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+CHAPTER I
INTRODUCTION
“In an ever-changing medical landscape, patient satisfaction has become a focal point
for providers and health-systems. Therefore, preferences regarding physician attire have become
In the year 1880s, wearing a white coat in medical practice begun when surgeons wore
them as a part of a “new aseptic” technique, non-surgical physicians were dressed in business
suit. Early of the 20th century, most physicians started wearing white coat and it has been
established as the “doctor’s uniform”. For decades now, the white coat ceremony reflected the
hurdles of medicine and a trophy of surviving them. The ceremony first held by Arnold P. Gold
Foundation of Columbia University College of Physicians and Surgeons, in the year 1993. By
the year 1997, majority of medical schools in the US started adapting this rite of passage.
Starting then the wearing of the white coat has been customary to physicians not until in the year
2007. During this year, the British government prohibited the wearing of long sleeved white coat
since it has been found to be a medium in spreading pathogens. (Wagner, P. et.al, 2007)
Fashion and tradition affects the choice of clothing of not only medical professionals but
of every professional as well. A major change to medical workforce and to societal expectations
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in the previous years led to change of mindset and perception towards dress and clothes
selection. One major factor that led to this change is the increasing number of female doctors that
enter the medical profession and traditionally, women does not have a well-defined “dress code”.
Another factor is the moving away from medical paternalism rendering a decreasing number of
physicians using the traditional white coat. Basing on the changes that happened in the previous
years, dress and clothing styles of doctors have become less and less formal. In an ever evolving
fashion and trends, the choice of clothing is leaning towards the comfort of the physician and
The goal of any medical intervention is to achieve a desired outcome with the patient.
However, foundation for all patient care is a good patient-physician relationship. Trust is an
important aspect of all human relationships. As a part of the patient-physician relationship, trust
comes from how patients perceive their doctors. Patients are not only more compliant to the
regimens when they perceive their doctor as being competent in both clinical and interpersonal
skills but are also more open to discuss important and sensitive personal information. In
situations where the patient is vulnerable; such as during out-patient consultations, and physical
important role in establishing patient-physician relationship. During this visit, the patient will
Development of the patient’s first impression is based on his or her physician’s verbal
and non-verbal communication, as well as personal attributes like clothing, grooming, and
cleanliness. The choice of clothing and style of each medical professional has an important
impact on presentation, credibility and appearance. Researches and related literatures that tackle
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these issues have been conducted abroad where culture and tradition differ from that of the
This study aims to find the association between the Physicians’ attire, Perceived
Physician Age and the Level of Trust and Confidence of Patients 18 years old and above in
Secondary-Private Hospitals.
hospitals?
2. What is the association of Physician’s attire and Perceived Physician age to the Level of
3. What is the preferred Physician’s attire and Perceived Physician age of the Research
respondents?
I.3 Objectives
A. To identify the demographic profile of the respondents from the Research Locales
Confidence
and Confidence
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An understanding of when, why and how attire positively influences patient’s perception
is important. Several developed countries, such as Belgium, have conducted a study that states
patient prefers a physician to be in their professional attire. Some of these studies capture the
influence of physician’s attire to the Level of Trust and Confidence of patients without
considering the impact of perceived age, gender and cultural background of physicians in their
choice of clothing.
This study will primarily help physicians in reinforcing first impressions and establish
rapport, trust and confidence of their patients. In addition, the physicians will better understand
the relationship of their attire to the Level of Trust and Confidence of patients.
Secondly, this will also shed in light to patients on what usually influences their
perception towards their physicians. When trust is built, the patient-physician relationship will
lead to return in follow –ups and compliance in recommended medical regimen, the goal of
Thirdly, hospitals and health care facilities can improve their rules and policies regarding
physician uniforms in their respective institution. This study will be a basis to better enforce
Lastly, this research study aims to determine the association of Physician’s attire and
Perceived age to the Level of Trust and Confidence of the patients in the Philippine setting.
There are several factors that generate patient-physician trust and confidence. This study
aims to associate Physicians’ attire and Perceived Physician Age to the Level of Trust and
Confidence of patients. In addition, this research will identify the patient’s preference when it
There is a vast classification of clothing when dealing with fashion and style, this
research will also be limited to only four typical hospital attires worn by physicians. In this
research, the male and female attires are separated not for comparison but to give the respondents
an idea and a visual representation of the physical difference of the four styles of clothing if
worn by the other sex. Nevertheless, the results will be treated and analyzed as a separate entity.
The four main styles that will be used in this research are Casual, Formal, Scrub suit, and White
coat. Each component of this style are described and elaborated in the operational definition of
terms.
In this research, the target respondents will be in-patients and out-patients of Metro Vigan
Multi-Purpose Cooperative Hospital and Northside Doctors Hospital that are 18 years old and
above.
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CHAPTER II
Clyde, J., (et. al), 2014 in their study entitled Medical professionalism: an experimental
look at physicians’ Facebook profiles concluded that by viewing a physician’s Facebook profile
a patient can accurately make inferences regarding the personality and characteristics of that
physician. Moreover, these inferences affect a patient’s perception of his or her doctor. More
specifically, the Facebook profiles affect the patient’s judgment regarding the doctor’s ability to
A total of 250 students were asked to participate in the study, the respondents were asked
to evaluate 3 categories of Facebook profile. The categories of the profiles include (1) solely
professional, (2) personal material that was strictly healthy and lastly (3), personal material
including an unhealthy behavior. In this same study, additional conclusions made states that self-
presentation of a physician whether it is face-to face or via Social Networking Services (SNS)
healthy profile may augment a patient’s perception of that physician’s character virtues if the
Several research studies were conducted to analyze the impact of physician’s attire to
patient trust and confidence. In one of these studies, Simon et, al. (2014), through survey
describes the epidemiologic profile of subjects who trusted their physicians more were U. S
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Chinese older adults aged 60 and above. Higher trust in physician was significantly correlated
with older age, female gender, lower educational level, being unmarried, having more children,
having lived longer in the United States, having lived longer in the community, China as the
country of origin, living with fewer persons, better overall health status, and those who had better
quality of life. Moreover, the researdh shows that older age was significantly associated with a
higher level of generalized trust, trust toward family members, friends, neighbors, and strangers
and this can be a coping strategy that buffers against the detrimental effect of declines in later
adulthood. Of the same study, trust toward strangers may be generally lower in countries with
Another detailed study done by Petrilli, CM., et.al, (2015), using previous researches
associating Physician attire to Level of Trust and Confidence, states that elements such as the age
of the patient, geography and population, and the context of care provided influences the
patient’s perceptions towards the attire of a physician. According to this study, older patients in
European and Asian nations leaned towards a more formal attire compared to those respondents
from USA. The result of the research gave a new perspective regarding the topic associating a
Physician’s attire and confidence of patients. Professional attire is an important modifiable facet
improbable. However, tailored and well-thought approaches to improve the Level of Trust of
patients through the physician’s attire should take into consideration the patient’s preference,
In the 3-year study of Croker et. al. (2013) with a 2 163 456 ages 18 years old and
above patients in the sample, registered under the care of General Physicians in England for at
least 6 months reported that patients’ confidence and trust in the doctor increased with the
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patient's age and was similar for men and women and was reported more frequently by those of
white ethnicity.
Preferences for Doctors Attire in Japan. The researches administered a 10-point questionnaire. A
5-point Likert scale was used to estimate patient preference for four types of attire in both male
and female physicians, including semi-formal attire, white coat, surgical scrubs, and casual wear.
In addition, a 4-point Likert Scale was used to measure the influence of doctors’ attire on patient
confidence. Of 2,272 outpatients enrolled, 1483 (67.1%) of respondents were women. Mean age
Rehman, S., et.al, (2005), studied the effects of the doctor’s attire to patient trust and
confidence. The research has 400 respondents with a mean age of 52.4 were enrolled. Of this
54% were men, 58% were white, 38% African-American, and 43% had greater than a high
school diploma.
The research entitled Judging a book by its cover: descriptive survey of patients’
preferences for doctors’ appearance and mode of address was done at Christchurch Hospital,
New Zealand conducted by researchers Lill, M., and Wilkinson, T., (2005). The 2-part survey
was administered within two weeks. Outpatients were first given the questionnaires and the
inpatients the second week. The sample population comprised 606 patient; 155 declined or were
unavailable. The researchers recruited 249 outpatients and 202 inpatients, comprising 214 men
and 232 women, the remaining did not identify their sex. A mean age of 55.9 years (SD 19.3
years), six people did not provide their age. In total, 127 people were aged less than 45 (28%),
144 were 45-65 (32%), and 174 were more than 65 (39%).
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When it comes to attire, Budny et.al, (2006) in his study involving 155 patient surveys
analysed- 68% indicated that they had more confidence in a physician who wore professional
attire, 17% preferred casual dress, and 15% preferred surgical scrubs. White coats inspired
confidence in 42% of all patients while only 2% responded that a white coat did not inspire
confidence in their provider. The study of Rehman, S.,et. al. (2005), showed respondents
answering that they were significantly more willing to share their social, sexual, and
psychological problems with the physician who is professionally dressed. These two initial
studies show that patients can better confide with a physician they perceive as professionally
dressed.
In the study of Chang et. al (2011), a sample population comprised 153 adult outpatients
with the mean age of 43.3 years were asked to assess identical photographs of the same medical
doctor wearing four different kinds of attires—Casual, Suit, Traditional, White Coat. Result
showed that patients preferred a doctor to wear a white coat, regardless of whether they thought
the doctor was a Western or Oriental medical doctor. They answered that the doctor looked
more competent and trustworthy in the white coat, and that they would also choose a doctor in a
white coat for their treatment. The same study was conducted by Chung et. al (2012), results
when the doctor was dressed with the white coat, and highest scores in ‘comfortableness’ and
‘contentment with the consultation’ when the doctor was dressed ‘Traditional’.
However in the study of Lill, M and Wilkinson, T., (2005) with a sample population of
202 inpatients and 249 outpatients, mean age 55.9 (SD 19.3) years, they found that patients
prefer doctors to dress in a semiformal style over formal suits and white coats but when
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accompanied by a smiling face it is even better which suggest a friendly manner. In line with
previous studies, casual dress styles were less popular. This finding, and the association with age,
suggests the beginnings of a trend away from patients preferring white coats. In general, patients
Yamada, Y., et.al, (2010), in his study conducted in Japan with outpatients in St. Luke’s
International Hospital learned that preference for male physicians’ attire was significantly
different between male and female respondents while for female physicians choice of attire did
not significantly vary between respondents of different gender. Relatively young respondents
with mean age of 46.6 years ranked casual attire the highest, surgical scrubs was chosen by
outpatients with mean age of 55.3 years while a mean age 0f 52.5 years preferred physicians
wearing white coats. In the preference of attire for female physicians mean ages of 55.1 years,
52.0 years old, 43.3 years selected surgical scrubs, white coat, and casual wear, respectively. The
researchers concluded that for male primary care physicians, pediatricians, and psychiatrists, the
white coat was most preferred. Respondents who chose white coats as best attire for physicians
said so because of hygiene and confidence of physician associated with wearing the coat.
Respondents who preferred casual dress as the best attire expressed that physicians wearing this
category of attire shows friendliness and approachability. Finally, most patients thought that
physician’s attire had an influence on their confidence in their physician’s ability to provide
In the parallel study of Gherardi, G., et al. (2009) surveyed 586 adult patients at Airedale General
Hospital, West Yorkshire, England in their research study. The respondents were found to be
more confident in doctors wearing white coats across all demographic groups because it serves
attire was the second most popular choice due to patients’ exposure to this dress type in clinical
settings, as well as patients’ perceptions of this attire being smart and professional. While many
found that professional formal attire was too intimidating and that even though it conveyed
authority, some regarded it as being slightly pretentious. Casual attire was found to be least
confidence inspiring as the unkempt appearance of the doctor was believed, by many patients, to
be associated with a lack of ability. Taylor, P., (1987), conducted his study for parents of
children admitted in a pediatric ward, using random sampling method. The results indicated that
parents were twice likely to attribute competence of the physician wearing formal dress
compared with physician wearing their scrub suits and four times more likely compared with
After studying the attitudes of surgical patients, surgeons, and the non-hospitalized public
(NHP) regarding surgeons’ attire, Major, K. et.al (2005) concluded that a surgeon’s appearance
affects perceptions of the quality of medical care received. In this study, a questionnaire
regarding surgeon attire and professional demeanor was administered to surgeons and
consecutive surgical inpatients. The questionnaire was also placed on the internet at Med Help
International, a non-profit health information service, to survey the attitudes of the non-
hospitalized public. Responses were collected from 38 surgeons, 38 surgical in patients and 343
NHP by way of internet. Their surveys have shown that that both surgical patients and surgeons
agreed that white should be worn while only 42% of the NHP believed that white coats were
appropriate. Surgeons believed that scrub suits were appropriate attire whereas patients and the
NHP had mixed responses with regard to scrub suits. A physician wearing blue jeans while
seeing patients was found to be inappropriate by most surgeons and most patients. Most surgeons
believe that rubber clogs were appropriate whereas most patients and the NHP believed that
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rubber clogs were inappropriate. Finally, surgeons, patients, and the NHP all agreed that a
A study of the impact of physician attire and behavior on perceptions of care was done in
two ICUs in Japan with a total of 223 respondents visiting the ICU, it shows that a majority of
visitors agreed that doctors should wear a white coat and name tag, and address the patient by
last name. Fewer visitors agree that scrubs, short-sleeve shirts, sneakers and clogs are acceptable.
While, majority of visitors disagree that wearing blue jeans or carrying a snack on rounds are
acceptable. Overall, 50% of visitors scored “agree” that physician attire affects their overall
perception of care, and 36% scored “neutral” with just 8% scoring “disagree” (Lofers, A., et al.,
2018). However in the study of Ikusaka, M., et al, (1999) with 599 respondents, result shows that
Japanese outpatients do not feel that a white coat affected their perception of care.
patients, shows that patient confidence was highest with the “respectable” dress protocol but
confidence levels did not deteriorate significantly with the loss of the white coat or a tie (Nair et
al., 2002).
Physician attire affects the Level of Trust and Confidence of Patient but is affected by
several other factors. Basing on the studies presented in the previous paragraphs, the use of white
coat is still conflicting but most researches suggested that physicians should wear professional,
casual or formal attire when attending to their patients. These clothing of choice impacts the
perception of patients towards their primary physicians. Physicians wearing these type of
clothing were seen to be trustworthy, sociable, competent, friendly and confident by their
patients.
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The study of Budny,et.al., (2006), results reflected that respondents preferred physicians
aged 31 to 40 years and 41 to 50 years, and commented that physicians in these groups will have
adequate clinical experience yet still be young enough to be familiar with the latest medical
technology. In the same study, 84% of the total population preferred age of physician was 41-60
years, however less than 10% of the population prefers physicians with age< 30 years.
This reasonable comment however, have been proved otherwise by several studies, that
young physicians have better knowledge about latest medical guidelines, in the study of Tsugawa,
Y., et.al (2017), young physicians have lower patient mortality rate, with knowledge of newest
medical guidelines compared to older physicians.The overall 30 day mortality rate in a final
sample of 736 537 hospital admissions in US acute care hospitals was 11.1%. After adjustment
for patient and physician characteristics and hospital fixed effects, older physicians had
significantly higher patient mortality than younger physicians. These associations were found
among physicians with low and medium volumes of patients but not among those with high
volumes. These findings suggest that differences in practice patterns or process measures of
quality between physicians with varying years of experience might have a meaningful impact on
patient outcomes.
After studying the factors associated with patient's choice of physician in the Korean
population, Kim et.al. (2018) came to the conclusion that the physician's age and medical school
were significant influencing factors for patient's choice of physician at the first visit with the
majority preferring younger physicians. However, a study conducted by Mason, L and Mason, J,
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2017 negated the results found by Kim et.al. (2018) , the studies showed that the age, gender and
race of the physician were not significantly associated with patient's trust.
A study taken in Boston, Chicago, and Los Angeles with a sample of 186 physicians
afforded the opportunity to test the effect of physicians' personal characteristics (age, gender, and
ethnic group) on patient adherence in a sample with an adequate number of physicians of each
gender, of White and number of physicians of each gender, of White and of non-White ethnic
status, and with good distribution across the age range of 31 to 55. Result found no significant
effects of these personal characteristics on patient adherence despite adequate power to detect
No researches were found to directly relate Physicians’ Perceived Age and the Level of
Trust and Confidence of Patients. Most of the researches found only suggest that the Age of the
Physician does not necessarily correlate with the Level of Trust and Confidence given by their
Patients. In one study Tsugawa, Y., et. al., 2017, presented above, categorized the age of the
physician as younger and older-physician. The result of this study is in conflict to majority of the
In Belgium, Hartmans, C., et.al (2014) stated that patients trusted a female doctor and an
older male doctor most when wearing professional clothing—that is with white coat on. The
patients, on the other hand, preferred the young and middle aged General Physicians to wear
semiformal attire. Semiformal attire was defined as a shirt with possibly a sporty jacket, pants
and shoes for men, and for women, a skirt with tights or possibly a smart pants and shoes with a
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small heel. This led the researchers to a conclusion, that the physician’s age is also a variable
when dealing with patient’s preference of clothing for male physicians. However, patients were
most at ease with a female doctor wearing leisure outfit, regardless of age.
In Japan, on the other hand, Kurihara, H. et.al, 2014, Asia Pacific Family Medicine,,
13:2, the researchers evaluated the importance of Physicians’ attire and the factors influencing
the impression it makes on patients. In this study, the researchers surveyed 530 patients or their
carers who visited pharmacies in different regions of Japan. Using a questionnaire showing four
subsets of attire for male and female doctors separately, they found out white coats were the
most appropriate style of clothing, followed by scrubs, for both male and female. Patients also
perceived scrubs as almost appropriate as white coats, but the inappropriateness of the scrubs
differed according to the age of the physician and the regions where the questionnaires were
in patients conducted at five pharmacies in three regions in Japan with a total of 1411
participants, white coat style ranked as the best for doctors of both genders. Elderly people aged
50 and above considered scrubs less appropriate for both male and female doctors compared with
the younger group. Regardless of physician gender, scrubs were rated significantly more highly
by female participants, whereas male participants ranked the smart casual style more highly for
female doctors (Kurihara, H., et al., 2014). Basing from the same study, participants rated a
doctor’s speech, reputation and attire as quite important in inspiring confidence and trust but age,
title and gender less so. However, each factor may make an important contribution to a patient’s
CONCEPTUAL FRAMEWORK
Map. This conceptual framework is an adaptation from Wagner, P., et.al (2007). This map, a
secondary themed map captures medicine as a unique profession, the congruence between
personal characteristics, outward appearance and behavior and the importance of peer
relationship. The diagram shows the triad of patient-physician relationship. Three cornerstones
are presented here namely: (1) Knowledge, and Technical Skill (2) Character virtues (3)
Relationship of patients with the physician. Focusing on the second cornerstone, Character
Virtue, is affected by personal congruence, and dress. Although not shown in the diagram, there
are other parameters also that comprise the two remaining cornerstone which are not central in
this research.
DEFINITION OF TERMS:
a. Research respondent – inpatients and outpatients ≥18 years old of Metro Vigan Multi-
b. Perceived Physician Age- divided into two age groups: (1) 25-45 years old and (2) 46-
65 years old. This pertains to how young or old the physician is basing on his/her looks.
25-45 years old belongs to a “younger” looking physician and 46-65 years old pertains to
c. Casual:
i) Female: Denim Pants/Corduroy with sleeveless or short sleeved shirt with tennis
shoes, flats or low-heeled footwear and does not fall under the criteria of formal attire
ii) Male: Jeans with an upper of collared, short sleeved shirt, polo shirt and tennis shoes
with black or white socks and does not fall under the criteria of formal attire
d. Scrub suit – a pair of scrub suit of any color with rubber shoes as footwear
e. Formal:
i. Female: Buttoned down blouse, suit pants/slacks, jumpsuit or dress with high-
heeled footwear
ii. Male: Buttoned-down short or long sleeves polo, pant suit or slacks with black
f. White coat- an inner of casual attire with an overlay of long sleeved white coat
g. Patient Level of Trust and Confidence- determined by the set of questions adapted
from the study of Rehman, S., et.al, (2005) and Petrilli, CM., et.al, (2015). The
compassion
o emergency
CHAPTER III
METHODOLOGY
Research Design
A cross-sectional study will be used, where the researcher will measure the
outcome in the population and study their association. This is an observational study design
(Maninder, S., 2016). Self-completion questionnaire will be distributed and written and verbal
consent will be obtained prior to the distribution. Patients will be interviewed afterwards with
regard to their answers. This will be helpful in assessing the importance of specific attire (white
coat, scrubs, casual attire, and formal attire) and the Perceived Age to the Level Trust and
Confidence of the patients to their physician and to evaluate the preferred physicians attire and
perceived age that influences the Level of Trust and Confidence of patients. No follow –up will
be done to the respondent after completion of the questionnaire and the post-survey interview,
thus the response of each patient is only taken by a single point in time.
Research Locale
hospital located in Bantay, Ilocos Sur. MVMCH is easily accessible to public transportation and
is 200-hundred away from the national highway. On the other hand, Northside Doctors Hospital
(NDH), also a secondary private hospital is 2.6 kilometers away from Metro Vigan Multi-
purpose Cooperative Hospital. The research locales were chosen due to its accessibility, and the
number of patients that comes for admission and consultation. In addition, teaching physicians in
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the University of Northern Philippines also conduct consultations in the said hospitals making
the quota for respondents easily attainable with the help of tutors from the university.
Basing on the data provided by Northside Doctors Hospital and Metro Vigan Multi-
purpose Cooperative Hospital, a total of 250-300 patients aging 18 years and above, visits the
hospitals per week as out-patients. However, these numerical data excludes the number of
patients consulting on Sundays. NDH has a total bed capacity of 100 while MVMCH has an 80-
Philippine Statistics Update on August 1, 2015 showed that a total of 35731 inhabit
Bantay, Ilocos Sur. According to the same survey, ages 18 years old and above comprises 65.1%
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of the total population. With this data on hand, it only goes to show that out of 35731 a total of
representative size inputting the following data: Margin of Error equivalent to 5%, Confidence
Level of 95%, and Population size of 23261. Presented below are the results from the online
Sample Size
Population size: 23,261 Total population of 18 years old and above in Bantay,
Ilocos Sur
answer.
Confidence level: 95% This tells you how sure you can be of the margin of
the population.
Table 3.2 will show the total respondents the researchers need to invite if only 80% of the
population can complete and answer the questionnaire. By doing this, the researchers will still be
able to attain the total 378 needed respondents despite foreseen setbacks such as incomplete
questionnaire. Therefore, a total of 473 respondents are needed to answer the questionnaire.
Estimated response rate: 80% What percent of those asked to participate in the survey
incentives, etc.
Number to invite: 473 This is the number of individuals out of the population
rate.
Quota sampling will be used in this research. To determine the correct proportion for the
respondents, the researchers first have to determine the average weekly admission and outpatient
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visits for both Metro Vigan Multi-purpose Cooperative Hospital and Northside Doctors Hospital.
The statistician will then help the researchers to determine a proportional number of respondents
from outpatient and inpatient from the two research locales. The respondents should meet a
certain criteria first. Initially, the patient should be 18 years old and then categorized whether the
respondent is inpatient or outpatient. Any patient that fulfills the criteria, and the categorization,
the patient will qualify as a respondent for the research until the researchers reach the quota for
both inpatient and outpatient from the hospitals. Fifty-percent of the respondents will be taken
from Metro Vigan Multi-purpose Cooperative Hospital and the remaining half from Northside
Doctors Hospital. According to the October, 2018 census of NDH, they have a total of 385 and
1143 adult in-patient and out-patient, respectively (Ratio of 1:3). MVMCH on the other hand,
has 1022 out-patients and in-patient of 411 for the month of October, 2018 (Ratio of 1:2.5).
Using the in-patient to outpatient ratio, the values found in Table 3.3 are calculated.
Hospital affiliation
Instrumentation
In this study, the researchers adapted two instruments from the researches of Rehman, S.,
et.al, (2005) and Petrilli, CM., et.al, (2015) with modification. The first section of the
questionnaire contains a brief cover letter and questions pertaining to the demographic data of
the respondent. A fill-up form is used to ask the respondent of his/her name, age, address, and
sex. Questions 1, 2 and 3, requires the patient to put and X mark in the box before their answer to
The second part of the research instruments shows four images of both female and male
physician lined up next to each other in a single page. The series of questions were replicated
from Rehman, S., et.al, (2005). The questions pertain to the Level of Trust and Confidence of
patients and are parameters of it. The images shown should be ranked from 1st to 4th in reference
to the question found in the adjacent column. Rank 1 is given to the image that represents the
primary choice of the respondent, 4 being the least among the respondents option. Separate
Below is a table showing the value in points of each rank for this section.
The third section of the questionnaire will assess the Level of Trust and Confidence of
the patient basing on Perceived Physician Age and Physician attire. This section is modified
from the study of Petrilli, CM., et.al, (2015). There is a separate page for female and male
physician attire, and Perceived age. In this section, the response to the questions is through a
Each question is a parameter of Level of Trust and Confidence of patients. For each
image depicted, the respondents are asked to scale and rate how likely they are to trust a
physician wearing the attire shown. The questions that will serve as parameters are: (1)How
knowledgeable does this doctor look? (2) How comfortable does this doctor make you feel? (3)
How caring does this doctor appear? (4) How likely are you to follow this doctor’s advice?
(5)How approachable does this doctor appear? (6) How confident are you of this doctor’s
treatment? In the last row of this section, an open ended question is asking the respondent to
provide their personal comment regarding the physician seen wearing the particular style or
manner of dressing.
The norm that will be used to determine the Level of Trust and Confidence of patients are
as follows:
Scale Descriptive Rating per Item Range of Values Overall Descriptive Rating
Initially, researchers will be developing their paper and the research questionnaire so as to
serve its intended respondents. The questionnaire will be formulated using suitable questions
adapted and modified from related research. The researchers will seek permission from the
Hospital Directors to administer the questionnaires in the research locales. In addition, a patient’s
Researchers will be divided into two groups and will be distributing the questionnaires to
a total of 480 respondents. Each patient should first pass the inclusion criteria aforementioned in
this research. First, respondent must be at least 18 years old and above and finally, the
respondent should be either an in-patient or out-patient at the time being, of the research locale.
If a patient passes the inclusion criteria, the now research respondent will be asked to sign an
informed consent prior to participating in the study. Instructions will be given before
administering the questionnaires and are reinforced by written instructions in the material. The
respondents will be given time to respond to the survey tool and will be timed from the start of
filling up of the questionnaire up to the time it will be returned to the researchers. To reinforce
and countercheck the responses, the researches will observe the respondent while answering and
After collecting all data required, the researchers with the aid of the statistician, will
tabulate, tally, analyze and interpret the responses. The tables that will be used in tallying the
data are adapted and modified, in accordance to the purpose of the study from the research by
Jennings JD., et.al, 2016. Along with primary data, the researchers also will make use of
secondary resources in the form of published articles and literatures to support the survey results.
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As it is for every study, this research is expected to have limitation. Listed below are
foreseen issues by the researchers and the accompanying plan to resolve it.
modelling for the research, and the research locales were given informed consent that bears the
purpose of the research, the assurance of confidentiality, and that no reward or compensation will
be given.
Secondly, the research locale are hospitals where most tutors from the University of
Northern Philippines are on duty, to eliminate a change of course of action or the manner of
dressing of the physician, tutors from the university will not be informed about the research or
Third, for reasons of confidentiality and bias, serving dual purpose, the faces of models
for this research study is blurred out to protect from unnecessary breach of confidentiality and
because the models belong to a single age group—pixelating faces will eliminate bias of
The following statistical tools will be used to treat and interpret the data gathered,
3. Mean to determine the Level of Trust and Confidence in relation to Physician Attire and
the individual Physician Attire to the Level of Trust and Confidence of patients, and the
Research Framework
DUMMY TABLES
MVMCH NDH
Variable Inpatients Out-patients Inpatients Out-patients TOTAL
F % F % F % F %
Age
18 to 34
35 to 54
55 or older
Total
Sex
Male
Females
Total
Education
Elementary Undergraduate
Elementary Graduate
HS Undergraduate
High School Graduate
Vocational Course
College Undergraduate
College Graduate
Post- graduate
Total
Physician of Choice
Yes
No
Total
30
Particulars Calculated Weight (No. of Respondents x Weight) Total Mean Over all Rank
Emergency
Casual
Formal
Scrub suit
White coat
Discuss
Casual
Formal
Scrub suit
White coat
32
Table 3.7 Level of Trust and Confidence, Physician Attire, and Perceived Age
̅
× DR ̅
× DR ̅
× DR ̅
× DR ̅
× DR ̅
× DR ̅
× DR
Age 25-45
Age 46-65
Female Casual
Female Formal
Male Casual
Male Formal
APPENDICES
34
Appendix “A”
Letter of Permission for Northside Doctors Hospital
Greetings!
We, the undersigned, are third year medical students of the University of Northern Philippines
College of Medicine, having a research proposal entitled “The association of Physician’s Attire and
Perceived Age to the Level of Trust and Confidence of Patients ≥18 years old in Secondary-private
Hospitals in Bantay, Ilocos Sur” in partial fulfillment of the requirements for the degree, Doctor of
Medicine.
In this regard, we would like to request from your good office to allow us to conduct this study in
your hospital and the patients. We would also want to ask your permission to take the daily, weekly, and
monthly census of the hospitals’ out-patient department and admissions. Further, we are requesting your
help in informing all doctors and faculties that we will be conducting this research.
Respectfully yours,
Sheinna Laica Barcelona Philip Omar dela Cruz Cherry Faith Labtang
Noted:
Appendix “B”
Letter of Permission for Metro Vigan Multi-Purpose Cooperative Hospital
Greetings!
We, the undersigned, are third year medical students of the University of Northern Philippines
College of Medicine, having a research proposal entitled “The association of Physician’s Attire and
Perceived Age to the Level of Trust and Confidence of Patients ≥18 years old in Secondary-private
Hospitals in Bantay, Ilocos Sur” in partial fulfillment of the requirements for the degree, Doctor of
Medicine.
In this regard, we would like to request from your good office to allow us to conduct this study in
your hospital and the patients. We would also want to ask your permission to take the daily, weekly, and
monthly census of the hospitals’ out-patient department and admissions. Further, we are requesting your
help in informing all doctors and faculties that we will be conducting this research.
Respectfully yours,
Sheinna Laica Barcelona Philip Omar dela Cruz Cherry Faith Labtang
Noted:
Appendix “C”
Letter of Consent for Models
It is to my knowledge and understanding that the photos printed will blur out my face, and
that my posing for these pictures will be kept confidential by the researchers. Moreover, I will
willingly help the researchers without expectation of a reward or compensation. Most especially,
the researchers are obliged to keep my identity and whereabouts private and concealed.
Respectfully yours,
_______________________________
(Signature of Model)
Agreed by:
Sheinna Laica Barcelona Philip Omar dela Cruz Cherry Faith Labtang
Appendix “D”
Letter of Consent for Respondent
Respectfully yours,
____________________________________
(Signature of Respondent)
38
Appendix “E”
Questionnaire in English
University of the Northern Philippines
COLLEGE OF MEDICINE
Vigan City, Ilocos Sur, Philippines
Thank you for taking the time to complete this questionnaire. Your answers will help us
understand better whether physician attire and perceived age affects the patient’s trust and
confidence with their doctors.
Your responses and opinions are important to us. There are no right or wrong answers
and we are very much interested in your honest responses. This questionnaire should only take a
few minutes.
All of your answers will be kept confidential. Your responses will also not be shared with any
of your doctors and hospital staffs.
Carefully read the instructions and questions found below. PUT AN X ON THE BOX
BEFORE YOUR CHOICE
ADDRESS: SEX:
INSTRUCTIONS: Carefully look at the images to below and the questions on the first
column, RANK (1ST, 2ND, 3RD, 4TH) these female physicians attire from 1 as your first option
to 4, your last option. DO NOT LEAVE ANY BOXES BLANK.
39
Carefully look at the images to
the left and the questions on this
column, RANK (1st, 2nd, 3rd,
4th) these female physicians
attire from 1 as your first
option to 4, your last option.
DO NOT LEAVE ANY
BOXES BLANK.
INSTRUCTION: The proceeding items will assess your Trust and Confidence to your doctors using
their Attire and your Perception of your doctor’s age. Please, RATE AND ENCIRCLE THE
NUMBER that best represents your choice referring to the scale below. The last question on this table
requires you to give a comment. PLEASE FILL ALL THE ITEMS, do not leave items blank.
5- Extremely
4- Very
3- Moderately
2- Slightly
1- Not at all
How comfortable
does this doctor make you feel? 1 2 3 4 5 1 2 3 4 5
5- Extremely
4- Very
3- Moderately
2- Slightly
1- Not at all
How
knowledgeable 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
does this doctor
look?
How comfortable
does this doctor 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
make you feel?
How caring does
this doctor appear? 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
5- Extremely
4- Very
3- Moderately
2- Slightly
1- Not at all
How
knowledgeable 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
does this doctor
look?
How comfortable
does this doctor 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
make you feel?
How caring does
this doctor appear? 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5
Appendix “F”
Systematized Approach to Patient
Good day, Ma’am/Sir! We are Third-year Medical Students from the University of Northern
Philippines. We are here today, to ask permission from you to become our respondent for our research
study entitled The association of Physician’s Attire and Perceived Age to the Level of Trust and
Confidence of Patients ≥18 years old in Secondary-private Hospitals in Bantay, Ilocos Sur. The
purpose of this study is determine if the Level of Trust and Confidence you have for your Physician is
affected by the clothing he/she wears and his/her Age. This will greatly help us in completing our
course.
We have already asked permission from the hospital director to conduct our research here in the
hospital. And if you agree to taking the survey, we will give you a questionnaire and a written consent
for you to sign. While you answer the questionnaire, we will also observe you and after you pass your
filled-out questionnaire we will conduct just a short interview to know if you understood what each item
is asking and to confirm your answers in each item. This will only take just a while. We assure you that
your identity will be kept confidential.
(If yes…) So to fill out the questionnaire, please write down first your identification information.
The first two pages of the questionnaire, will ask you to put an X in the box before your answer. Items 3
and 4, asks you to state your reason for your answer, as much as possible, do not leave it blank.
The 3rd up to the last page of the questionnaire tells you to encircle a number that represents what
you think about the doctor in reference to the doctor. For example, I ask you “How handsome is this
doctor?” If you think the doctor is extremely handsome you encircle five, if you think he’s not
handsome at all encircle one. The description of each number from one to five is in the questionnaire.
Do you have any clarification before you start?
44
Appendix “G”
Post-Survey Interview
Thank you Ma’am/Sir for responding to our questionnaire. Give us atleast 5-10minutes to go over
your responses to the questionnaire. For confirmation purposes, you are (name of respondent),(age)
years old, from (address) and (educational attainment, confirm and note last grade/year level
accomplished) . Note responses, facial expression, and gestures by patient all through out interview.
Ma’am/Sir, let us review your answers to the 2nd section of the questionnaire. This section asked
you to ranked the physician attire basing on the questions. For the question, who would you more likely
to follow advise, you rank the images as (rank 1 attire, pointing on the image at the same time) as 1, rank
2 is (rank 2 attire, pointing on the image at the same time), your 3rd is as (rank 3 attire, pointing on the
image at the same time) and you rated this as (rank 4 attire, pointing on the image at the same time) the
physician whose advice you’ll least likely to follow. Will you tell as if you have specific reasons why
you ranked this attire in this order? Wait for answers or reasons. Observe non-verbal cues.
This section asked you to ranked the physician attire basing on the questions. For the question,
Would you have the most confidence in their diagnosis and treatment? , you rank the images as (rank 4 attire,
pointing on the image at the same time) as 4, rank 3 is (rank 3 attire, pointing on the image at the same
time), your 2nd is as (rank 2 attire, pointing on the image at the same time) and you rated this as (rank 1
attire, pointing on the image at the same time) the physician whose advice you have the most confidence
in. Again, will you tell as if you have specific reasons why you ranked this attire in this order? Wait for
answers or reasons. Observe non-verbal cues. Do the same for the next four questions under Section two
for both male and female physician attire.
We are now on the last part of the questionnaire. Kindly, bear with us as we review the answers you
gave. Is that alright? Are you okay? Thank you. Let us go first with the young and old doctors. For you,
a younger doctor is (numerical rating and description) knowledgeable and the older doctor is (numerical
rating and description). Do you mean to say that an (age group with a higher rating) is more
knowledgeable than (age group with lower rating)?Note response and write-down reason or comment
given, if there are any.
You also noted that you are more comfortable with a (age group with a higher rating) because you
rate it as (numerical rating and description) than (numerical rating and description) of the (age group
with lower rating). Is that right?
In your opinion, a (age group with a higher rating) appear to be more caring with a rating of
(numerical rating and description) than the (age group with lower rating). Note response and write-down
reason or comment given, if there are any.You are also more likely to follow the advice of the (age
group with a higher rating) than that of (age group with lower rating), am I right? Note response and
write-down reason or comment given, if there are any.You rated a younger doctor’s approachability as
(numerical rating and description) and an older doctor as (numerical rating and description), right? So,
for you a (age group with a higher rating) is more approachable, correct? Last question for age, your
confidence of a younger doctor’s treatment is (numerical rating and description) and older doctors as
(numerical rating and description), meaning to say you are more confident of a (age group with a higher
45
rating) treatment, am I correct? Can you give comment on the younger /older doctors? If respondent
finds this hard to answer, use keywords and leading words e.g knowledgeable, friendly, approachable,
and caring.
Note: Use the interview structure for attire, reiterate to respondent what he/she rated highest, which
attires were rated the same, and attire rated least. Encourage patient to give comments on each attire.
We took so much of your time, Ma’am/Sir. We are sorry but thank you very much, for allowing us
to ask you questions. This will be a great help to us. We hope and pray and you will be out of the
hospital soon enough. Thank you again. God bless.
Legend:
Red and italized – for the interviewers only
(underlined) – answers given by patient in the questionnaire
46
Appendix “H”
CONTENT VALIDATION FORM
Using the criteria below, please assess the attached questionnaire on the “The association of
Physician’s Attire and Perceived Age to the Level of Trust and Confidence of Patients ≥18
years old in Secondary private Hospitals in Bantay, Ilocos Sur” by putting a check mark (✔)
on the appropriate column or box.
5- Excellent
4- Very Good
3- Good
2- Fair
1- Poor
Kindly include your comments and suggestions for the improvement of our study.
Criteria 5 4 3 2 1
1. Focused (all questionnaires are directed on the association of
Physician Attire and Perceived Age to the Level of Trust and
Confidence of patients)
2. Clear (statements are simple and easily understood)
3. Relevance (questions are within the topic)
4. Concise (adequately short enough to read and understand targeted
respondents)
5. Simple (terms used suits the level of the respondents)
Comments and Suggestions:
Validator:
_________________________ Position:
(Signature over Printed Name) Department/Agency
47
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