 - 4.21- 5.00 Excellent - Significantly manifests the behavior
4 - 3.41 – 4.20 Above Average - Regularly manifests the behavior 3 – 2.61 – 3.40 Average - Occasionally manifests the behavior
2 - 1.81 - 2.60 Fair - Hardly manifests the behavior
1- 1.00 – 1.80 Poor - No manifestations of the expected behavior

The questionnaires were reproduced and these were shown to the researcher’s adviser for final correction. Then, these were submitted to a panel for validation purposes. Validity refers to the appropriateness, meaningfulness, and usefulness of the data collected from the instruments. The members of the panel of experts scrutinized each item of the questionnaires to find out if it measures the content of the study, in this case the implementation of school health nursing program.
Data Gathering Procedure The researcher prepared a letter to the superintendent of Capiz and Roxas city division requesting permission to conduct and avail of the data needed in the current study. Permission for the conduct and distribution of the research instrument to the respondents were secured from the office of the elementary school principals. The questionnaires were distributed personally to the respondents to ensure 100 percent retrieval. The questionnaires were collected after the respondents have accomplished them. However, copies for respondents who were not around were left to the teacher for the respondents to accomplish these. The completed questionnaires were scored based on the scoring guide, tallied, and tabulated, in preparation for computation, analysis, and interpretation. A scheduled interview was done to ten public and private elementary pupils from Jamindan, Mambusao, Sapian, Roxas city, Panay, Maayon, and Pres. Roxas. Interview questions consisted of yes-no and open-ended questions that evolved on school health programs such as nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure, level of health status and academic performance of the interviewees. Proofs of scheduled interview include a signed consent, transcribed answers, photos and video clips.
Data Analysis and Interpretation Procedure The analysis and interpretation were facilitated by the use of descriptive statistics such as frequency counts, ranking, percentage, and mean. For Problem No. I on socio-demographic characteristics, the frequency counts, percentage and mean were used. The percentage was computed by dividing the number of cases per category by the total number of respondents, and then multiplying the result by 100. For Problem 2, extent of implementation of the School Health Nursing Program, Problem 3 level of health status and Problem 4 level of academic performance of the pupils in public and private elementary schools, the weighted mean and rank of the statements were used. It is important to determine the weighted mean since it is the representative value in a set of observations and relatively reliable since it does not usually fluctuate or vary when drawn from many samples from the same population. For problem 5 on the effect of the School Health Program on the health status and academic performance of the respondents, the simple linear regression analysis was computed. For Problems 6, 7 and 8 on the mean differences on the extent of implementation of School Health Program, on the level of health status of the respondents and the difference in the level of academic performance when grouped according to their socio-demographic characteristics, the Mann Whitney U-test (nonparametric counterpart of t-test) and Kruskal- Wallis H test (nonparametric counterpart of F-test or analysis of variance)were used. These statistical tools measure significant differences of the variables, Mann Whitney U-test for two means and Kruskal- Wallis H test for three or more means. For Problem 9 on the relationship between the extent of implementation of the School Health Nursing Program and the health status and academic performance of the respondents the Spearman rank correlation was used. All inferential statistics (significant difference and significant relationship) used alpha 0.05 level of significance. All findings were presented in figures and tables in Chapter III.

CHAPTER III

Presentation of Data

This chapter includes the presentation of the data gathered on the socio-demographic characteristics of the pupils in the province of Capiz, the extent of implementation of the School Health Nursing Program, level of health status of the pupils in public and private elementary schools, their level of academic performance, the effect of the School Health Program on the health status and academic performance of the elementary school pupils, and possible relationships of these variables.

Socio-Demographic Characteristics of the Pupils

The distribution of respondents according to their sex is displayed in Table 2.

Table 2. Distribution of respondents according to their sex. SEX | FREQUENCY | PERCENTAGE | Male | 594 | 42.8 | Female | 793 | 57.2 | Total | 1387 | 100.0 |

Figure 2. Distribution of respondents by sex.

Age

Table 3 presents the distribution of respondents according to their age.
Table 3. Distribution of respondents according to their age. AGE | FREQUENCY | PERCENTAGE | 8 | 1 | 0.1 | 9 | 166 | 12.0 | 10 | 354 | 25.5 | 11 | 430 | 31.0 | 12 | 342 | 24.6 | 13 | 64 | 4.6 | 14 | 19 | 1.4 | 15 | 6 | 0.4 | 16 | 4 | 0.3 | 19 | 1 | 0.1 | Total | 1387 | 100.0 |
Mean Age: 10.92 years old

Figure 3. Distribution of respondents by age.

Grade Level

Table 4 presents the distribution of respondents according to their grade level.

Table 4. Distribution of respondents according to their grade level. GRADE LEVEL | FREQUENCY | PERCENTAGE | Grade 4 | 454 | 32.7 | Grade 5 | 468 | 33.7 | Grade 6 | 465 | 33.5 | Total | 1387 | 100.0 |

Figure 4. Distribution of respondents by grade level.

Parents’ Educational Attainment

Tables 5 and 6 show the distributionsof respondents according to their parents’ educational attainment.

Table 5. Distribution of respondents according to their father’s educational attainment. FATHER’S EDUCATIONAL ATTAINMENT | FREQUENCY | PERCENTAGE | No schooling | 19 | 1.4 | Elementary Level | 176 | 12.7 | Elementary Graduate | 100 | 7.2 | High School Level | 150 | 10.8 | High School Graduate | 194 | 14.0 | College Level | 178 | 12.8 | College Graduate | 570 | 41.1 | Total | 1387 | 100.0 |

Table 6. Distribution of respondents according to their mother’s educational attainment. MOTHER’S EDUCATIONAL ATTAINMENT | FREQUENCY | PERCENTAGE | No schooling | 9 | 0.6 | Elementary Level | 122 | 8.8 | Elementary Graduate | 86 | 6.2 | High School Level | 156 | 11.2 | High School Graduate | 235 | 16.9 | College Level | 186 | 13.4 | College Graduate | 593 | 42.8 | Total | 1387 | 100.0 |

Figure 5. Distribution of respondents according to their parents’ educational attainment.

Employment Status of Parents

The distribution of respondents according to their parents’ educational attainment is displayed in Tables 7 and 8.

Table 7. Distribution of respondents according to their father’s employment status. FATHER’S EMPLOYMENT STATUS | FREQUENCY | PERCENTAGE | Employed (Government) | 243 | 17.5 | Employed (Private) | 218 | 15.7 | Self-employed | 544 | 39.2 | Laborer | 283 | 20.4 | Unemployed | 99 | 7.1 | Total | 1387 | 100.0 |

Table 8. Distribution of respondents according to their mother’s employment status. MOTHER’S EMPLOYMENT STATUS | FREQUENCY | PERCENTAGE | Employed (Government) | 203 | 14.6 | Employed (Private) | 150 | 10.8 | Self-employed | 483 | 34.8 | Laborer | 188 | 13.6 | Unemployed | 363 | 26.2 | Total | 1387 | 100.0 |

Legend:

Figure 6. Distribution of respondents according to their parents’ employment status
Estimated Monthly Family Income

The distribution of respondents according to their estimated monthly family income is shown in Table 9.

Table 9. Distribution of respondents according to their monthly family income. MONTHLY FAMILY INCOME | FREQUENCY | PERCENTAGE | PhP 5,000 and below | 588 | 42.4 | PhP 5,001 – 10,000 | 267 | 19.3 | PhP 10,001 – 15,000 | 157 | 11.3 | PhP 15,001 – 20,000 | 183 | 13.2 | PhP 20,001 - up | 192 | 13.8 | Total | 1387 | 100.0 |

Figure 7. Distribution of respondents according to theirestimated monthly family income.

Type of School

Table 10 presents the distribution of respondents according to the type of school they were enrolled in.

Table 10. Distribution of respondents according to their type of school. TYPE OF SCHOOL | FREQUENCY | PERCENTAGE | Public | 1197 | 86.3 | Private | 190 | 13.8 | Total | 1387 | 100.0 |

Figure 8. Distribution of respondents according to type of school.

Extent of Implementation of the School Health Nursing Program

Tables11to 16 show the extent of implementation of the School Health Nursing Program in schools in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure .
Nutrition Education

Table 11. Extent of Implementation of School Health Nursing Program in terms of nutrition education. STATEMENT | WEIGHTED MEAN | VERBAL INTERPRETATION | RANK | 1. Our teacher explains that nutritious foods and drinks are important to our body. | 4.50 | Always | 2 | 2. Our canteen sells nutritious foods and drinks. | 3.99 | Often | 5 | 3. Our school has bulletin containing information about nutrition. | 4.19 | Often | 4 | 4. We celebrate nutrition month. | 4.54 | Always | 1 | 5. We have a vegetable garden. | 4.39 | Always | 3 | GRAND MEAN | 4.32 | Always | |

Health Instruction

Table 12. Extent of Implementation of School Health Nursing Program in terms of health instruction. STATEMENT | WEIGHTED MEAN | VERBAL INTERPRETATION | RANK | 1. Our teacher instructs us to cut our nails short. | 4.32 | Always | 2 | 2. Our teacher gives information about dengue. | 4.27 | Always | 3.5 | 3. We celebrate “National Handwashing Day”. | 4.27 | Always | 3.5 | 4. We throw our garbage in the proper trash can. | 4.38 | Always | 1 | 5. We participate during fire drill and earthquake drill. | 4.15 | Often | 5 | GRAND MEAN | 4.28 | Always | |

Healthful School Living

Table 13. Extent of Implementation of School Health Nursing Program in terms of healthful school living. STATEMENT | WEIGHTED MEAN | VERBAL INTERPRETATION | RANK | 1. Our school is clean and safe from danger. | 4.25 | Always | 1 | 2. Our toilet is clean and has water for flushing. | 4.08 | Often | 2 | 3. Our school has a faucet for safe drinking water. | 3.68 | Often | 4 | 4. Our school conducts immunization. | 3.64 | Often | 5 | 5. Our school has an herbal garden. | 3.98 | Often | 3 | GRAND MEAN | 3.93 | Often | |
School-community Coordination

Table 14. Extent of Implementation of School Health Nursing Program in terms of school-community coordination. STATEMENT | WEIGHTED MEAN | VERBAL INTERPRETATION | RANK | 1. Parents, guardians, and supporters help our school during “brigade eskwela”. | 4.35 | Always | 3 | 2. We plant trees. | 4.00 | Often | 5 | 3. Our school is used as “evacuation center” during “Typhoon”. | 4.18 | Often | 4 | 4. Our school is a “no smoking zone”. | 4.48 | Always | 1 | 5. Our school has separate garbage cans for biodegradable and nonbiodegradable. | 4.41 | Always | 2 | GRAND MEAN | 4.28 | Always | |

Referral Procedure

Table 15. Extent of Implementation of School Health Nursing Program in terms of school-community coordination. STATEMENT | WEIGHTED MEAN | VERBAL INTERPRETATION | RANK | 1. Our teacher or nurse brings sick pupils to the hospital for medical treatment. | 3.96 | Often | 3 | 2. Our teacher or nurse brings wounded or injured pupils to the hospital after applying first aid. | 4.16 | Often | 1 | 3. Our teacher or nurse refers pupils with tooth problems to the dentist. | 3.83 | Often | 4 | 4. Our teacher or nurse refers pupils bitten by dogs to “Bite Center” for treatment”. | 3.56 | Often | 5 | 5. Our teacher or nurse refers pupils with special needs to school that has facilities for special children. | 4.02 | Often | 2 | GRAND MEAN | 3.91 | Often | |

Extent of Implementation of the School Health Nursing Program in General

Table 16. Extent of Implementation of School Health Nursing Program in General. | WEIGHTED MEAN | VERBAL INTERPRETATION | RANK | A. Nutrition Education | 4.32 | Always | 1 | B. Health Instruction | 4.28 | Always | 2.5 | C. Healthful School Living | 3.93 | Often | 4 | D. School-Community Coordination | 4.28 | Always | 2.5 | E. Referral Procedure | 3.91 | Often | 5 | OVERALL EXTENT OF IMPLEMENTATION | 4.14 | Often | |

Level of Health Status

The level of health status as experienced by the respondents is given in Tables 17.

Table 17. Level of health status as experienced by the respondents. STATEMENT | WEIGHTED MEAN | VERBAL INTERPRETATION | RANK | 1. My scalp is healthy. | 4.47 | Always | 4 | 2. My eyesight is clear. | 4.66 | Always | 2 | 3. My hearing is clear. | 4.71 | Always | 1 | 4. My gums and teeth are healthy. | 4.29 | Always | 7 | 5. My fingernails are pinkish. | 4.28 | Always | 9 | 6. My skin glows. | 3.96 | Often | 10 | 7. My appetite is good. | 4.54 | Always | 3 | 8. My height is within normal range. | 4.41 | Always | 6 | 9. My weight is within normal range. | 4.29 | Always | 8 | 10. I sleep soundly at night. | 4.47 | Always | 5 | GRAND MEAN | 4.41 | Always | |

Level of Academic Performance

Table18 displays the level of academic performance of respondents.

Table 18. Level of Academic performance of respondents. STATEMENT | WEIGHTED MEAN | VERBAL INTERPRETATION | RANK | 1. I submit my assignment and projects on time. | 4.15 | Above Average | 3 | 2. I recite in the class. | 4.10 | Above Average | 4 | 3. I answer my test easily. | 3.93 | Above Average | 5 | 4. I participate in Spelling Bee contest, Math Olympiad, Science Quiz Bowl, or Essay Writing Contest. | 2.82 | Average | 10 | 5. I can answer mathematical problems or board work. | 3.82 | Above Average | 6 | 6. I can speak and understand English and Filipino. | 4.27 | Excellent | 2 | 7. I can perform laboratory experiments. | 3.13 | Average | 9 | 8. I belong to the top ten pupils in the class. | 3.32 | Average | 8 | 9. I can understand and follow teacher’s instructions. | 4.32 | Excellent | 1 | 10. I can perform basic computer operations. | 3.77 | Above Average | 7 | GRAND MEAN | 3.76 | Above Average | |

Effect of the School Health Program on the Health Status and Academic Performance of the Elementary School Pupils

School Health Program and Health Status of Pupils

Prediction model: where Yi = ith observed value of the random variable Y Xi = ith observed value of the random variable X 0 = regression constant. It is the true Y intercept 1 = regression coefficient. It measures the true increase in Y per unit increase in X.

Level of Health Status = o + 1 School Health Program = 2.237** + 0.524**School Health Program

School Health Program and Academic Performance of Pupils

Prediction model: where Yi = ith observed value of the random variable Y Xi = ith observed value of the random variable X 0 = regression constant. It is the true Y intercept 1 = regression coefficient. It measures the true increase in Y per unit increase in X.

Level of Academic performance = o + 1 School Health Program = 1.320** + 0.590**School Health Program
Mean differences on the Extent of Implementation of the School Health Nursing Program when grouped according to their Socio-demographic Characteristics

The measures of mean differences on the scores in determining the extent of implementation of the School Health Nursing Program (in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure) of respondents when grouped according to their selected characteristics variables are shown in Tables 19 to 24.

Nutrition Education

Table 19. Measures of mean differences on the scores in determining extent of implementation of the School Health Nursing Program in terms of nutrition education of the respondents when grouped according to their selected characteristics variables. SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | NUTRITION EDUCATION | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 1. Sex | | Mann-Whitney U test | | | Male | 4.27b | | -2.109* | 0.035 | Female | 4.36a | | | | 2. Age | | Kruskal Wallis H test | | | Younger than 10 years old | 4.33a | | 8.341ns | 0.080 | 10 years old | 4.37a | | | | 11 years old | 4.36a | | | | 12 years old | 4.26a | | | | Older than 12 years old | 4.23a | | | | 3. Grade Level | | Kruskal Wallis H test | | | Grade 4 | 4.36a | | 7.753* | 0.021 | Grade 5 | 4.34ab | | | | Grade 6 | 4.27b | | | | ab– means with the same letter superscript are not significantly different * - significant ns – not significant

Table 19. Continued… SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | NUTRITION EDUCATION | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 4. a. Father’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 4.16a | | 4.642ns | 0.591 | Elementary Level | 4.27a | | | | Elementary Graduate | 4.27a | | | | High School Level | 4.33a | | | | High School Graduate | 4.39a | | | | College Level | 4.28a | | | | College Graduate | 4.34a | | | | b. Mother’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 4.18a | | 4.676ns | 0.586 | Elementary Level | 4.29a | | | | Elementary Graduate | 4.29a | | | | High School Level | 4.27a | | | | High School Graduate | 4.33a | | | | College Level | 4.29a | | | | College Graduate | 4.36a | | | | 5. a. Father’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.41a | | 8.767ns | 0.067 | Employed (Private) | 4.35a | | | | Self-employed | 4.30a | | | | Laborer | 4.31a | | | | Unemployed | 4.23a | | | | b. Mother’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.39a | | 4.681ns | 0.322 | Employed (Private) | 4.36a | | | | Self-employed | 4.30a | | | | Laborer | 4.31a | | | | Unemployed | 4.31a | | | | 6. Estimated Monthly Family Income | | | | | PhP 5,000 and below | 4.25b | Kruskal Wallis H test | 17.197** | 0.002 | PhP 5,001 – 10,000 | 4.34b | | | | PhP 10,001 – 15,000 | 4.37ab | | | | PhP 15,001 – 20,000 | 4.44a | | | | PhP 20,001 - up | 4.37ab | | | | 7. Type of School | | Mann-Whitney U test | | | Public | 4.35a | | -4.900** | 0.000 | Private | 4.14b | | | | ab– means with the same letter superscript are not significantly different ns – not significant
** - highly significant

Health Instruction

Table 20. Measures of mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of health instruction of the respondents when grouped according to their selected characteristics variables. SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | HEALTH INSTRUCTION | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 1. Sex | | Mann-Whitney U test | | | Male | 4.25a | | -1.250ns | 0.211 | Female | 4.30a | | | | 2. Age | | Kruskal Wallis H test | | | Younger than 10 years old | 4.40a | | 20.341** | 0.000 | 10 years old | 4.35a | | | | 11 years old | 4.27ab | | | | 12 years old | 4.20bc | | | | Older than 12 years old | 4.07c | | | | 3. Grade Level | | Kruskal Wallis H test | | | Grade 4 | 4.41a | | 29.650** | 0.000 | Grade 5 | 4.20b | | | | Grade 6 | 4.22b | | | | 4. a. Father’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 4.33a | | 21.854** | 0.001 | Elementary Level | 4.15b | | | | Elementary Graduate | 4.10b | | | | High School Level | 4.27a | | | | High School Graduate | 4.36a | | | | College Level | 4.22ab | | | | College Graduate | 4.33a | | | | b. Mother’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 4.11cd | | 27.513** | 0.000 | Elementary Level | 4.18cd | | | | Elementary Graduate | 4.05d | | | | High School Level | 4.17c | | | | High School Graduate | 4.30ab | | | | College Level | 4.22bc | | | | College Graduate | 4.37a | | | | abcd– means with the same letter superscript are not significantly different ns – not significant
** - highly significant

Table 20. Continued… SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | HEALTH INSTRUCTION | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 5. a. Father’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.39a | | 16.595** | 0.003 | Employed (Private) | 4.36a | | | | Self-employed | 4.22b | | | | Laborer | 4.26b | | | | Unemployed | 4.15b | | | | b. Mother’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.42a | | 13.719** | 0.008 | Employed (Private) | 4.32a | | | | Self-employed | 4.25b | | | | Laborer | 4.18b | | | | Unemployed | 4.26b | | | | 6. Estimated Monthly Family Income | | | | | PhP 5,000 and below | 4.16b | Kruskal Wallis H test | 30.032** | 0.000 | PhP 5,001 – 10,000 | 4.31a | | | | PhP 10,001 – 15,000 | 4.41a | | | | PhP 15,001 – 20,000 | 4.41a | | | | PhP 20,001 - up | 4.34a | | | | 7. Type of School | | Mann-Whitney U test | | | Public | 4.28a | | -1.892ns | 0.059 | Private | 4.25a | | | | ab– means with the same letter superscript are not significantly different ** - highly significant ns – not significant

Healthful School Living

Table 21. Measures of mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of healthful school living of the respondents when grouped according to their selected characteristics variables. SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | HEALTHFUL SCHOOL LIVING | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 1. Sex | | Mann-Whitney U test | | | Male | 3.92a | | -0.275ns | 0.784 | Female | 3.93a | | | | 2. Age | | Kruskal Wallis H test | | | Younger than 10 years old | 4.08a | | 22.209** | 0.000 | 10 years old | 4.05b | | | | 11 years old | 3.86b | | | | 12 years old | 3.84b | | | | Older than 12 years old | 3.80b | | | | 3. Grade Level | | Kruskal Wallis H test | | | Grade 4 | 4.12a | | 41.081** | 0.000 | Grade 5 | 3.83b | | | | Grade 6 | 3.84b | | | | 4. a. Father’s Educational Attainment | | Kruskal Wallis H test | | | No education | 4.12a | | 15.289* | 0.018 | Elementary Level | 3.87b | | | | Elementary Graduate | 3.87b | | | | High School Level | 4.03a | | | | High School Graduate | 4.09a | | | | College Level | 3.88ab | | | | College Graduate | 3.88ab | | | | b. Mother’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 3.87a | | 4.720ns | 0.580 | Elementary Level | 3.99a | | | | Elementary Graduate | 3.82a | | | | High School Level | 3.88a | | | | High School Graduate | 3.95a | | | | College Level | 3.86a | | | | College Graduate | 3.95a | | | | ab– means with the same letter superscript are not significantly different ns – not significant ** - highly significant
* -significant

Table 21. Continued… SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | HEALTHFUL SCHOOL LIVING | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 5. a. Father’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 3.99a | | 4.185ns | 0.382 | Employed (Private) | 3.99a | | | | Self-employed | 3.86a | | | | Laborer | 3.94a | | | | Unemployed | 3.95a | | | | b. Mother’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.01a | | 3.757ns | 0.440 | Employed (Private) | 4.01a | | | | Self-employed | 3.88a | | | | Laborer | 3.90a | | | | Unemployed | 3.92a | | | | 6. Estimated Monthly Family Income | | | | | PhP 5,000 and below | 3.86b | Kruskal Wallis H test | 10.517* | 0.033 | PhP 5,001 – 10,000 | 3.92b | | | | PhP 10,001 – 15,000 | 4.09a | | | | PhP 15,001 – 20,000 | 4.02ab | | | | PhP 20,001 - up | 3.93ab | | | | 7. Type of School | | Mann-Whitney U test | | | Public | 3.96a | | -4.511** | 0.000 | Private | 3.70b | | | | ab– means with the same letter superscript are not significantly different ns – not significant
* -significant ** - highly significant

School-Community Coordination

Table 22. Measures of mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of school-community coordination of the respondents when grouped according to their selected characteristics variables. SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | SCHOOL-COMMUNITY COORDINATION | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 1. Sex | | Mann-Whitney U test | | | Male | 4.24a | | -1.495ns | 0.135 | Female | 4.31a | | | | 2. Age | | Kruskal Wallis H test | | | Younger than 10 years old | 4.25a | | 2.125ns | 0.713 | 10 years old | 4.29a | | | | 11 years old | 4.30a | | | | 12 years old | 4.30a | | | | Older than 12 years old | 4.21a | | | | 3. Grade Level | | Kruskal Wallis H test | | | Grade 4 | 4.29a | | 1.371ns | 0.504 | Grade 5 | 4.27a | | | | Grade 6 | 4.28a | | | | 4. a. Father’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 4.22a | | 15.822* | 0.015 | Elementary Level | 4.29ab | | | | Elementary Graduate | 4.25a | | | | High School Level | 4.39a | | | | High School Graduate | 4.40a | | | | College Level | 4.31ab | | | | College Graduate | 4.21b | | | | b. Mother’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 4.33a | | 9.091ns | 0.169 | Elementary Level | 4.38a | | | | Elementary Graduate | 4.29a | | | | High School Level | 4.30a | | | | High School Graduate | 4.35a | | | | College Level | 4.33a | | | | College Graduate | 4.22a | | | | ab– means with the same letter superscript are not significantly different ns – not significant
* -significant

Table 22. Continued... SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | SCHOOL-COMMUNITY COORDINATION | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 5. a. Father’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.24a | | 1.700ns | 0.791 | Employed (Private) | 4.28a | | | | Self-employed | 4.28a | | | | Laborer | 4.33a | | | | Unemployed | 4.31a | | | | b. Mother’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.28a | | 0.991ns | 0.911 | Employed (Private) | 4.28a | | | | Self-employed | 4.28a | | | | Laborer | 4.31a | | | | Unemployed | 4.28a | | | | 6. Estimated Monthly Family Income | | | | | PhP 5,000 and below | 4.29a | Kruskal Wallis H test | 11.535* | 0.021 | PhP 5,001 – 10,000 | 4.29a | | | | PhP 10,001 – 15,000 | 4.40a | | | | PhP 15,001 – 20,000 | 4.25ab | | | | PhP 20,001 - up | 4.18b | | | | 7. Type of School | | Mann-Whitney U test | | | Public | 4.36a | | -10.164** | 0.000 | Private | 3.82b | | | | ab– means with the same letter superscript are not significantly different ns – not significant
* -significant ** - highly significant

Referral Procedure

Table 23. Measures of mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of referral procedure of the respondents when grouped according to their selected characteristics variables. SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | REFERRAL PROCEDURE | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 1. Sex | | Mann-Whitney U test | | | Male | 3.90ns | | -0.537ns | 0.591 | Female | 3.91ns | | | | 2. Age | | Kruskal Wallis H test | | | Younger than 10 years old | 3.98a | | 4.910ns | 0.297 | 10 years old | 3.92a | | | | 11 years old | 3.90a | | | | 12 years old | 3.89a | | | | Older than 12 years old | 3.78a | | | | 3. Grade Level | | Kruskal Wallis H test | | | Grade 4 | 4.00a | | 13.211** | 0.001 | Grade 5 | 3.85b | | | | Grade 6 | 3.87b | | | | 4. a. Father’s Educational Attainment | | Kruskal Wallis H test | | | No education | 3.87a | | 4.844ns | 0.564 | Elementary Level | 3.92a | | | | Elementary Graduate | 3.82a | | | | High School Level | 3.96a | | | | High School Graduate | 3.97a | | | | College Level | 3.82a | | | | College Graduate | 3.91a | | | | b. Mother’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 3.98a | | 6.316ns | 0.389 | Elementary Level | 4.02a | | | | Elementary Graduate | 3.83a | | | | High School Level | 3.88a | | | | High School Graduate | 3.88a | | | | College Level | 3.82a | | | | College Graduate | 3.94a | | | | ab– means with the same letter superscript are not significantly different ns – not significant
** - highly significant

Table 23. Continued… SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | REFERRAL PROCEDURE | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 5. a. Father’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 3.98a | | 7.287ns | 0.121 | Employed (Private) | 4.00a | | | | Self-employed | 3.85a | | | | Laborer | 3.87a | | | | Unemployed | 3.95a | | | | b. Mother’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.05a | | 12.422* | 0.014 | Employed (Private) | 3.99ab | | | | Self-employed | 3.90b | | | | Laborer | 3.86b | | | | Unemployed | 3.83b | | | | 6. Estimated Monthly Family Income | | | | | PhP 5,000 and below | 3.82c | Kruskal Wallis H test | 19.289** | 0.001 | PhP 5,001 – 10,000 | 3.85bc | | | | PhP 10,001 – 15,000 | 4.08a | | | | PhP 15,001 – 20,000 | 3.98ab | | | | PhP 20,001 - up | 4.04a | | | | 7. Type of School | | Mann-Whitney U test | | | Public | 3.90a | | -1.013ns | 0.311 | Private | 3.98a | | | | abc– means with the same letter superscript are not significantly different ns – not significant
* -significant ** - highly significant

Extent of Implementation of School Health Nursing Program in General

Table 24. Measures of mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in general of the respondents when grouped according to their selected characteristics variables. SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | EXTENT OF SCHOOL HEALTH NURSING PROGRAM IN GENERAL | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 1. Sex | 4.11a | | -1.500ns | 0.134 | Male | 4.16a | | | | Female | 4.11a | | | | 2. Age | | Kruskal Wallis H test | | | Younger than 10 years old | 4.21a | | 10.734* | 0.030 | 10 years old | 4.19a | | | | 11 years old | 4.14ab | | | | 12 years old | 4.10b | | | | Older than 12 years old | 4.02b | | | | 3. Grade Level | | Kruskal Wallis H test | | | Grade 4 | 4.24a | | 19.490** | 0.000 | Grade 5 | 4.10b | | | | Grade 6 | 4.10b | | | | 4. a. Father’s Educational Attainment | | Kruskal Wallis H test | | | No education | 4.14a | | 9.737ns | 0.136 | Elementary Level | 4.10a | | | | Elementary Graduate | 4.06a | | | | High School Level | 4.20a | | | | High School Graduate | 4.24a | | | | College Level | 4.10a | | | | College Graduate | 4.14a | | | | b. Mother’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 4.09a | | 4.310ns | 0.635 | Elementary Level | 4.17a | | | | Elementary Graduate | 4.06a | | | | High School Level | 4.10a | | | | High School Graduate | 4.16a | | | | College Level | 4.10a | | | | College Graduate | 4.17a | | | | abc– means with the same letter superscript are not significantly different ns – not significant
* -significant ** - highly significant

Continued... SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | EXTENT OF SCHOOL HEALTH NURSING PROGRAM IN GENERAL | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 5. a. Father’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.20a | | 6.452ns | 0.168 | Employed (Private) | 4.20a | | | | Self-employed | 4.10a | | | | Laborer | 4.14a | | | | Unemployed | 4.12a | | | | b. Mother’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.23a | | 7.680ns | 0.104 | Employed (Private) | 4.19a | | | | Self-employed | 4.12a | | | | Laborer | 4.11a | | | | Unemployed | 4.12a | | | | 6. Estimated Monthly Family Income | | | | | PhP 5,000 and below | 4.08c | Kruskal Wallis H test | 18.304** | 0.001 | PhP 5,001 – 10,000 | 4.14bc | | | | PhP 10,001 – 15,000 | 4.27a | | | | PhP 15,001 – 20,000 | 4.22ab | | | | PhP 20,001 - up | 4.17abc | | | | 7. Type of School | | Mann-Whitney U test | | | Public | 4.17a | | -4.769** | 0.000 | Private | 3.98b | | | | abc– means with the same letter superscript are not significantly different ns – not significant
** - highly significant

Mean differences on the Level of Health Status of Pupils when grouped according to their Socio-demographic Characteristics

Table 25 displays the measure of mean differences on the scores in determining the level of health status of pupils when grouped according to their selected characteristics variables.

Table 25. Measures of mean differences on the scores in determining the level of health status of the pupils when grouped according to their selected characteristics variables. SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | HEALTH STATUS OF PUPILS | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 1. Sex | | Mann-Whitney U test | | | Male | 4.37b | | -2.216* | 0.027 | Female | 4.44a | | | | 2. Age | | Kruskal Wallis H test | | | Younger than 10 years old | 4.44a | | 5.241ns | 0.263 | 10 years old | 4.37a | | | | 11 years old | 4.46a | | | | 12 years old | 4.38a | | | | Older than 12 years old | 4.34a | | | | 3. Grade Level | | Kruskal Wallis H test | | | Grade 4 | 4.46a | | 16.751** | 0.000 | Grade 5 | 4.37b | | | | Grade 6 | 4.39a | | | | 4. a. Father’s Educational Attainment | | Kruskal Wallis H test | | | No education | 4.35abc | | 18.224** | 0.006 | Elementary Level | 4.34bc | | | | Elementary Graduate | 4.20c | | | | High School Level | 4.45a | | | | High School Graduate | 4.40ab | | | | College Level | 4.42ab | | | | College Graduate | 4.45a | | | | b. Mother’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 4.37a | | 10.490ns | 0.105 | Elementary Level | 4.35a | | | | Elementary Graduate | 4.27a | | | | High School Level | 4.42a | | | | High School Graduate | 4.37a | | | | College Level | 4.40a | | | | College Graduate | 4.45a | | | | abc– means with the same letter superscript are not significantly different * -significant ns – not significant
** - highly significant

Table 25. Continued... SOCIO-DEMOGRAPHIC CHARATERISTICS VARIABLES | HEALTH STATUS OF PUPILS | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 5. a. Father’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.49a | | 18.806** | 0.001 | Employed (Private) | 4.50a | | | | Self-employed | 4.37b | | | | Laborer | 4.34b | | | | Unemployed | 4.39ab | | | | b. Mother’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.50a | | 8.004ns | 0.091 | Employed (Private) | 4.40a | | | | Self-employed | 4.39a | | | | Laborer | 4.39a | | | | Unemployed | 4.40a | | | | 6. Estimated Monthly Family Income | | | | | PhP 5,000 and below | 4.35b | Kruskal Wallis H test | 22.187** | 0.000 | PhP 5,001 – 10,000 | 4.37b | | | | PhP 10,001 – 15,000 | 4.46b | | | | PhP 15,001 – 20,000 | 4.55a | | | | PhP 20,001 - up | 4.47b | | | | 7. Type of School | | Mann-Whitney U test | | | Public | 4.40a | | -0.360ns | 0.719 | Private | 4.43a | | | | abc– means with the same letter superscript are not significantly different **- highly significant ns – not significant

Mean differences on the Level of Academic Performance of Pupils when grouped according to their Socio-demographic Characteristics

The measure of mean differences on the scores in determining the level of academic performance of pupils when grouped according to their selected characteristics variables is displayed on Table 26.

Table 26. Measures of mean differences on the scores in determining the level of academic performance of the pupils when grouped according to their selected characteristics variables. SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | LEVEL OF ACADEMIC PERFORMANCEOF PUPILS | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 1. Sex | | Mann-Whitney U test | | | Male | 3.74a | | -1.599ns | 0.110 | Female | 3.78a | | | | 2. Age | | Kruskal Wallis H test | | | Younger than 10 years old | 3.87a | | 10.665* | 0.031 | 10 years old | 3.78a | | | | 11 years old | 3.75a | | | | 12 years old | 3.77a | | | | Older than 12 years old | 3.57b | | | | 3. Grade Level | | Kruskal Wallis H test | | | Grade 4 | 3.84a | | 21.625** | 0.000 | Grade 5 | 3.66b | | | | Grade 6 | 3.79a | | | | 4. a. Father’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 3.58bc | | 81.160** | 0.000 | Elementary Level | 3.47c | | | | Elementary Graduate | 3.49c | | | | High School Level | 3.74b | | | | High School Graduate | 3.67b | | | | College Level | 3.75b | | | | College Graduate | 3.95a | | | | b. Mother’s Educational Attainment | | Kruskal Wallis H test | | | No schooling | 3.67bc | | 80.275** | 0.000 | Elementary Level | 3.52c | | | | Elementary Graduate | 3.45c | | | | High School Level | 3.66b | | | | High School Graduate | 3.61b | | | | College Level | 3.73b | | | | College Graduate | 3.96a | | | | abc– means with the same letter superscript are not significantly different ns – not significant
* -significant
** - highly significant

Table 26. Continued… SOCIO-DEMOGRAPHIC CHARACTERISTICS VARIABLES | LEVEL OF ACADEMIC PERFORMANCEOF PUPILS | | WEIGHTED MEAN | TYPE OF TEST | TEST VALUE | Asymp. Sig. | 5. a. Father’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 3.94a | | 55.158** | 0.000 | Employed (Private) | 3.99a | | | | Self-employed | 3.70b | | | | Laborer | 3.59c | | | | Unemployed | 3.66bc | | | | b. Mother’s Employment Status | | Kruskal Wallis H test | | | Employed (Government) | 4.04a | | 50.981** | 0.000 | Employed (Private) | 3.88ab | | | | Self-employed | 3.68c | | | | Laborer | 3.58d | | | | Unemployed | 3.77bc | | | | 6. Estimated Monthly Family Income | | | | | PhP 5,000 and below | 3.57d | Kruskal Wallis H test | 89.727** | 0.000 | PhP 5,001 – 10,000 | 3.75c | | | | PhP 10,001 – 15,000 | 3.88bc | | | | PhP 15,001 – 20,000 | 4.06a | | | | PhP 20,001 - up | 4.00ab | | | | 7. Type of School | | Mann-Whitney U test | | | Public | 3.70b | | -7.705** | 0.000 | Private | 4.13a | | | | abc– means with the same letter superscript are not significantly different ** - highly significant

Measure of Relationship between the Extent of Implementation of the School Health Nursing Program and their Level of Health Status

The measures of relationships between the extent of implementation of the School Health Nursing Programming general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure)and their level of health status are shown in Table 27.

Table 27. Measures of relationships between extent of implementation of the School Health Nursing Program and their level of health status of the respondents. EXTENT OF IMPLEMENTATION OF SCHOOL HEALTH NURSING PROGRAM | LEVEL OF HEALTH STATUS | | TYPE OF TEST | TEST VALUE | Asymp. Sig. | Nutrition Education | Spearman’s rank correlation | 0.357** | 0.000 | Health Instruction | Spearman’s rank correlation | 0.375** | 0.000 | Healthful School Living | Spearman’s rank correlation | 0.350** | 0.000 | School-Community Coordination | Spearman’s rank correlation | 0.376** | 0.000 | Referral Procedure | Spearman’s rank correlation | 0.352** | 0.000 | School Health Nursing Program in general | Spearman’s rank correlation | 0.454** | 0.000 |
**- highly significant

Measure of Relationship between the Extent of Implementation of the School Health Nursing Program and their Level of Academic Performance

Table 28 presents the measures of relationships between the extent of implementation of the School Health Nursing Program (in general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure) and their level of academic performance.

Table 28. Measures of relationships between extent of implementation of the School Health Nursing Program and their level of health status of the respondents. EXTENT OF IMPLEMENTATION OF SCHOOL HEALTH NURSING PROGRAM | LEVEL OF HEALTH STATUS | | TYPE OF TEST | TEST VALUE | Asymp. Sig. | Nutrition Education | Spearman’s rank correlation | 0.283** | 0.000 | Health Instruction | Spearman’s rank correlation | 0.373** | 0.000 | Healthful School Living | Spearman’s rank correlation | 0.349** | 0.000 | School-Community Coordination | Spearman’s rank correlation | 0.271** | 0.000 | Referral Procedure | Spearman’s rank correlation | 0.377** | 0.000 | School Health Nursing Program in general | Spearman’s rank correlation | 0.426** | 0.000 |
**- highly significant

CHAPTER IV

Interpretation and Analysis of Data

This chapter includes the interpretation and analysis of the data gathered on the socio-demographic characteristics of the pupils in the province of Capiz, the extent of implementation of the School Health Nursing Program, level of health status of the pupils in public and private elementary schools, their level of academic performance, the effect of the School Health Program on the health status and academic performance of the elementary school pupils, and possible relationships of these variables.

Socio-Demographic Characteristics of the Pupils

Sex

As displayed in Table 2, more than half (793 or 57.2 percent of 1387) are females and (594 or 42.8 percent of 1387) are males. This simply implies the dominance of female students in the province of Capiz.

Age

As presented in Table 3, a greater number (430 or 31 percent of 1387) of the pupil-respondents were 11- years old, approximately one in every four (354 or 25.5 percent of 1387) respondents aged 10-years old; 342 (24.6 percent of 1386) of the pupils aged 12 years old; 166 (12 percent of 1387) aged nine years old; 64 (4.6 percent of 1387) were thirteen years old; 19 (1.4 percent of 1387) were fourteen years old; 15 students (0.4 percent of 1387) aged 15 years old; 16 (0.3 percent of 1387) were sixteen years old; one student was 16 years old and also one was n19 years old. With a mean age of 10.92 years or approximately 11 years old, it can be implied that pupil-respondents are still school-aged children

Grade Level

Pupil-respondents were almost equally divided into three grade levels that is, Grade 4 (454 or 32.7 percent of 1387), Grade 5 (468 or 33.7 percent of 1387), and Grade 6 (465 or 33.5 percent of 1387) as shown in Table 4.

Parents’ Educational Attainment

Father
As displayed in Table 5, a greater number (570 or 41.1 percent of 1387) of respondents had a college graduate father; 194 (14 percent of 1387) pupils had a father that was high school graduates; 178 (12.8 percent) pupils had a father that was college undergraduate; 176 (12.7 percent of 1387) pupil-respondents had a father that was elementary undergraduate; 150 (10.8 percent) of the pupils had a father that was secondary undergraduate; 100 (7.2 percent of 1387) pupils had an elementary graduate father; and 19 (1.4 percent of 1387) pupils had a father that did not have any school attendance.

Mother
As presented in Table 6, a greater number (593 or 42.8 percent of 1387) of respondents had a college graduate mother; 235 (16.9 percent of 1387) pupils had a mother that was high school graduate; 186 (13.4 percent) pupils had a mother that were college undergraduate; 156 (11.2 percent of 1387) pupil-respondents had a mother that was secondary undergraduate; 122 (8.8 percent) of the pupils had a mother that was elementary undergraduate; 86 (6.2 percent of 1387) pupils had an elementary graduate mother; and nine (0.6 percent of 1387) pupils had a mother that did not have any school attendance.

Employment Status of Parents

Father

As displayed in Table 7, a greater number (544 or 39.2 percent of 1387) of pupils had a father that runs his own business; 283 (20.4 percent of 1387) of the respondents had a father that was laborer; 243 (17.5 percent of 1387) of the pupils had a father that was employed in government; 218 (15.7 percent of 1387) pupils had a father that was employed in private institution; and 99 (7.1 percent of 1387) of the respondents had an unemployed father.

Mother

A greater number (483 or 34.8 percent of 1387) of pupils had a mother that was self-employed; 363 (26.2 percent of 1387) of the respondents had an unemployed mother, 203 (14.6 percent of 1387) pupils had a mother that worked inthe government; 188 (13.6 percent of 1387) pupils had a mother that worked as a laborer; and 150 (10.8 percent of 1387) respondents was employed in private institution as shown in Table 8.

Estimated Monthly Family Income

As shown in Table 9, a greater number (588 or 42.4 percent) of pupils had an estimated monthly family income that belonged to the lowest bracket of PhP 5,000 and below; 267 (19.3 percent of 1387) respondents belonged to a family that earned PhP5,001 to PhP 10,000; 192 (13.8 percent of 1387) pupils belonged to the highest estimated monthly family income bracket of more than PhP 20,000; 183 (13.2 percent of 1387) pupil-respondents were from family that earned a monthly income that ranges from PhP15,001 to PhP20,000; and 157 (11.3 percent of 1387) pupils had an estimated monthly family income of PhP10,001 – 15,000.
Type of School

Majority (1197 or 86.3 percent of 1387) of the respondents were enrolled in public schools, whereas, 190 (13.8 percent of 1387) were pupils from private schools as shown in Table 10.

Extent of Implementation of the School Health Nursing Program

Nutrition Education

As displayed in Table 11, School Health Nursing Program in terms of nutrition education is implemented at all times. Particularly, pupils always celebrate nutrition month; their teacher always explains that nutritious foods and drinks are important to their body; they had always a vegetable garden; their school had always bulletin containing information about nutrition; and their canteen always sells nutritious foods and drinks.

Health Instruction

School Health Nursing Program in terms of health instruction is implemented at all times, as presented in Table 12. Distinctively, pupils always throw their garbage in the proper trash can; their teacher always instructs them to cut their nails short; their teacher always gives information about dengue; they always celebrate “National Handwashing Day”; and they often participate during fire drill and earthquake drill.

Healthful School Living

As shown in Table 13, in terms of healthful school living, School Health Nursing Program is implemented most of the time. Specifically, their school is always clean and safe from danger; their toilet is often clean and had water for flushing; their school often has an herbal garden; their school often has a faucet for safe drinking water; and their school often conducts immunization.

School-community Coordination

As displayed in Table 14, School Health Nursing Program in terms of school-community coordination is implemented at all times. Particularly, their school is always a “no smoking zone”; their school always has separate garbage cans for biodegradable and nonbiodegradable; parents, guardians, and supporters always help their school during “brigade eskwela”. Moreover, their school is often used as “evacuation center” during “Typhoon”; and they often plant trees.

Referral Procedure

School Health Nursing Program in terms of referral procedure is implemented most of the time, as presented in Table 15. Distinctively, their teacher or nurse often brings wounded or injured pupils to the hospital after applying first aid; their teacher or nurse often refers pupils with special needs to school that has facilities for special children; their teacher or nurse often brings sick pupils to the hospital for medical treatment; their teacher or nurse often refers pupils with tooth problems to the dentist; and their teacher or nurse often refers pupils bitten by dogs to “Bite Center” for treatment”, as shown in Table 15.
School Health Nursing Program in general

As a whole, as displayed in Table 16, School Health Nursing Program was implemented most of the time. School Health Nursing Program in terms of nutrition education, health instruction and school-community coordination were always implemented, whereas, in terms of healthful school living and referral procedure, the program was often implemented.
Level of Health Status

Pupils had an excellent level of health status as shown in Table 17.Specifically, elementary school pupils’ hearing is always clear; their eyesight is always clear; their appetite is always good; their scalp is always healthy; they always sleep soundly at night; their height is always within normal range; their gums and teeth are always healthy; their weight is always within normal range; their fingernails are always pinkish; and their skin often glows.

Level of Academic Performance

In general, as viewed in Table 18, elementary school pupils in the province of Capiz had an above average level of academic performance. Distinctively, pupils were excellent in understanding and following teacher’s instructions; and they can excellently speak and understand English and Filipino. Moreover, they regularly manifest the following behaviours: submitting their assignment and projects on time, reciting in the class, answering their test easily, answering mathematical problems or board work, and performing basic computer operations.
Furthermore, elementary school pupils sometimes belong to the top ten pupils in the class; they sometimes perform laboratory experiments; and they sometimes participate in Spelling Bee contest, Math Olympiad, Science Quiz Bowl, or Essay Writing Contest.

Effect of the School Health Program on the Health Status and Academic Performance of the Elementary School Pupils

School Health Program and Health Status of Pupils

Using simple linear regression analysis, results showed that School Health program has a highly significant positive effect on the level of health status of the elementary school pupils. With a regression constant of 2.237, it means that without a School Health Program, the pupils seldom or hardly manifests the behavior or condition of having a good level of health status. With a regression coefficient of + 0.524, it means that the presence of School Health Program has a positive effect on the health status of the pupils. For every one unit increase in the extent of implementation of School Health Nursing Program, it would result to an increase of 0.524 unit score to the initial level of health status of pupils, thus improving the health status of the elementary school pupils.

School Health Program and Academic Performance of Pupils

Results showed that School Health program has a remarkably significant positive effect on the level of academic performance of the elementary school pupils. With a regression constant of 1.320, it means that without a School Health Program, the pupils perform poorly in academics. With a regression coefficient of + 0.590, it means that the presence of School Health Program has a positive effect on the level of academic performance of the pupils. For every one unit increase in the extent of implementation of School Health Nursing Program, it would result to an increase of 0.590 unit score to the initial level of academic performance of the pupils, thus improving their level of academic performance.

Mean differences on the Extent of Implementation of the School Health Nursing Program when grouped according to their Socio-demographic Characteristics

Nutrition Education

As shown in Table 19, there were no significant mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of nutrition education of respondents when grouped according to their age, parents’ educational attainment and employment status. However, significant variations were noted on the scores in determining the extent of implementation of the School Health Nursing Program in terms of nutrition education of respondents when they were grouped according to their sex, grade level, estimated monthly family income, and type of school attended. Female pupils have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of nutrition education than male pupils, though both groups perceived that the program in terms of nutrition education was implemented at all times. Pupils in Grade 4 have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of nutrition education than Grade 6 pupils, though across Grades 4 to 6, pupils perceived that the program in terms of nutrition education was implemented at all times. Pupils that have an estimated monthly income of PhP15,001 – 20,000 have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of nutrition education than pupils in at most lower estimated monthly income bracket of PhP10,000 and below, though across all income brackets, pupils perceived that the program in terms of nutrition education was always implemented. Pupils from public school perceived that the program in terms of nutrition education was always implemented, whereas, pupils from public schools professed that the program in their schools was implemented only most of the time.

Health Instruction

There were no significant mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of health instruction when grouped according to their sex and type of school attended, as displayed in Table 20. However, significant variations were noted on the scores in determining the extent of implementation of the School Health Nursing Program in terms of health instruction when they were grouped according to their age, grade level, parents’ educational attainment and employment status, and estimated monthly family income.
Pupils who were at least 12-years old perceived that the program in terms of health instruction was often implemented, whereas, pupils aged 10 years old and younger professed that the program in their schools was implemented at all time in terms of health instruction. Pupils in Grade 4 have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of nutrition education than Grades 5 and 6 pupils, though across Grades 4 to 6, pupils perceived that the program in terms of health instruction was implemented at all times.
Pupils with a father that either experienced or graduated elementary education as the highest educational attainment perceived that the program in terms of health instruction was often implemented, whereas, pupils with a father that either with no education or at least high school undergraduate perceived that the program in terms of health instruction was implemented at all times.
Pupils that had a mother that were at least high school graduate perceived that the program in terms of health instruction was always implemented, whereas, pupils with mother that attained at most high school level professed that the program in their schools was implemented only most of the time.
Pupils with an unemployed father perceived that the program in terms of health instruction was often implemented, whereas, pupils with employed father (either, laborer, self-employed, working in government or private) perceived that the program in terms of health instruction was implemented at all times.
Pupils with an employed mother (either in government or private) perceived that the program in terms of health instruction was always implemented, whereas, pupils whose mother was either self-employed, laborer or unemployed professed that the program in their schools was implemented only most of the time.
Pupils belonged to the lowest estimated monthly family income bracket perceived that the program in terms of health instruction was often implemented, whereas, pupils in a higher estimated monthly family income bracket perceived that the program in terms of health instruction was implemented all the time.

Healthful School Living

As presented in Table 21, there were no significant mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of healthful school living of respondents when grouped according to their, sex, mother’s educational attainment, and parents’ employment status. However, significant variations were noted on the scores in determining the extent of implementation of the School Health Nursing Program in terms of healthful school living of respondents when they were grouped according to their age, grade level, father’s educational attainment, estimated monthly family income, and type of school attended. Pupils younger than 10 years old have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of healthful school living than pupils of at least 10 years old, though pupils across all ages perceived that the program in terms of healthful school living was implemented most of the time.

Pupils in Grade 4 have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of healthful school living than Grades 5 and 6 pupils, though across Grades 4 to 6, pupils perceived that the program in terms of healthful school living was often implemented. Pupils with a father that either experienced or graduated elementary education as the highest educational attainment have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of healthful school living than pupils with a father that either with no education or at least high school undergraduate, though regardless of father’s educational attainment, elementary school pupils perceived that the program in terms of healthful school living was implemented most of the time.
Pupils belonged to the lower estimated monthly family income bracket of PhP 10,000 and below have significantly lower scores in determining the extent of implementation of the School Health Nursing Program in terms of healthful school living than pupils with an estimated monthly income of PhP10,0001 and up, though regardless of pupils’ estimated monthly family income, they perceived that the program in terms of healthful school living was often implemented. Pupils from public schools have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of healthful school living than pupils from private schools, though both groups perceived that the program in terms of healthful school living was implemented most of the time.

School-Community Coordination

There were no significant mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of school-community coordination when grouped according to their sex, age, grade level, mother’s highest educational attainment and parents’ employment status, as displayed in Table 22. However, significant variations were noted on the scores in determining the extent of implementation of the School Health Nursing Program in terms of school-community coordination when they were grouped according to their father’s educational attainment, estimated monthly family income, and type of school attended. Pupils with a college graduate father have significantly lower scores in determining the extent of implementation of the School Health Nursing Program in terms of school-community coordination than pupils with a non-degree holder father, though regardless of father’s educational attainment, elementary school pupils perceived that the program in terms of school-community coordination was implemented all the time.
Pupils that belonged to the highest estimated monthly family income bracket perceived that the program in terms of health instruction was often implemented, whereas, pupils in a lower estimated monthly family income bracket perceived that the program in terms of school-community coordination was implemented all the time. Pupils from public school perceived that the program in terms of school-community coordination was always implemented, whereas, pupils from public schools professed that the program in their schools was implemented only most of the time in terms of school-community coordination.

Referral Procedure

As shown in Table 23, there were no significant mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of referral procedure when respondents were grouped according to their sex, age, parents’ educational attainment, father’s employment status, and type of school attended. However, significant mean variations were noted on the scores in determining the extent of implementation of the School Health Nursing Program in terms of referral system when respondents were grouped according to their grade level, mother’s employment status, estimated monthly family income, and type of school attended. Pupils in Grade 4 have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of referral system than Grades 5 and 6 pupils, though across Grades 4 to 6, pupils perceived that the program in terms of referral system was often implemented.
Pupils with a mother working in government have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of referral system than pupils with a mother with other employment status, though regardless of mother’s employment status, pupils perceived that the program in terms of referral system was often implemented.
Pupils belonged to the lower estimated monthly family income bracket of PhP 10,000 and below have significantly lower scores in determining the extent of implementation of the School Health Nursing Program in terms of referral procedure than pupils with an estimated monthly income of PhP10,0001 and up, though regardless of pupils’ estimated monthly family income, they perceived that the program in terms of referral procedure was often implemented. Pupils from private schools have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of referral procedure than pupils from public schools, though both groups perceived that the program in terms of referral procedure was implemented most of the time.

School Health Nursing Program in general

As a whole, no significant mean differences were observed on the scores in determining the extent of implementation of the School Health Nursing Program in general when grouped according to their sex, parents’ highest educational attainment and employment status, as displayed in Table 24. However, significant variations were noted on the scores in determining the extent of implementation of the School Health Nursing Program in general when they were grouped according to their age, grade level, estimated monthly family income, and type of school attended.
Younger pupils (less than 10-years old) perceived that the School Health Nursing program was always implemented, whereas, older pupils (aged 10 years old and older) professed that the program in their schools was implemented most of the time.
Grade 4 pupils perceived that the School Health Nursing program was always implemented, whereas, pupils in higher grade level professed that the program in their schools was implemented most of the time.
Pupils belonged to the lower estimated monthly family income bracket of PhP 10,000 and below and highest estimated monthly family income bracket perceived that the School Health Nursing Program in general was often implemented, whereas pupils with an estimated monthly income of PhP10,0001 to PhP 20,000 perceived that the program in general was implemented all the time. Pupils from public schools have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in general than pupils from private schools, though both groups perceived that the program in general was implemented most of the time.

Mean differences on the Level of Health Status of Pupils when grouped according to their Socio-demographic Characteristics

As viewed in Table 25, there were no significant mean differences on the scores in determining the level of health status of the respondents when they were grouped according to their age, mother’s educational attainment and employment status, and type of school attended. However, significant mean variations were noted on the scores in determining level of health status of the respondents when they were grouped according to their sex, grade level, father’s educational attainment and employment status, and estimated monthly family income. Female pupils have significantly higher scores in determining their level of health status than male pupils, though both groups perceived that they have excellent level of health status. Pupils in Grades 4 and 6 have significantly higher scores in determining their level of health status than Grades 5 pupils, though across Grades 4 to 6, pupils perceived that they have excellent level of health status. Pupils with a father that graduated elementary education as the highest educational attainment perceived that they have a very good level of health status, whereas, pupils who had a father with other educational attainment had an excellent level of health status. Pupils with an employed father (either in government or private) have significantly higher scores in determining their level of health status than pupils whose father were either laborer, self-employed or unemployed, though regardless of their father’s employment status, pupils perceived that they have excellent level of health status. Pupils belonged to a family that earned PhP15,001 to 20,000 in a month have significantly higher scores in determining their level of health status than pupils belonged to other estimated monthly family income bracket, though regardless of their estimated monthly family income bracket, pupils perceived that they have excellent level of health status.

Mean differences on the Level of Academic Performance of Pupils when grouped according to their Socio-demographic Characteristics

There were no significant mean differences on the scores in determining the level of academic performance of pupils when grouped according to their sex as displayed in Table 26. However, significant variations were noted on the scores in determining the level of academic performance of pupils when they were grouped according to their age, grade level, parent’s educational attainment and employment status, estimated monthly family income, and type of school attended. School aged pupils (12 years old and younger) have significantly higher scores in determining their level academic performance than teen-aged pupils, though pupils across all ages perceived that they have above average level of academic performance. Pupils in Grades 4 and 6 have significantly higher scores in determining their level academic performance than Grade 5 pupils, though pupils across Grades 4 to 6 perceived that they have above average level of academic performance. Pupils with college graduate parents have significantly higher scores in determining their level academic performance than pupils who had non-degree holder parents, though regardless of their parents’ educational attainment, pupils perceived that they have above average level of academic performance. Pupils with employed parents (in either government or private institutions), have significantly higher scores in determining their level academic performance than pupils with parents who were either self-employed, laborers or unemployed, though regardless of their parents’ employment status, pupils perceived that they have above average level of academic performance. Pupils belonged to a family that earned more than PhP15,000 in a month have significantly higher scores in determining their level of academic performance than pupils belonged to a lower estimated monthly family income brackets (PhP15,000 and below), though regardless of their estimated monthly family income bracket, pupils perceived that they have above average level of academic performance. Pupils from private schools have significantly higher scores in determining their level of academic performance than pupils from public schools, though both groups perceived that they have above average level of academic performance.

Measure of Relationship between the Extent of Implementation of the School Health Nursing Program and their Level of Health Status

There were positive, highly significant correlation between the scores in determining the extent of implementation of the School Health Nursing Program(in general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure)as perceived by the elementary school pupils and their level of health status as shown in Table 27. It can be implied that the higher the extent of implementation of School Health Nursing Program (in general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure), the higher the level of health status of the pupils, and vice-versa.

Measure of Relationship between the Extent of Implementation of the School Health Nursing Program and their Level of Academic Performance

As shown in Table 28, the scores in determining the extent of implementation of School Health Nursing Program (in general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure) and their level of academic performance were positively, remarkably significantly correlated. It can be implied that the higher the extent of implementation of School Health Nursing Program (in general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure), the pupils performed better in academics, and vice-versa.

CHAPTER V

Summary of Findings, Conclusions, Recommendations

This chapter includes the summary of findings, conclusions and recommendations based on the data gathered on the socio-demographic characteristics of the pupils in the province of Capiz, the extent of implementation of the School Health Nursing Program, level of health status of the pupils in public and private elementary schools, their level of academic performance, the effect of the School Health Program on the health status and academic performance of the elementary school pupils, and possible relationships of these variables.

Summary of Findings

Generally, the study aims to determine the extent of implementation of School Health Nursing Program, levels of health status and academic performance of elementary school pupils in the province of Capiz for SY 2015-2016. A stratified random sample of 1387 elementary school pupils in the province of Capiz, proportionally allocated by school was considered to be the respondents of the study. The study used descriptive and correlation techniques of the descriptive design.
Data were gathered through the use of researcher-made survey questionnaire pilot tested with 0.963 reliability using Cronbach alpha and validated by a pool of experts including the advisory committee.
Specifically, the study sought to answer the following questions:
1) What are the socio-demographic characteristics of the respondents in terms of sex, age, grade level, parent’s educational attainment and employment status, estimated monthly family income and type of school attended?

More than half (793 or 57.2 percent of 1387) are females and (594 or 42.8 percent of 1387) are males.A greater number (430 or 31 percent of 1387) and the mean age of the pupil-respondents were 11- years old, equivalently in their Grade V (468 or 33.7 percent of 1387). A greater number of respondents had a college graduate father (570 or 41.1 percent of 1387) and mother (593 or 42.8 percent of 1387). Also, a greater number of pupils had a father that runs his own business (544 or 39.2 percent of 1387), and unemployed mother (483 or 34.8 percent of 1387) with an estimated monthly family income that belonged to the lowest bracket of PhP 5,000 and below (588 or 42.4 percent). Majority (1197 or 86.3 percent of 1387) of the respondents were enrolled in public schools.

2) What is the extent of implementation of the School Health Nursing Program (in general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure)?

School Health Nursing Program was implemented most of the time. School Health Nursing Program in terms of nutrition education, health instruction and school-community coordination were always implemented, whereas, in terms of healthful school living and referral procedure, the program was often implemented.

3) What is the level of health status of the pupil-respondents?

Elementary school pupils in the province of Capiz had an excellent level of health status.

4) What is the level of academic performance of the pupil-respondents?

Elementary school pupils in the province of Capiz had an above average level of academic performance.

5) What is the effect of the School Health Program on the health status and academic performance of the elementary school pupils?

School Health Program and Health Status of Pupils

School Health program has a highly significant positive effect on the level of health status of the elementary school pupils.

School Health Program and Academic Performance of Pupils

School Health program has a remarkably significant positive effect on the level of academic performance of the elementary school pupils.

6) Are there any significant mean differences on the extent of implementation of the School Health Nursing Program when grouped according to their Socio-demographic Characteristics?

Nutrition Education
There were significant mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of nutrition education of respondents when grouped according to their sex, grade level, estimated monthly family income, and type of school attended.

Health Instruction

There were significant mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of health instruction when grouped according to their age, grade level, parents’ educational attainment and employment status, and estimated monthly family income.

Healthful School Living

There were significant mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of healthful school living of respondents when grouped according to their age, grade level, father’s educational attainment, estimated monthly family income, and type of school attended.

School-Community Coordination

There were significant mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of school-community coordination when grouped according to their father’s educational attainment, estimated monthly family income, and type of school attended.

Referral Procedure

There were significant mean differences on the scores in determining the extent of implementation of the School Health Nursing Program in terms of referral procedure when respondents were grouped according to their grade level, mother’s employment status, estimated monthly family income, and type of school attended.

School Health Nursing Program in General

Significant mean differences were observed on the scores in determining the extent of implementation of the School Health Nursing Program in general when grouped according to their age, grade level, estimated monthly family income, and type of school attended.
7) Are there any significant mean differences on the level of health status of pupils when grouped according to their socio-demographic characteristics?
There were significant mean differences on the scores in determining the level of health status of the respondents when they were grouped according to their sex, grade level, father’s educational attainment and employment status, and estimated monthly family income.

8) Are there any significant mean differences on the level of academic performance of pupils when grouped according to their socio-demographic characteristics?
There were significant mean differences on the scores in determining the level of academic performance of pupils when grouped according to their age, grade level, parent’s educational attainment and employment status, estimated monthly family income, and type of school attended.

9) Are there any significant relationship between the following:
a. Extent of implementation of the School Health Nursing Program and their Level of Health Status?

There were positive, highly significant correlation between the scores in determining the extent of implementation of the School Health Nursing Program(in general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure)as perceived by the elementary school pupils and their level of health status.

b. Extent of implementation of the School Health Nursing Program and Level of Academic Performance of Pupils?

The scores in determining the extent of implementation of School Health Nursing Program (in general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure) and their level of academic performance were positively, remarkably significantly correlated.

Conclusions Based on the findings, the following conclusions were made: 1. Elementary school pupils in the province of Capiz were mostly females, 11 years old, equivalently in their fifth grade in public schools, with college graduate parents, particularly self-employed father and unemployed mother, with an estimated monthly family income that belonged to the lowest bracket of PhP 5,000 and below. 2. a. Nutrition Education. Pupils always celebrate nutrition month; their teacher always explains that nutritious foods and drinks are important to their body; they had always a vegetable garden; their school had always bulletin board containing information about nutrition; and their canteen always sells nutritious foods and drinks. b. Health Instruction. Pupils always throw their garbage in the proper trash can; their teacher always instructs them to cut their nails short; their teacher always gives information about dengue; they always celebrate “National Handwashing Day”; and they often participate during fire drill and earthquake drill. c. Healthful School Living. Elementary school pupils perceived that their school is always clean and safe from danger; their toilet is often clean and had water for flushing; their school often has an herbal garden; their school often has a faucet for safe drinking water; and their school often conducts immunization. d. School-Community Coordination. Elementary school pupils perceived that their school is always a “no smoking zone”; their school always has separate garbage cans for biodegradable and non-biodegradable; parents, guardians, and supporters always help their school during “brigade eskwela”. Moreover, their school is often used as “evacuation center” during “Typhoon”; and they often plant trees. e. Referral Procedure. Elementary school pupils perceived that their teacher or nurse often brings wounded or injured pupils to the hospital after applying first aid; their teacher or nurse often refers pupils with special needs to school that has facilities for special children; their teacher or nurse often brings sick pupils to the hospital for medical treatment; their teacher or nurse often refers pupils with tooth problems to the dentist; and their teacher or nurse often refers pupils bitten by dogs to “Bite Center” for treatment. 3. Elementary school pupils’ hearing is always clear; their eyesight is always clear; their appetite is always good; their scalp is always healthy; they always sleep soundly at night; their height is always within normal range; their gums and teeth are always healthy; their weight is always within normal range; their fingernails are always pinkish; and their skin often glows.
4. Elementary school pupils were excellent in understanding and following teacher’s instructions; and they can excellently speak and understand English and Filipino. They regularly manifest the following behaviours: submitting their assignment and projects on time, reciting in the class, answering their test easily, answering mathematical problems or board work, and performing basic computer operations. They sometimes belong to the top ten pupils in the class; they sometimes perform laboratory experiments; and they sometimes participate in Spelling Bee contest, Math Olympiad, Science Quiz Bowl, or Essay Writing Contest.
5. a. School Health Program and Health Status of Pupils. Without a School Health Program, the pupils seldom or hardly manifest the behavior or condition of having a good level of health status. The presence of School Health Program has a positive effect on the health status of the pupils. A mere presence of the program would result to at least average level of health status of the pupils.
b. School Health Program and Academic Performance of Pupils. Without a School Health Program, the pupils perform poorly in academics. A mere presence of the program would result to at least fair level of academic performance of the elementary school pupils.
6. a. Nutrition Education. Pupils that are females, in Grade 4, with an estimated monthly income of PhP15,001 – 20,000, have significantly higher scores in determining the extent of implementation of the School Health Nursing Program. Pupils from public school perceived that the program in terms of nutrition education was always implemented, whereas, pupils from private schools professed that the program in their schools was implemented only most of the time.
b. Health Instruction. Younger pupils (aged 10 years old and below), with a father that either with no education or at least high school undergraduate, with a mother that were at least high school graduate, with employed father (either, laborer, self-employed, working in government or private), with employed mother (either in government or private), with a higher estimated monthly family income bracket professed that the program in their schools was implemented at all times.
c. Healthful School Living. Pupils younger than 10 years old, in Grade 4, enrolled in public schools, with a father that either experienced or graduated elementary education, with an estimated monthly income of PhP10,0001 and up, have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of healthful school living.
d. School-community coordination. Pupils with a non-degree holder father have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of school-community coordination. Pupils from public schools and with a lower estimated monthly family income bracket perceived that the program in terms of school-community coordination was implemented all the time.
e. Referral Procedure. Pupils in Grade 4, enrolled in private schools, with a mother working in government, with an estimated monthly income of PhP 10,001 and up, have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in terms of referral procedure.
f. School Health Nursing Program in General. Younger pupils (less than 10-years old, in 4th grade level, with an estimated monthly income of PhP10,0001 to PhP 20,000 perceived that the School Health Nursing program was always implemented. Pupils from public schools have significantly higher scores in determining the extent of implementation of the School Health Nursing Program in general than pupils from private schools, though both groups perceived that the program in general was implemented most of the time.
7. Female pupils, in Grades 4 and 6, with an employed father (either in government or private), belonged to a family that earned PhP15,001 to 20,000 in a month have significantly higher scores in determining their level of health status, though all groups perceived that they have excellent level of health status. Pupils with a father that graduated elementary education as the highest educational attainment perceived that they have a very good level of health status, whereas, pupils who had a father with other educational attainment had an excellent level of health status.
8. School aged pupils (12 years old and younger), in Grades 4 and 6, enrolled in private schools, with college graduate parents, with employed parents (in either government or private institutions),belonged to a family that earned more than PhP15,000 in a month, have significantly higher scores in determining their level academic performance than teen-aged pupils, though pupils across all ages perceived that they have above average level of academic performance.
9a. School Health Nursing Program and Health Status of Pupils. The higher the extent of implementation of School Health Nursing Program (in general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure), the higher the level of health status of the pupils, and vice-versa.
b. School Health Nursing Program and Academic Performance of Pupils. The higher the extent of implementation of School Health Nursing Program (in general and in terms of nutrition education, health instruction, healthful school living, school-community coordination, and referral procedure), the pupils performed better in academics, and vice-versa.
Recommendations
Based on the findings and conclusions the following recommendations are proposed: 1. Efforts should be exerted by school administrators to invite parents to participate in the implementation of the School Health Nursing Program, especially in terms of healthful living where the pupils should transfer this training in school to the home. They should also participate in the referral procedure. 2. The level of health status of the pupils should be maintained and enhanced in both the school and the home. 3. School principal and teachers should develop strategies to improve the academic performance of the pupils. Enrichment classes should be held regularly, especially in English, Science, and Math. These classes should be evaluated and result discussed during teachers meetings for massive information campaign. 4. The School Health Program should be evaluated periodically by the school personnel and parents to sustain a high level of health status of the pupils. 5. An efficient implementation of the School Health Program should be sustained for the improvement of the academic performance of pupils. When pupils are physically and emotionally healthy, they can perform better in class. 6. The provisions of the School Health Program should be discussed periodically and during PTA-PTC assemblies for massive information of its effect on the pupils. 7. Health institution in the elementary schools should be integrated in the different subjects to insure the efficient implementation of the School Health Program. The school and the community should establish linkage so that both sectors can help in the continued well-being of the school children. 8. The role of the parents in the implementation of the school program is initial in terms of the significant relationship of the School Health Program should be discussed during meetings and assemblies. 9. The government should allocate sufficient budget for the School Health Nursing Program for additional nurses at least each school district so that both nurses and teachers can collaborate in the efficient and effective implementation of the program. 10. Further studies should be conducted in the implementation of the school program and its relationship to the academic performance and the general well-being to that pupil in the elementary schools, especially those in remote barangays can avail of the benefits of the program. Both quantitative and qualitative approaches may be used.

References
A. Books

American Association of Colleges of Nursing. (2011). 2010-2011 Enrollment and graduations in baccalaureate and graduate programs in nursing. Washington, DC: AACN.

Anastasi, Anne and Susana Urbina. (2005). Psychological Testing. New Jersey, USA: Prentice-Hall, Inc.

Ard, N., & Valiga, T. M., Eds. (2009). Clinical nursing education: Current reflections. New York: National League for Nursing.

Benner, P., Sutphen, M., Leonard, V. & Day, L. (2009). Educating Nurses: A Call for Radical Transformation. Carnegie Foundation for the Advancement of Teaching. San Francisco: Jossey-Bass.

Cochran, W. G. (1977). Sampling Techniques, 3rd edition.John Wiley & Sons, Inc. USA.p. 75.

Cuevas, et., al. (2007). Public health Nursing in the Philippines. National Leagueof Philippines Government Nurses, Incorporated.

Good, Carter V. (2007). Dictionary of Education. New York: McGraw-Hill Book Company.

Health Resources and Services Administration. (2010, March). 2008 National Sample Survey of Registered Nurses. Washington, DC: U.S. Department of Health and Human Services.

Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press.

Penn, B.K. (2008). Mastering the Teaching Role: A Guide for Nurse Educators. Philadelphia, PA: F.A.

Reganit, Arnulfo Aaron R., Ronaldo SP Elicay., Cresencia C. Laguerta. (2010). Assessment of Student Learning. Quezon City: C & E Publishing.
Sanchez, Custodiosa A. (2001). Methods and Techniques of Research. Quezon City. Rex Printing Company, Inc.,

Vizcarra, Florante O. (2003). Introduction to Educational Research. Quezon City: Greats Books Trading.

B. Journal

Baker, S.L. (2010). Nurse Educator Orientation: Professional Development that Promotes Retention. The Journal of Continuing Education in Nursing, 41(9), 413-7.

Davis. Penn, B.K., Wilson, L., & Rosseter, R. (2008, September 30). Transitioning from nursing practice to a teaching role. OJIN: The Online Journal of Issues in Nursing, 13(3).

Farmer, J.E., Clark, M.J, Drewel, E.H., Swenson, T.M. & Ge, B. (2010) Consultative care coordination through the medical home for CSHCN: A randomized controlled trial. Maternal Child Health Journal, 15: 1110-1118

Horton, C., DePaoli, S., Hertach, M., Bower, M. (2012). Enhancing the Effectiveness of Nurse Preceptors. Journal for Nurses in Staff Development, 28(4), E1-E7.

Laughlin, C. B. and Beisel, M. (2010). Evolution of the chronic care role of the registered nurse in primary care. Nursing Economics, 28 (6), 1, 409-414.

Moscato, S., Kaakinen, J., Gatlin, P., Mitchell, C., & Miller, J. (2004). Dedicated Education Unit: Innovative Strategy For Optimal Clinical Learning. Communicating Nursing Research, 37, 247.

Rantz, M., Phillips, L., Aud, M., Popejoy, L., Dorman-Marek, K., Hicks, L.,Zaniletti, I., and Miller, S.J. (2011). Evaluation of aging in place model with home care services and registered nurse care coordination in senior housing. Nursing Outlook, 59, 37- 46.

Santos, M. (2012). Nurses’ Barriers to Learning: an Integrative Review. Journal for Nurses in Staff Development, 28(4), 182-185.

Semeniuk,P., Mildon, B., Purkis, M.E., Thorne, S., Wejr, P. (2010). The BC Educator Pathway Collaborative Framework: Creating the Foundation for Nursing Education Capacity. Nursing Research, 23(2), 47-59. JAMA, 281 (7), 613-620.

Wennberg, D. E., Marr, A., Lang, L., O’Malley, S., & Bennett, G. (2010). A randomized trial of a telephone care-management strategy. New England Journal of Medicine, 363 (13), 1245-1255.

C. Unpublished Theses and Dissertation

Babasa, Ruth. (2006). “Effects of School Nutrition Program on Pupils’ Performance.” Unpublished Master’s Thesis. Naga College Foundation, Philippines.

Ilagan, Christopher Mathew. (2007). “The Effect of Organizational Culture in the Delivery of Health Services in Public Elementary Schools: A Study of DepEd’s Health and Nutrition Section in NCR.” Unpublished Master’s Thesis. University of Asia and the Pacific, Philippines.

Muhi, Crisonia S. (2009). “Factors Related to the Nutritional Status of School Age Children in Selected Barangays of Boac.” Unpublished Master’s Thesis. Marinduque State College, Philippines.

Ruiz, A and Guiking, M. A. (2013). Strategies for Optimizing Implementation of the School Health and Nutrition Program in Public Elementary Schools in the Philippines. Philippines: Proceeding of the Global Summit on Education 2013.

Shuxteau, J. (Spring 2010). Incentives, coordination key to healthy blue, medical homes. Health Leaders: Interstudy's Mid-Atlantic Health Plan Analysis.

University of Portland School of Nursing DEU Bibliography American Association of Colleges of Nursing. (2012). Academic-practice partnership tool-kit.

D. Other Sources

Del Rosso, Joy Miller. (2009). Investing in School Health and Nutrition in Indonesia. European Commission Basic Education Capacity Trust Fund, World Bank. October 2009.

Monse, B. et. al.. Fit for School Inc. (2011). Manual for teachers for the implementation of essential health care program in schools. Fit for School Inc., Cagayan de Oro, Philippines.

Abstract This study aimed to investigate the effect of positive reinforcement on the attitudes and academic performance of pupils in the Capiz Division school year 2015-2016. The respondents were 375in public elementary school pupils. The design used was descriptive research

Pauly, M. V. & Schwartz, J. S. (1999). Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized trial.…...

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