covid 19 opinion essay tagalog

• Subscribe Now

[OPINYON | Wikapedia] Paanyayang magsulat ng COVID-19 – Coronavirus Dagli

Already have Rappler+? Sign in to listen to groundbreaking journalism.

This is AI generated summarization, which may have errors. For context, always refer to the full article.

the virus and the Monstrance duel to death in a dance to give you another chance.

Kung hindi ako nagkakamali,   5 ang kaniyang ipinadala.

At ito ang pinakaeksakto sa pagpatak ng 12 midnight.

Kumbaga, itong dionang ito ang pinakahuling lahok na pasok na pasok para sa nakaraang timpalak nitong Marso .

Tuldok na ito kung tutuusin.

Subalit gagawin natin itong tutuldok.

Sapagkat, ngayong Abril, na  Pambansang Buwan ng Panitikan , ay ating uumpisahan ang isa pang hamon.

Gaya ng ipinangako namin sa inyo, may isa pang paligsahan.

Pasusulatin naman namin kayo ng kuwento.

Sa dinarami-rami ng mga nangyayari sa loob at labas ng bahay nating sawi, tiyak hindi tayo mauubusan.

Dahil nga sa nagbabantang Extended bilang karugtong ng Extreme na at Enhanced pang Community Quarantine, pihadong makakasulat kayo kahit ng isa pang E – epiko!

Ngunit wala muna tayong tugma.

At binibilang na talinghaga.

Magpahinga tayo sa pagtula.

Ako yata ang di makawala.

Kaya, magkuwento lamang kayo nang magkuwento.

Sa buong buwan ng Abril, inaanyayahan namin kayong sumulat ng inyong karanasang maligaya o malungkot o masalimuot o kung ano pa.

I-post ito sa Facebook at i-tag ang Rappler  at ang Foundation AWIT .

Iikot ito sa COVID-19, gamit ang 19 salita, susulat kayo ng daglî.

ANO ANG DAGLI ?

Ang daglî, ayon sa Sagisag Kultura ng Filipinas , ay isang kuwento na mabilisang isinusulat at inilalabas.

Mas madalas kaysa hindi, ang daglî noong una ay “mapagpatawa” at “nagpapahayag ng matapang na pamumunáng pampolitika.”

Maihahambing ito ng mga Tagalog sa pasingáw  sa isang pagsasalaysay lamang tungkol sa pag-ibig.

Para kay Fausto Galauran, ang daglî ay isang “bukas na liham” ng pagtatapat para sa isang paraluman o pagbanggit ng isang pangyayari o tagpo para sa sinumang nilalangit.

Alam ba ninyong ang itinuturing na makabuluhang daglî ay isinulat ng isang Bisaya sa wikang Sebwano?

Pinamagatan itong “Maming”  at lumabas sa Ang Suga noong Hulyo 16, 1901.

At ang awtor?

Walang iba kundi ang lolo ni Vic Sotto.

O di-kaya’y lolo sa tuhod ni Mayor Vico Sotto.

Magkatokayo sila ni Tito Sotto na ang buong pangalan ay Vicente Sotto III.

Ang aking tinutukoy ay si Vicente Sotto, na hindi lamang isang politiko kundi isa ring peryodista na mas kinikilala bilang “Ama ng Wika at Panitikang Sebwano.”  

Sa kabilang banda, sumulat din ng daglî si Deogracias Rosario, na itinuturing namang “Ama ng Maikling Kuwentong Tagalog.”

Hindi iilan ang mga daglîng isinulat sa Espanyol at Ingles.

Maitutumbas ito sa rápidá , instantanéa , o rafága ng Espanya.

O maitatapat   ito sa flash o sudden fiction ng Estados Unidos.

Subalit, kung susuriing maigi, maigigiit ang mga pagkakaiba.

Isaalang-alang natin ang depinisyon o deskripsiyon ni   Alejandro G. Abadilla (AGA), na napansing ang mga daglî ay didaktiko o “nangangaral” o nagsesermon.

Samantala, ang flash o sudden fiction ay magkaiba rin subalit, para kina Robert Shapard at James Thomas, editor ng Flash Fiction Forward: 80 Very Short Stories (2006) at New Sudden Fiction: Short-Short Stories from America And Beyond , ang dalawang ito ay kapuwa nagpapagitaw o tumatawag ng panagano o mood at nanggigising ng isip o intelek – habang ipinapakilala tayo sa mga taong interesante o inilalarawan sa kakaiba ngunit nauunawaang pangyayari.

Ano’t ano man, ang karaniwan sa lahat ay ang pagtutuon ng pansin hindi sa haba kundi sa lalim o liwanag ng bisyon sa pagpapahalaga sa pagiging tao o pagpapakatao.

Tanda lamang na kaya o may kapangyarihan ang daglî na umayon, o sumang-ayon, o sumabay o sumakay sa panahon.

Dagsa ang daglî sa mga babasahin noong sinakop ang Filipinas ng mga   Amerikano.

Kung kaya, masasabing ang daglî ay naging daluyan ng pang-uuyam o pangungutya, lalo noong tayo ay nasa ilalim ng mapanupil na pamahalaan.

Sa pagpapalit ng kolonya – mula Espanyol patungong Amerikano – isa sa mga uring pampanitikang pinili ng mga manunulat ay ang daglî.

Noong 1902, ang mga isinulat ni Lope K. Santos na daglî ay ihinalintulad ni AGA sa sketches .

Basahin ang Muling Pagsilang ni Santos – na unang lumabas sa pahayagang Tagalog – upang maintindihan ang katangian ng mga namayaning daglî.

Oo, nandoon ang anggulo ng pagsinta, pero hindi maiwasan ang panig ng panunuligsa.

BAKIT NAMAN ANG IKLI ?

Ani AGA: “Ang naging pagtangkilik ng mga Pilipino sa mga daglî ay hindi lang dahil sa panlalamig nila sa mahahabang babasahin, kundi dahil sa naging angkop sa pangangailangan ng mga tao noon na makatipid ng panahon at gugol sa mga babasahing umaaliw na’y nagangaral pa rin.”

Saksi ang Dekada ’90 sa pagbangon at pagbagsak ng mga di-mahahabang prosa.

Oras na para ibalik sila.

Ngayon pang nagkakasya tayo sa kuwadro ng cellular phone, iPad, laptop, at iba pang gadget na grabe sa liit pero lintik sa pagiging high tech.

Mula noon hanggang ngayon, diyaryo ang isinilang, lumaki, at tumanda sa ganitong kalagayan.

Sanay na sanay ang mga peryodistang isilid ang mga titik sa em at en.

Inabot ko pa nga ang pagbibilang ng mga salita at parirala para sumakto sa ulo ng balita.

At bilang manunulat, ako ang isa sa naging tagapagtaguyod ng Panitikang Panakip-butas!

Nariyan din ang mga magasing nagsilang sa mga minadaling ginto na pagtagal ay inaampon ng mga aklat o antolohiya ng iba’t ibang literatura, pangkampus o panrehiyon o pambansa o pandaigdig man ang mga ito.

Noong 2003, ang kuwentistang Filipina na isinilang sa Estados Unidos na si Noelle de Jesus ang nakaisip bumuo ng antolohiya ng Fast Food Fiction Short Short Stories To Go na inilimbag muli noong 2014 at inilabas ang Singapore edition noong 2016.

Isang kasamahan namin noon sa College Editors Guild of the Philippines (CEGP), si Roland Tolentino, ay isa mga kuwentistang nagsimula bilang editor sa pahayagang pampaaralan. Kaya, hindi kataka-taka nang maglabas siya ng ng 100 daglî mula sa mga balita:  Sakit sa Kalingkingan: 100 Dagli sa Edad ng Krisis (2005). Pagkaraan, naglabas siya ng kaniyang pag-aaral dito: Weder-weder Lang! Ang Materialidad ng Panahon at Espasyo ng Dagli (2007) at   Ang Dagling Tagalog 1903-1936 .

Halos magkasabay silang naglathala ni Alwin Aguirre ng kaniyang Semi-kalbo at iba pang kwento (2005), na may pagka-sci-fi gayong ito pa rin ay pantao at hindi pang-robot na sipat sa estado sa lipunan.

Sinundan din ito ng isa pang eksperimental na daglî ni Eros Atalia, na nasa kontrobersiyal niyang Taguan-Pung: Koleksyon ng Dagling Kathang Di-Pambata at Manwal ng mga Napapagal Kopi Teybol Dedbol Buk (2006) ukol sa karanasan ng mga bata ngunit di-pambata. Inilimbag ito ng University of Santo Tomas Publishing House na diumano’y pinakiusapan siya na palitan ang titulo nito sa halip na sensitibong “Manwal ng Pagpapatiwakal” at pumayag naman ang awtor nang buong pagpapakumbaba. Pagkalipas ng 12 taon, muling maglalabas siya ng Taguan-Pung (2014) na tututok na sa ugaling Filipino at usaping panlipunan.  

Mabunga sa daglî ang gitna ng unang dekada ng bagong milenyum.

Marahil dahil nga sa ang pormang pampanitikang ito ay pang-milenyal.

Isa na rito si Loree Cruz-Mante sa kaniyang Biyaheng FX Round Trips to Pinoy Life (2006), na paglalarawan sa karaniwang buhay-pasahero ng mga pampublikong sasakyan.

Sa sobrang sigla ng siglong ito, nagpasiya si Vicente Garcia Groyon III na mangumbinsi ng iba pa at mangolekta. Ito ang naging Mga Kuwentong Paspasan (2007), na tila mas naimpluwensiyan ng flash o sudden fiction kaysa daglî.

Katunayan, kapanabayan ito ng isa pa sa Ingles na may titulong Very Short Stories for Harried Readers at ng nabanggit kong koleksiyon nina Shapard at Thomas.

Pinabulaanan ni Abdon Balde Jr na siya ay hanggang nobela na lamang at ang daglî ay para sa mga milenyal. Hindi naging madali ang pamimili niya ng pamagat dahil nagtanong-tanong muna siya kung ano dapat ang tawag sa “panibagong porma ng maikling prosa.”   Kapagdaka ang sagot ko ay “Kagyat” at karaka ring tumugon ang iba pa.

Pero si Mike Coroza ang nagwagi sa kaniyang “KISLAP” o   K uwentong Is ang Ig lap .  

Kaya nagbunsod ng 100 Kislap (2011) si Balde, na tiniyak na ang bawat kuwento niya ay may tig-150 salita, walang labis, walang kulang.

Rumesbak na naman si Atalia nang magpakitang-gilas siya sa kaniyang Wag Lang Di Makaraos: 100 Dagli (Mga kwentong Pasaway, Paaway at Pamatay) . Ang Pambansang Alagad ng Sining na si Bienvenido Lumbera ang unang pumuna’t pumuri sa kaniya: “Kung lilingunin ang kasaysayan ng daglî bilang anyong pampanitikan, makikitang bago ang hipo ni Eros sa anyo noong namalasak sa mga dyaryo mga unang taon ng ika-20 siglo.”

Kung paramihan lang din naman ng danas, di magpapatalo ang overseas Filipino worker (OFW) na si Jack Alvarez sa kaniyang Ang Autobiografia ng Ibang Lady Gaga (2012).   Sa unang tingin, kinuwestiyon ito ni Reuel Molina Aguila kung daglî nga ba ang mga ito o hindi, ngunit, sa bandang huli, kinumbinsi niya ang sarili na ang mga ito ay daglî at hindi lamang “maiikling personal/malikhaing sanaysay.”

Isa sa mga kauna-unahang tesis tungkol sa kaniyang koleksiyon ng daglî ay isinulat ni Hazel Karyl R. Madanguit para sa kaniyang BA Malikhaing Pagsulat sa Filipino sa Unibersidad ng Pilipinas Diliman. Tinawag niyang Sa Pagmamadali , ito ay kalipunan ng 14 na daglî hinggil sa mga taong nabuhay sa pagmamadali dahil minamadali na sumasalamin sa suliraning panlipunan.

Para naman sa kaniyang MA Malikhaing Pagsulat, isinulat ni Melencio Fernando Jr ang tesis niyang Kumpisal: Kalipunan ng mga Dagling Di-Banal . Tungkol ito sa kasalukuyang kalagayan ng   Katolisismo sa Filipinas. Dating sekretaryo ng pari, siya ay lumikha ng mga daglî ukol sa kanila at mga nangyayari sa loob ng kumbento at simbahan. Nakatakda sana siya na magdepensa ngayon.

Kaya lamang…

MGA HALIMBAWA NG DAGLING MAY 19 SALITA:

Paulit-ulit kong pinakinggan ang “All By Myself,”“Right Here Waiting,” “Survivor,” at “The Climb.” Umiyak akong mag-isa.

Madaling dumistans’ya kung ikaw ay nakatira sa isang subdibisyon, may sariling kotse, at hawak ang sariling oras sa trabaho.

Gusto kong panoorin ang bayaning isinilang sa Wuhan, China. Pero may pumigil sa buong mundo na manood ng “Mulan.”

Naglaro ng ML. Nagbasa ng libro. Nakinig ng podcast. Naglaro ng ML. Nagbasa ng libro. Nakinig ng podcast. Naglaro…

Pinakinggan ko ang tinig ng Diyos. Wala akong marinig. Para Siyang sinisipon at umuubo. Pa’no na kaya ako, Lord?

“Ano ang lason?” Tanong ko sa matanda. Sagot niya: “Lahat ng bagay nang sobra sa kailangan mo.” Nagkatinginan kami.

Sa Mayo. Magtsitsismisan daw sina Buwan, Venus, at Jupiter. Di nila alam. Mukha silang smiley sa Kalawakan. Pagtatawanan tayo.

“Gawa ka ng gamot sa COVID-19.” Sagot ng scientist: “Bigyan mo muna ako ng suweldo ni LeBron James.”

“Ina, ikaw ang puso ng tahanan natin.” Ngayon ko lang ito nasabi. Sa ipinapagawa kong lapida para sa kaniya.

My God! I had been so busy with all these timekillers that I forget one most important calling. Writing.  

Paki-tag ang  https://www.facebook.com/rapplerdotcom/   at  https://www.facebook.com/Foundation.AWIT/. 

– Rappler.com 

Sa ngalan ng siyensiya’t sining, tumutulong si Vim Nadera sa mga maykanser, may AIDS, nagdodroga, “comfort women,” batang kalye, inabuso, naipit sa mga kalamidad na likha’t likas, at mga nagdadalamhati. Ilan sa kaniyang mga proyekto ay Textanaga, Panitikabataan, panitikan.com.ph, Pistang Panitik, Pagpupugay sa mga Pambansang Alagad ng Sining. Conspiwriters’ Tuesdays, O.M.G. (Open Mic Gig), Kaakuhan, Word Jam, at Akdang Buhay. Itinanag nila ng kaniyang kabiyak ang Foundation AWIT (Advancing Wellness, Instruction, and Talents) Inc.  

Add a comment

Please abide by Rappler's commenting guidelines .

There are no comments yet. Add your comment to start the conversation.

How does this make you feel?

Related Topics

Recommended stories, {{ item.sitename }}, {{ item.title }}.

Checking your Rappler+ subscription...

Upgrade to Rappler+ for exclusive content and unlimited access.

Why is it important to subscribe? Learn more

You are subscribed to Rappler+

Pisay student tops essay writing tilt on COVID-19

A Grade 12 student of the Philippine Science High School-Western Visayas Campus (PSHS-WVC) emerged as Grand Prize winner in the Southeast Asian Ministers of Education Organization Tropical Medicine and Public Health (SEAMEO TROPMED) Network 55th Founding Anniversary Essay Contest.

Altair Mizar Emboltura bagged the Grand Prize after besting 210 entries in the Senior High School Category from the member-countries of the SEAMEO TROPMED, the PSHS said in a statement on Saturday, Oct. 16.

Emboltura’s winning piece is titled, “A Thief, A Tyrant, A Teacher”. In his essay, Emboltura, editor-in-chief of PSHS-WVC’s school paper Banaag, discussed how the COVID-19 pandemic significantly redefined aspects of life.

This year’s theme of the SEAMEO TROPMED essay writing contest is “What COVID-19 means to me”. It focused on the integration and inter-relation between Sustainable Development Goal (SDG) # 3 “Good Health and Well-being” and SDG # 4 “Quality Education”, according to the PSHS.

Among the objectives of the essay writing competition were to gather information related to COVID-19 effect on students; motivate students to write and discuss their perspectives about COVID-19; promote listening to students’ voices; and document these perspectives for further use in school programmes and policies.

Emboltura cited the crucial role of the youth in the country’s fight against COVID-19.

“I believe in the power of the proactive youth. Our role in winning the battle against COVID-19 includes inspiring, impacting, and speaking up not just for our fellow youth but for our whole community as well. However, all of our dedication, effort, and active participation would be put to waste if our leaders won’t listen to us,” he said.

“I call unto our leaders to not just hear us but also listen to us because our voice matters, especially in this unprecedented time,” he added.

The PSHS said the student leader is planning to pursue either biology, public health, or an accelerated medicine course in college, but his ultimate goal is to be a physician for the Filipino people.

Emboltura expressed hope that the healthcare workers will receive the necessary assistance from the government, including wage hike and hazard pay.

“Young people like me have been championing change in our fight against COVID-19 from the very beginning. As digital natives, social media became our biggest platform to speak up, to initiate and conduct countless community projects especially for the underprivileged and marginalized sectors of our society, and to advocate for noble causes such as the #NoStudentLeftBehind,” he said.

Emboltura was named as Young Achiever Awardee by the Municipality of Oton, and Outstanding Student of Iloilo Awardee 2020 by JCI Regatta.

He was also selected as one of the Ten Outstanding Junior High School Students of Iloilo for Academic Year 2019-2020 by The Outstanding Students Circle of Iloilo (OSCI).

Philippine Center for Investigative Journalism

Filipinos face the mental toll of the Covid-19 pandemic — a photo essay

Share this:.

• Click to share on Facebook (Opens in new window)
• Click to share on X (Opens in new window)

BY ORANGE OMENGAN

Depression, anxiety, and other mental health-related illnesses are on the rise among millennials as they face the pressure to be functional amidst pandemic fatigue. Omengan's photo essay shows three of the many stories of mental health battles, of struggling to stay afloat despite the inaccessibility of proper mental health services, which worsened due to the series of lockdowns in the Philippines.

“I was just starting with my new job, but the pandemic triggered much anxiety causing me to abandon my apartment in Pasig and move back to our family home in Mabalacat, Pampanga.” 

This was Mano Dela Cruz's quick response to the initial round of lockdowns that swept the nation in March 2020. 

Anxiety crept up on Mano, who was diagnosed with Bipolar Disorder Type II with Attention Deficit Hyperactivity Disorder and Obsessive-Compulsive Personality Disorder traits. The 30-year-old writer is just one of many Filipinos experiencing the mental health fallout of the pandemic. 

Covid-19 infections in the Philippines have reached 1,149,925 cases as of May 17. The pandemic is unfolding simultaneously with the growing number of Filipinos suffering from mental health issues. At least 3.6 million Filipinos suffer from mental, neurological, and substance use disorders, according to Frances Prescila Cuevas, head of the National Mental Health Program under the Department of Health.

As the situation overwhelmed him, Mano had to let go of his full-time job. “At the start of the year, I thought I had my life all together, but this pandemic caused great mental stress on me, disrupting my routine and cutting my source of income,” he said. 

Mano has also found it difficult to stay on track with his medications. “I don’t have insurance, and I do not save much due to my medical expenses and psychiatric consultations. On a monthly average, my meds cost about P2,800. With my PWD (person with disability) card, I get to avail myself of the 20% discount, but it's still expensive. On top of this, I pay for psychiatric consultations costing P1,500 per session. During the pandemic, the rate increased to P2,500 per session lasting only 30 minutes due to health and safety protocols.”

The pandemic has resulted in substantial job losses as some businesses shut down, while the rest of the workforce adjusted to the new norm of working from home. 

Ryan Baldonado, 30, works as an assistant human resource manager in a business process outsourcing company. The pressure from work, coupled with stress and anxiety amid the community quarantine, took a toll on his mental health. 

Before the pandemic, Ryan said he usually slept for 30 hours straight, often felt under the weather, and at times subjected himself to self-harm. “Although the symptoms of depression have been manifesting in me through the years, due to financial concerns, I haven't been clinically diagnosed. I've been trying my best to be functional since I'm the eldest, and a lot is expected from me,” he said.

As extended lockdowns put further strain on his mental health, Ryan mustered the courage to try his company's online employee counseling service. “The free online therapy with a psychologist lasted for six months, and it helped me address those issues interfering with my productivity at work,” he said.

He was often told by family or friends: “Ano ka ba? Dapat mas alam mo na ‘yan. Psych graduate ka pa man din!” (As a psych graduate, you should know better!)

Ryan said such comments pressured him to act normally. But having a degree in psychology did not make one mentally bulletproof, and he was reminded of this every time he engaged in self-harming behavior and suicidal thoughts, he said.

“Having a degree in psychology doesn't save you from depression,” he said. 

Depression and anxiety are on the rise among millennials as they face the pressure to perform and be functional amid pandemic fatigue. 

Karla Longjas, 27, is a freelance artist who was initially diagnosed with major depression in 2017. She could go a long time without eating, but not without smoking or drinking. At times, she would cut herself as a way to release suppressed emotions. Karla's mental health condition caused her to get hospitalized twice, and she was diagnosed with Borderline Personality Disorder in 2019. 

“One of the essentials I had to secure during the onset of the lockdown was my medication, for fear of running out,” Karla shared. 

With her family's support, Karla can afford mental health care. 

She has been spending an average of P10,000 a month on medication and professional fees for a psychologist and a psychiatrist. “The frequency of therapy depends on one's needs, and, at times, it involves two to three sessions a month,” she added. 

Amid the restrictions of the pandemic, Karla said her mental health was getting out of hand. “I feel like things are getting even crazier, and I still resort to online therapy with my psychiatrist,” she said.

“I've been under medication for almost four years now with various psychologists and psychiatrists. I'm already tired of constantly searching and learning about my condition. Knowing that this mental health illness doesn't get cured but only gets manageable is wearing me out,” she added.    In the face of renewed lockdowns, rising cases of anxiety, depression, and suicide, among others, are only bound to spark increased demand for mental health services.  

MANO DELA CRUZ

Writer Mano Dela Cruz, 30, is shown sharing stories of his manic episodes, describing the experience as being on ‘top of the world.’ Individuals diagnosed with Bipolar Disorder Type II suffer more often from episodes of depression than hypomania. Depressive periods, ‘the lows,’ translate to feelings of guilt, loss of pleasure, low energy, and thoughts of suicide. 

Mano says the mess in his room indicates his disposition, whether he's in a manic or depressive state. “I know that I'm not stable when I look at my room and it's too cluttered. There are days when I don't have the energy to clean up and even take a bath,” he says. 

Mano was diagnosed with Bipolar Disorder Type II in 2016, when he was in his mid-20s. His condition comes with Attention Deficit Hyperactivity Disorder and Obsessive-Compulsive Personality Disorder traits, requiring lifelong treatment with antipsychotics and mood stabilizers such as antidepressants.

Mano resorts to biking as a form of exercise and to release feel-good endorphins, which helps combat depression, according to his psychiatrist.

Mano waits for his psychiatric consultation at a hospital in Angeles, Pampanga.

Mano shares a laugh with his sister inside their home. “It took a while for my family to understand my mental health illness,” he says. It took the same time for him to accept his condition.

RYAN BALDONADO

Ryan Baldonado, 30, shares his mental health condition in an online interview. Ryan is in quarantine after experiencing symptoms of Covid-19.

KARLA LONGJAS

Karla Longjas, 27, does a headstand during meditative yoga inside her room, which is filled with bottles of alcohol. Apart from her medications, she practices yoga to have mental clarity, calmness, and stress relief. 

Karla shares that in some days, she has hallucinations and tries to sketch them. 

In April 2019, Karla was inflicting harm on herself, leading to her two-week hospitalization as advised by her psychiatrist. In the same year, she was diagnosed with Borderline Personality Disorder.  The stigma around her mental illness made her feel so uncomfortable that she had to use a fake name to hide her identity. 

Karla buys her prescriptive medications in a drug store. Individuals clinically diagnosed with a psychosocial disability can avail themselves of the 20% discount for persons with disabilities.

Karla Longjas is photographed at her apartment in Makati. Individuals diagnosed with Borderline Personality Disorder (BPD) exhibit symptoms such as self-harm, unstable relationships, intense anger, and impulsive or self-destructive behavior. BPD is a dissociative disorder that is not commonly diagnosed in the Philippines.

This story is one of the twelve photo essays produced under the Capturing Human Rights fellowship program, a seminar and mentoring project

organized by the Philippine Center for Investigative Journalism and the Photojournalists' Center of the Philippines. 

Check the other photo essays here.

Larry Monserate Piojo – “Terminal: The constant agony of commuting amid the pandemic”

Orange Omengan – “Filipinos face the mental toll of the Covid-19 pandemic”

Lauren Alimondo – “In loving memory”

Gerimara Manuel – “Pinagtatagpi-tagpi: Mother, daughter struggle between making a living and modular learning”

Pau Villanueva – “Hinubog ng panata: The vanishing spiritual traditions of Aetas of Capas, Tarlac”

Bernice Beltran – “Women's 'invisible work'”

Dada Grifon – “From the cause”

Bernadette Uy – “Enduring the current”

Mark Saludes – “Mission in peril”

EC Toledo – “From sea to shelf: The story before a can is sealed”

Ria Torrente – “HIV positive mother struggles through the Covid-19 pandemic”

Sharlene Festin – “Paradise lost”

PCIJ's investigative reports

THE SHRINKING GODS OF PADRE FAURA | READ .

7 MILLION HECTARES OF PHILIPPINE LAND IS FORESTED – AND THAT'S BAD NEWS | READ   

FOLLOWING THE MONEY: PH MEDIA LESSONS FOR THE 2022 POLL | READ

DIGGING FOR PROFITS: WHO OWNS PH MINES? | READ

THE BULACAN TOWN WHERE CHICKENS ARE SLAUGHTERED AND THE RIVER IS DEAD | READ  

• Open access
• Published: 10 May 2023

Determinants of COVID-19 vaccination decision among Filipino adults

• Lourdes Marie Sequerra Tejero 1 ,
• Rosemary Ruiz Seva 2 ,
• Bettina Joyce Petelo Ilagan 3 &
• Kattleea Lorezca Almajose 4  

BMC Public Health volume  23 , Article number:  851 ( 2023 ) Cite this article

5470 Accesses

3 Citations

1 Altmetric

Metrics details

With a number of vaccines against COVID-19 now widely available globally, it is opportune to determine what tips the decision to get vaccinated. In most countries like the Philippines where the government provides these vaccines for free to all its citizens, their COVID-19 vaccine awareness and COVID-19 information sources as well as their socio-demographic profile were considered as primary factors that could possibly affect vaccination decisions. Participants’ income level was considered as a possible financial consideration that can affect vaccination decision as transport to vaccination sites might entail costs to them.

This study used a cross sectional survey design wherein participants came from all regions of the Philippines. An online questionnaire was voluntarily answered by Filipinos aged 18–80 years of age.

A total of 2,268 participated in the survey with 1,462 having complete responses which were included in the analysis. Those who are younger, with higher educational attainment, with public health insurance, with employers requiring vaccination, high awareness about COVID-19 vaccination, and high vaccine confidence are more likely to get vaccinated. On the other hand, those with long-standing illness and those residing outside the national capital region are less likely to get vaccinated.

Vaccination decisions among Filipinos are determined by their age, educational attainment, health insurance, employer requirement, high awareness of the disease, and a high level of vaccine confidence.

Peer Review reports

Introduction

On March 11, 2020, the World Health Organization (WHO), in a media briefing opening remarks by its director-general, characterized COVID-19 as a pandemic. While the development of vaccines is deemed as one of the most important responses to curb this global health crisis, WHO emphasized that it is vaccination per se, and not the vaccines that will put an end to this pandemic. However, WHO also acknowledged that there are challenges to ensure that people around the world get vaccinated.

In January 2021, the Department of Health of the Philippines issued an interim plan for the deployment of COVID-19 vaccines [ 1 ]. The strategy was that of a whole-of-society approach with the government leading the deployment of vaccines and implementation of the vaccination program. Of the 110 million population, about 70 million were considered eligible for the vaccines for 2021, based on pre-identified groupings.

Sallam [ 2 ] found out that vaccine hesitancy, or the “delay in acceptance or refusal of vaccination despite availability of vaccination services”[ 3 ], is considered as a common phenomenon globally. He furthers that, in his review of COVID-19 vaccine acceptance rates worldwide, vaccine hesitancy can be the major hindrance of the control efforts to lessen the negative consequences of COVID-19 pandemic, at least in certain countries/regions.

In the Philippines, decisions to get vaccinated, particularly of the COVID-19 vaccine, are driven by Filipinos’ concerns about having more information about the various vaccines available to them [ 4 ]. United Nations Development Programme (UNDP) Philippines, in August 2021 reported that the facilitating factors for vaccination included concern for family and loved ones, COVID-19 risk perception, approval of an endorsement by either the Food and Drug Administration (FDA) or the Department of Health (DOH), and work-related reasons; while barriers to vaccination included concerns about side-effects, medical reasons, news about vaccines, and vaccine effectiveness and efficacy [ 5 ]. It was mentioned in this same report that COVID-19 vaccination in the Philippines started in March 2021 and that by August 15, 2021, around 40.4 to 44.1% of the adult population have received at least one COVID-19 vaccine shot. The Philippine government’s initial target was 70% of the population by the end of 2021.

Despite these findings, however, several factors affecting decisions to get vaccinated against COVID-19, given the multifaceted nature of vaccine hesitancy [ 2 ] and the history of vaccine uptake in the Philippines marked by critical challenges [ 6 ] required further studies.

Hence, this quantitative, correlational research on the determinants of COVID-19 vaccination decision among Filipino adults. As transport to vaccination sites might entail costs for people, participants’ income level was considered as a financial factor that can affect their vaccination decision. Non-financial factors considered were socio-demographic characteristics; COVID-19 information sources, awareness, and worry; and vaccine confidence and functional health literacy. The study examined if both these financial and non-financial factors could determine participants’ vaccination decision.

Research design

This is a cross sectional survey design wherein participants from all the 17 administrative regions of the Philippines were included in the sample. Following the formula provided by Bujang, et al. [ 7 ], the required number of participants is 850.

Data collection was conducted in the first quarter of 2022, the time when a recent surge of cases was declining early in that quarter [ 8 ], and when the Philippine government is nearing its target of vaccinating 70% of its population against COVID-19 [ 9 ]. It was opportune at this time to investigate the drivers for actual vaccination. Participants of the study were Filipinos aged 18–80 years old, currently residing in the country, were qualified to take the COVID-19 vaccine, could read, and understand Filipino and/or English, and could answer the questionnaire online.

Two questionnaires were developed in two languages: English and Filipino. The English questionnaire was translated from English to Filipino by a qualified translator. The English questionnaire was piloted first to 25 individuals to ensure the clarity of questions. Corrections were made on the format of the questionnaire and order of questions. After translation, the Filipino questionnaire was piloted to another 25 people. The Filipino version was revised to simplify the difficult Filipino terms used in the first version.

The survey was administered online using two methods: first is self-administered (91%) and the second was by a trained research assistant interviewer (9%) for those who were in remote areas and had difficulty accessing the Internet. The main survey questionnaire administration was conducted between March to April of 2022. Participation in the study was voluntary. Recruitment was done through social media platforms and through email. Participants were given an online survey link and they had the option to answer either a questionnaire in English or a questionnaire in Filipino. Answering the questionnaire and subsequently submitting it, constituted participant’s consent in the study. Those who requested reimbursement for the internet services incurred in answering the online questionnaire were reimbursed accordingly. The responses to the questionnaire remained anonymous since the request for reimbursement came in separately from the questionnaire. All the questions in the questionnaire were mandatory.

A questionnaire was designed ad hoc to collect the data for this research. The sociodemographic data included age, sex, educational attainment, employment status, income level, health insurance, health status, and region of residence.

Employer requirement for vaccination and advice by a health care provider to vaccinate against the disease are binary variables in the model where a yes answer was coded as 1. Information sources included three items that identify a person’s social context - family and friends, co-workers, and healthcare workers. Nine items that describe their information environment - government agencies, TV, newspaper, radio, Facebook, Instagram, Twitter, TikTok, and YouTube. The frequency of access followed a five-point Likert scale measured as (1) never, (2) rarely, (3) sometimes, (4) often, and (5) always. For COVID-19 vaccination awareness, participants were asked to answer a 9-item quiz-type survey with statements formulated based on information presented on the websites of the Philippines’ Department of Health and the United States of America’s Center for Disease Control and Prevention. The three levels of awareness were given scores as follows: 1 (correct information), 0 (unaware of the information), and − 1 (wrong information) in the model.

COVID-19-related worry was determined using a three-item scale taken from Head et al., [ 10 ] to measure participants’ personal worry about COVID-19. A 5-point Likert-type scale was used where 1 = strongly disagree to 5 = strongly agree.

Participants’ vaccine-related profiles included information on functional health literacy (FHL) and vaccine confidence. All four items to measure FHL were taken from Biasio et al., [ 11 ]. As for vaccine confidence , five items were adapted from the 8-item Vaccine Confidence Scale by Gilkey et al., [ 12 ] measured using a 10-point sliding scale from 0-strongly disagree to 10-strongly agree because of their relevance to study objectives. The 5 items included were: (1) Vaccines are necessary to protect health, (2) Vaccines do a good job in preventing the diseases they are intended to prevent, (3) Vaccines are safe, (4) If I get vaccinated there can be serious side effects and, (5) In general, medical professionals in charge of vaccinations have my best interest at heart. Item 4 was reverse coded.

Participants’ vaccination status is a binary variable where one refers to getting the full dose of the vaccine or at least one shot of a two-dose vaccine. Their vaccination status equated to their vaccination decision, considered as the dependent variable in the model.

Data analysis

Aside from age, all sociodemographic data were considered categorical variables in the model. Coded data was processed using MS Excel and scored. Responses with scores were summed and used in calculating the total scores of vaccination awareness, COVID-19-related worry, FHL, and vaccine confidence. Sociodemographic data were summarized using a frequency table. Quantitative data were presented as mean and standard deviation. Binary logistic regression (BLR) was performed to determine predictors of COVID-19 vaccine decision. The BLR model was constructed by including all 15 covariates at the same time. A full model was constructed that included all the variables in the analysis. This approach was used to prevent bias in the selection of variables to be included in the model.

Data were analyzed using SPSS 21.0 (IBM Corp.: Armonk, NY, USA). Significance level considered was 0.05.

Ethics statement

All methods were carried out in accordance with relevant guidelines and regulations. Since all participants were 18 years old and above, the consent of a guardian was not required. The introductory letter to participants in the survey questionnaire contained relevant information about the research including objectives, benefits to the participant, anonymity, expected time for their participation, utilization of data gathered, contact information of the researchers, etc. It also indicated that participation was voluntary and continuing to answer the survey was an expression of consent. The study protocol, survey questionnaire, including ‘waiver of informed consent documentation’ were reviewed and approved by the University of the Philippines Manila’s Review Ethics Board, with code UPMREB 2021-0673-01.

A total of 2,268 participated in the survey from which 1,462 complete survey responses were recorded and analyzed. Incomplete responses were not included in the data analysis. A response is considered incomplete if the respondent failed to finish the survey.

Participants’ sociodemographic characteristics

Table  1 summarizes the sociodemographic characteristics of the 1,462 participants in the study. When data gathering was conducted, around 70% of the Philippine population had already been vaccinated. Participants came from all the regions in the Philippines but the distribution of the sample did not follow the actual geographical distribution. 61% (61%) of the participants came from densely populated areas in the Philippines, such as CALABARZON (25%), National Capital Region (20%), and Central Visayas (16%). Participants aged 21–30 comprised the highest percentage of the sample (36%), followed by those younger than 21 (20%). People older than 60 comprised 6% (6%) of the sample only. 69% (69%) of the sample were female. Approximately two-thirds (66%) were college graduates, and 54% were employed. More than half (52%) belong to the poor and low-income group, and 47% have no health insurance. Eighty one percent (81%) do not have a long-standing illness.

Participants’ COVID-19-related Profile

Most (86%) of the participants were either partially or fully vaccinated. Seventy one percent (71%) received a recommendation from a healthcare professional to get a COVID-19 vaccine. Of the 785 employed participants, 83% were required by their employers to get vaccinated against the disease.

As can be seen in Table  2 , the average awareness score is 2.81 indicating that participants know at least 3 correct COVID-19 vaccine information. Details of the COVID-19 Awareness data were included in Annex 2. Majority (93%) are aware that the vaccines are free, that they come in different brands (89%) and they are effective in helping protect against severe disease and death (83%). However, around 96% are not aware that vaccines have side effects that are normal and believe that it contains microchips that can alter DNA (89%).

The mean FHL score indicates a general difficulty understanding published information about COVID-19 vaccines. The participants are highly worried about getting infected by the virus but have high levels of confidence in the vaccine.

Table  3 summarizes the sources and frequency of access to COVID-19 vaccination information. The top three most often accessed sources of information on COVID-19 vaccination are Facebook, TV, and family and friends.

Sociodemographics, COVID-19-related Profile, and vaccine-related Profile Associated with Vaccination decision

The results of the binomial logistic model of the sociodemographic, COVID-19-related profile and information sources are presented in Table  4 . Logistic regression analysis was performed to explore the influencing factors associated with the decision to get vaccinated against the COVID-19 virus. Younger age (aOR = 0.94, 95% CI = 0.92–0.96), higher educational attainment (aOR = 5.25, 95% CI = 2.75–10.03; aOR = 6.22, 95% CI = 2.14–18.13), those with public health insurance (aOR = 2.47, 95% CI = 1.23–4.96), those with employers requiring vaccination (aOR = 4.28, 95% CI = 2.18–8.43), high awareness about COVID-19 vaccination (aOR = 1.22, 95% CI = 1.11–1.34), and high vaccine confidence (aOR = 1.15, 95% CI = 1.12–1.19) are more likely to get vaccinated. Those with long-standing illness tend not to get vaccinated (aOR = 0.38, 95% CI = 0.19–0.76). As for the region of residence, those regions outside the national capital region (NCR) are less likely to get vaccinated.

Several socio-demographic variables significantly affect the vaccination decision of participants in the sample. Results suggest that young participants are more likely to take the vaccine as the proportion of unvaccinated individuals increases with age. This is consistent with previous findings that young people are less hesitant to receive the COVID19 vaccine [ 13 , 14 ]. During the survey, health authorities in the Philippines struggled to vaccinate its elderly population because they do not turn up at the vaccination sites, meeting only 5% of the target during a three-day vaccination drive [ 15 ]. One of the reasons cited by health authorities is the belief of older adults that they do not have many years to live, making the vaccine unnecessary[ 16 ]. Some elderly people are also difficult to reach, especially those living in rural areas [ 16 ].

Higher education levels such as college and postgraduate degrees, largely determine vaccination decisions in this study. A closer look at the data showed vaccine awareness and functional literacy levels are lower for those without college degrees. Literature on vaccine determinants worldwide consistently showed that fewer years of education decreases the chance of COVID19 vaccine uptake [ 17 , 18 ]. People with higher education have heightened awareness of the risks and benefits of the vaccine because they have more knowledge about the vaccine and the vaccination process. Similarly, high vaccine acceptance rates among college students in China were associated with high knowledge [ 19 ].

Sex, employment status, and family income were unrelated to the study’s vaccination decision, probably because the Philippine government made COVID-19 vaccines free for all its citizens; thus, financial incapacity and unemployment did not deter anyone from getting vaccinated. Men and women received the vaccines to comply with institutional requirements. Our study showed that employers requiring COVID-19 vaccination increased Filipinos’ likelihood of vaccinating. The Presidential announcement requiring vaccination for employees working onsite [ 20 ] strongly influenced the people’s decision to get the shots. For the unvaccinated, their options were to work from home or undergo regular RT-PCR testing as prescribed by the Philippine Department of Labor and employment [ 21 ]. With the high costs of tests, employees generally opted to get vaccinated.

Geographic location has a strong association with vaccination uptake since the Philippines is an archipelago consisting of more than 7,000 islands. Delivering the vaccines to far-flung areas from the National Capital Region (NCR) is a logistical challenge that contributes to the difference in vaccination rates across areas. During the time of the vaccine rollout, local government units (LGUs) interviewed from Luzon, Visayas, and Mindanao expressed concerns about vaccine handling, especially the need for cold storage facilities and vehicles to transport the vaccines [ 22 ]. Aside from logistical problems, the Geographically Isolated and Disadvantaged Areas (GIDA) in the Philippines are also affected by the pandemic response due to communist terrorist groups in the area [ 23 ].

The participants came from all the regions of the country although the distribution of the sample did not reflect the actual geographical distribution. The participants lived mainly in highly urbanized areas whereas the Philippines has more rural communities. NCR is the center of the country’s economic activity and the largest of all metropolitan areas. The likelihood of getting vaccinated decreases as the region gets further away from the NCR as urbanization significantly determines the vaccine acceptance rate [ 24 ]. In Canada, more people were vaccinated in large metropolitan areas, just like the NCR [ 24 ]. Moreover, population density is generally higher in urban areas, especially in the NCR, making the people more concerned about disease transmission.

Vaccine awareness of participants in this study is generally high as most lived in urban areas. There was high awareness in NCR and Luzon. People who live far from the capital and/or urban areas may have less access to information materials and modalities, hence the lower vaccination uptake in these areas. Two common mistakes emerged from our results about COVID19 vaccines. Most participants believed that they do not have to take the full dose of the vaccine and that vaccines can alter or change their DNA, turning them into genetically modified human beings. The false information about DNA modification lowered vaccine acceptance and was found to be one of the most common themes in a study of 52 countries about vaccine rumors and conspiracy theories [ 25 ]. Taking only the first of a 2-dose COVID-19 vaccine gives protection for a limited period. The second dose prolongs the duration of this protection by activating the helper T cells of the immune system [ 26 ].

Participants who know about vaccine brands, compositions, and doses, as well as vaccination effectiveness and side effects after vaccination being considered normal, have a higher tendency to decide to get vaccinated than those with little or no knowledge of these things. Nomura et al. [ 27 ] also found that people’s perceptions of the risks and benefits of a COVID-19 vaccine were significantly associated with their vaccination intention. These findings imply that for vaccination intention and eventually vaccination decision to increase, people should be made aware of the benefits of availing the COVID-19 vaccine.

Having misconceptions about the vaccine strongly correlated with the study participants’ not getting vaccinated. This is corollary of their most frequently cited source of information which was Facebook where fake news abound [ 28 ]. Moreover, the moderate level of functional health literacy of the participants reflects the difficulties they may have in discerning false from true information. Thus, more effective and targeted information dissemination schemes are needed to address this situation.

People with long standing illness were not likely to get vaccinated against COVID 19. Vaccine hesitancy remains to be an issue among those with health problems. Reluctance is due to lack of understanding, fear of adverse effects, and negative COVID-19 Vaccination information [ 16 ]. In the Philippines, more than a quarter of those aged 35–59 years have been diagnosed with illnesses that predispose them to serious effects of COVID-19 [ 29 ]. With the community quarantine focusing more on these high-risk groups, they are more susceptible to such fear and reluctance.

The level of vaccine confidence among the participants is high. Those who indicated that the COVID-19 vaccines are safe and needed to protect one’s health were more likely to get vaccinated. The lowest confidence rating was related to the vaccine’s side effects, followed by doubt about its safety. Findings of similar studies in Japan and South Korea showed that the most cited reasons for low vaccine confidence were side effects and that vaccines had not been sufficiently tested [ 30 ]. The decline in the COVID19 vaccine confidence in the Philippines may have been influenced by the Dengvaxia vaccine fiasco in 2017. The controversy caused the vaccine confidence of Filipinos to decline from 93% to 2015 to 32% in 2018 [ 31 ]. Traumatic experiences concerning previous vaccination and information obtained from traditional, social media, and neighbors further contribute to delay and refusal of vaccination [ 32 ].

Those who have public health insurance are more likely to get vaccinated. Since the COVID-19 vaccination program for the whole Philippines is government-funded and controlled, those with public health insurance may be more familiar with the public health system and may be able to access the COVID-19 vaccination program.

The results of this study have implications for the public health approach to increasing COVID-19 vaccinations. Since the younger ones are more inclined to get vaccinated, they may serve as the conduit to reach the older ones, especially the hesitant people with chronic illnesses, as they are more at risk of contracting COVID-19. The government can increase the vaccination rate of older people by offering packages to incentivize young people taking their older parents for vaccination. Since the lines for vaccination are usually long, a young person together with a person aged more than 50 years old may be in the priority lane.

Results also indicate that the educated and those with higher awareness levels of COVID-19 are more likely to get vaccinated. This is consistent with the findings of previous studies [ 33 , 34 ]. Since the community quarantine is easing up and people can go out of their homes, information, education, and communication (IEC) materials should be designed for the less educated people and be situated in locations where these people frequent like the streets, bus stops, and the like. Around 72% of Filipinos have access to a smartphone [ 35 ] so the government can possibly tie up with telecommunications companies to spread crucial information through text messages about COVID-19 vaccination and correct false information from social media. This can be especially effective for those in the rural areas where information through the media may be harder to reach. Thus, for rural areas the IEC materials may be placed in locations and settings where people usually congregate, like in the market, plaza, municipal hall, and the like.

Study findings showed that participants actively sought for COVID-19 vaccination information from Facebook, TV, and family and friends almost every week. This result implies that there is a need for concerned officials to fill their Facebook pages and posts with information related to their respective COVID-19 vaccination programs. In this case, individuals who can acquire these pieces of information can share these with family and friends who seek the same from them.

The study should also provide an impetus for the government to provide the infrastructure and equipment for better vaccine deployment for COVID-19 and other potential disease outbreaks in the future. The US Agency for International Development pledged USD 315 million for cold chain facilities and mobile vaccination sites to reach far flung areas in the Philippines [ 36 ]. This is a short-term solution to address current needs; however, the government has to strategically plan and identify supply chain solutions at the national level such as providing roads, bridges, and basic infrastructure especially to underdeveloped areas.

This study’s results are comparable to the findings in countries near the Philippines. In Malaysia where the government also purchased their vaccines against COVID, about two-thirds of the respondents were willing to get vaccinated. They were those from the lower age group, those with higher education, females, and not having chronic disease. Moreover, the strongest drivers for their decision to get vaccinated were vaccine effectiveness and suggestions from their Ministry of Health [ 37 ]. In China on the other hand, those who were older, had a lower education level, lower income, higher trust in the vaccine and higher perceived risk of infection showed a higher probability to vaccinate [ 38 ]. There is a greater proportion of older people in China than in the Philippines or Malaysia which may explain the differing results in terms of age. There are also differences in literacy rate which may account for the different results. What is common among these countries is that the perceived effectiveness of the vaccine is the main driver for people to get vaccinated.

The present study was conducted in the second year after the start of the pandemic when the Philippines had gone through peaks of the COVID-19 infection that claimed thousands of lives. The vaccine seemed to be the only hope to avoid deaths. Moreover, people needed to work for their sustenance. Even those who were previously hesitant to get vaccinated, did so because it was required by their employers [ 20 ]. Thus, the proportion of those who got vaccinated is high. As the threat of COVID-19 waned with the increased herd immunity, there is a decreased uptake of the booster doses of the vaccine [ 39 ]. It is foreseen that there may be an eventual decline in the uptake of the biannual booster shots. Unless there is an effective campaign not only from the medical community but more importantly from the government, people will not take the succeeding doses of the vaccine. This study offers some directions in devising campaign strategies based on the factors influencing decision to vaccinate against COVID-19.

Limitations for this present study include using purposive sampling in recruiting participants instead of probability sampling because of the constraints brought about by the pandemic situation. The link to the survey was sent to contacts and institutions all over the country through electronic means. Researchers ensured that respondents came from all the 17 regions in the country, representing the different categories of the main variables of this study. There were difficulties in finding unvaccinated individuals as the proportion of the vaccinated went over 80% in the NCR. With the collaboration of enumerators from different regions, an adequate number of unvaccinated people were eventually included in the study, approximating the proportions in the regional levels. Potential bias in the collection of data by enumerators from various regions may have happened but this was minimized with the proper orientation of the enumerators.

Online questionnaires naturally are accessible by those with the appropriate gadgets and internet access, thus potentially limiting the inclusion of those with low resources. To mitigate this, the researchers offered to refund the internet fees incurred by respondents. Moreover, the enumerators aided those who were old, illiterate, and without gadgets to record their responses on their own devices. Thus, there were some respondents from these categories who were able to participate in this study.

Based on the findings of the study, it can be concluded that among Filipino adults, COVID-19 vaccination decision is determined by their age, educational attainment, health insurance, and employer requirement. Further, it can be concluded that a high awareness of the disease and a high level of vaccine confidence correlates with the decision to get vaccinated.

Accessing the true information about the disease and vaccine is key in reaching the decision to get vaccinated. It also contributes to high levels of vaccine confidence. Thus, effective information dissemination schemes targeted according to the socio-demographic profile, health literacy and sources of information of the intended audience will result in better vaccine uptake.

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Department of Health. The PhilippineNational Deployment and Vaccination January 2021. https://doh.gov.ph/sites/default/files/basic-page/The%20Philippine%20National%20COVID-19%20Vaccination%20Deployment%20Plan.pdf . Accessed 25 December 2022.

Sallam M. COVID-19 Vaccine Hesitancy Worldwide: a concise systematic review of Vaccine Acceptance Rates. Vaccines. 2021;9(2):160.

Article   CAS   PubMed   PubMed Central   Google Scholar  

MacDonald NE. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161–4.

Article   PubMed   Google Scholar  

Berdida DJE, Grande RAN, Lopez V. Filipinos’ health information-seeking behaviors and their implications for COVID-19 vaccination. Public Health Nurs. 2022;39(3):553–61.

UNDP. Trends in COVID-19 vaccine acceptance in the Philippines and their implications on health communication. Philippines; 2021.

Reyes M, Dee EC, Ho BL. Vaccination in the Philippines: experiences from history and lessons for the future. Hum Vaccin Immunother. 2021;17(6):1873–6.

Bujang MA, Sa’at N, Sidik T, Joo LC. Sample size guidelines for logistic regression from Observational Studies with large Population: emphasis on the Accuracy between Statistics and Parameters based on Real Life Clinical Data. Malays J Med Sci. 2018;25(4):122–30.

PubMed   PubMed Central   Google Scholar  

World Health Organization. Philippines Coronavirus disease (COVID-19) Situation Report #98, 28 March 2022 Apr 4., 2022. https://reliefweb.int/report/philippines/philippines-coronavirus-disease-covid-19-situation-report-98-28-march-2022 . Accessed 21 December 2022.

Department of Health. Vaccines Administered in the Philippines as of March 2., 2022. https://caro.doh.gov.ph/vaccines-administered-in-the-philippines-as-of-march-2-2022/ . Accessed 21 December 2022.

Head KJ, Kasting ML, Sturm LA, Hartsock JA, Zimet GD. A National Survey assessing SARS-CoV-2 vaccination intentions: implications for Future Public Health Communication efforts. Sci Commun. 2020;42(5):698–723.

Article   PubMed Central   Google Scholar  

Biasio LR, Bonaccorsi G, Lorini C, Pecorelli S. Assessing COVID-19 vaccine literacy: a preliminary online survey. Hum Vaccines Immunotherapeutics. 2021;17(5):1304–12.

Article   CAS   Google Scholar  

Gilkey MB, Magnus BE, Reiter PL, McRee A-L, Dempsey AF, Brewer NT. The vaccination confidence scale: a brief measure of parents’ vaccination beliefs. Vaccine. 2014;32(47):6259–65.

Article   PubMed   PubMed Central   Google Scholar  

Bermejo-Martins E, Luis EO, Sarrionandia A, Martínez M, Garcés MS, Oliveros EY et al. Different Responses to Stress, Health Practices, and Self-Care during COVID-19 Lockdown: A Stratified Analysis. Int J Environ Res Public Health. 2021;18(5).

Marzo R, Sami W, Alam M, Acharya S, Jermsittiparsert K, Songwathana K, et al. Hesitancy in COVID-19 vaccine uptake and its associated factors among the general adult population: a cross-sectional study in six southeast asian countries. Tropical Medicine and Health; 2022.

Aben E. Philippines struggles to vaccinate elderly as few turn up for COVID-19 jabs. Arab News. 2022. https://www.arabnews.com/node/2041226/world . Accessed 11 June 2022.

Montemayor T. 2.4 M senior citizens still unvaxxed vs. Covid-19: NVOC. Philippine News Agency. 2022. https://www.pna.gov.ph/articles/1168191 . Accessed 11 June 2022.

de Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. The Lancet. 2020;396(10255):898–908.

Article   Google Scholar  

Galanis P, Vraka I, Siskou O, Konstantakopoulou O, Katsiroumpa A, Moisoglou I et al. Cross-sectional assessment of predictors for COVID-19 vaccine uptake: an online survey in Greece. Vacunas. 2022.

Jiang N, Gu P, Liu K, Song N, Jiang X. Acceptance of COVID-19 vaccines among college students: a study of the attitudes, knowledge, and willingness of students to vaccinate. Hum Vaccines Immunotherapeutics. 2021;17(12):4914–24.

Lema K, Sanjeev M, editors. Philippines to require vaccination for employees working on-site. [Internet]. 2021. https://www.reuters.com/world/asia-pacific/philippines-require-vaccination-employees-working-on-site-2021-11-12/ . Accessed 1 September 2022.

Patinio F. Work options for unvaxxed workers up to employers: DOLE. Philippine News Agency. 2021. https://www.pna.gov.ph/articles/1160519 . Accessed 10 June 2022.

Nieva J, Romulo F, Robles YR, Benosa C, Aileen C, Faraon A, Rosendo G. Strengthening Provincial Supply Chain Management Capacity for COVID-19 Vaccines. In: Governance DJMRIo, editor. Policy Brief2021.

Kabagani LJ. PH rises above challenges in Covid-19 vax rollout Manila. Philippine News Agency; 2022. https://www.pna.gov.ph/articles/1166135 .

Shareef L, Fawzi Al-Hussainy A, Majeed Hameed S. COVID-19 vaccination hesitancy among Iraqi general population between beliefs and barriers: An observational study [version 2; peer review: 2 approved]. F1000Research. 2022;11(334).

Islam MS, Kamal A-HM, Kabir A, Southern DL, Khan SH, Hasan SMM, et al. COVID-19 vaccine rumors and conspiracy theories: the need for cognitive inoculation against misinformation to improve vaccine adherence. PLoS ONE. 2021;16(5):e0251605.

Wei-Haas M. Why we shouldn’t panic about the millions who missed their second vaccine dose—yet. National Geographic - Science [Internet]. 2021. Available from: https://www.nationalgeographic.com/science/article/why-we-shouldnt-panic-about-the-millions-who-missed-their-second-vaccine-dose-yet . Accessed 18 December 2022.

Nomura S, Eguchi A, Yoneoka D, Kawashima T, Tanoue Y, Murakami M, et al. Reasons for being unsure or unwilling regarding intention to take COVID-19 vaccine among japanese people: a large cross-sectional national survey. Lancet Reg Health - Western Pac. 2021;14:100223.

Guess A, Nagler J, Tucker J. Less than you think: prevalence and predictors of fake news dissemination on Facebook. Sci Adv. 2019;5(1):eaau4586.

Abalos JB. Prevalence of chronic diseases associated with increased risk of severe COVID-19 in the Philippines. N-IUSSP. 2020 November 9, 2020.

Mahase E. Covid-19: UK has highest vaccine confidence and Japan and South Korea the lowest, survey finds. BMJ (Clinical research ed). 2021;373:n1439.

PubMed   Google Scholar  

Mendoza RU, Dayrit MM, Alfonso CR, Ong MMA. Public trust and the COVID-19 vaccination campaign: lessons from the Philippines as it emerges from the Dengvaxia controversy. Int J Health Plann Manag. 2021;36(6):2048–55.

Landicho-Guevarra J, Reñosa MDC, Wachinger J, Endoma V, Aligato MF, Bravo TA, et al. Scared, powerless, insulted and embarrassed: hesitancy towards vaccines among caregivers in Cavite Province, the Philippines. BMJ Global Health. 2021;6(9):e006529.

Di Giuseppe G, Pelullo CP, Lanzano R, Lombardi C, Nese G, Pavia M. COVID-19 Vaccination Uptake and Related Determinants in Detained Subjects in Italy. Vaccines (Basel). 2022;10(5).

Biswas N, Mustapha T, Khubchandani J, Price JH. The Nature and Extent of COVID-19 vaccination hesitancy in Healthcare Workers. J Community Health. 2021;46(6):1244–51.

Statista. Mobile phone internet user penetration in the Philippines from 2017 to 2025. 2021.

Calonzo A. After supply, logistics emerges as biggest threat to vaccination programs. Business Standard 2022. https://www.business-standard.com/article/current-affairs/after-supply-logistics-emerges-as-biggest-threat-to-vaccination-programs-122011900257_1.html . Accessed 19 December 2022.

Mohamed NA, Solehan HM, Mohd Rani MD, Ithnin M, Che Isahak CI. Knowledge, acceptance and perception on COVID-19 vaccine among Malaysians: a web-based survey. PLoS ONE. 2021;16(8):e0256110.

Leng A, Maitland E, Wang S, Nicholas S, Liu R, Wang J. Individual preferences for COVID-19 vaccination in China. Vaccine. 2021;39(2):247–54.

Article   CAS   PubMed   Google Scholar  

Number of coronavirus (COVID. -19) vaccine doses administered in the Philippines as of December 13, 2022. Statistica. 2022. https://www.statista.com/statistics/1236727/philippines-coronavirus-covid19-vaccine-rollout/ Accessed 19 Dec 2022.

Download references

Acknowledgements

The researchers are grateful to all the enumerators from the different regions of the Philippines in effectively collecting data from the respondents.

The publication of this paper is funded by the De La Salle University Manila and the Engineering Research and Development for Technology (ERDT) of the Philippine government. The research was partially funded by Cavite State University.

Author information

Authors and affiliations.

Technology Transfer and Business Development office, University of the Philippines Manila, Manila, Philippines

Lourdes Marie Sequerra Tejero

Industrial and Systems Engineering, De La Salle University, Manila, Philippines

Rosemary Ruiz Seva

College of Arts and Sciences, Cavite State University, Indang, Cavite, Philippines

Bettina Joyce Petelo Ilagan

Lyceum of the Philippines University Manila, Manila, Philippines

Kattleea Lorezca Almajose

You can also search for this author in PubMed   Google Scholar

Contributions

LMST, RRS and BJPI conceptualized and wrote the protocol of the research. KLA, BJPI, LMST, RRS collected data. RRS and LMST statistically analyzed the data. LMST, RRS, BJPI, KLA wrote the article, reviewed and edited the final manuscript.

Corresponding author

Correspondence to Lourdes Marie Sequerra Tejero .

Ethics declarations

Ethics approval and consent to participate.

All methods were carried out in accordance with relevant guidelines and regulations. A survey questionnaire was used for data collection, wherein the identity of the respondent remained anonymous. As such, a formal informed consent was not necessary since the act of answering the questionnaire expressed consent from the participant. The study protocol, research tool, including the ‘waiver of informed consent documentation’ were reviewed and approved by the University of the Philippines Manila’s Review Ethics Board, with code UPMREB 2021-0673-01. Since all participants were 18 years old and above, they did not need the consent of a guardian. An introductory letter at the beginning of the questionnaire provided the participant about the necessary information regarding the study like the research objectives, benefits to the participant, anonymity, expected time for their participation, utilization of data gathered, contact information of the researchers, etc. Thus, the privacy and autonomy of the participant were ensured, as well as respect of the rights of the individual. The letter likewise indicated that participation is voluntary and continuing to answer the survey is an expression of consent . (Please see ‘waiver of informed consent documentation’ in #13 under the section ‘ETHICAL GUIDELINES FOR EPIDEMIOLOGIC RESEARCH’ in the National Ethical Guidelines located through this link: http://49.231.15.21/deptw13/upload/files/hercF256312041721022781.pdf ).

Consent for publication

Not applicable.

Competing interest

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Tejero, L.M.S., Seva, R., Petelo Ilagan, B. et al. Determinants of COVID-19 vaccination decision among Filipino adults. BMC Public Health 23 , 851 (2023). https://doi.org/10.1186/s12889-023-15712-w

Download citation

Received : 10 September 2022

Accepted : 19 April 2023

Published : 10 May 2023

DOI : https://doi.org/10.1186/s12889-023-15712-w

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Vaccination
• Logistic regression
• Vaccine acceptance

BMC Public Health

ISSN: 1471-2458

• Submission enquiries: [email protected]
• General enquiries: [email protected]

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Front Psychol

The Importance of Well-Being on Resiliency of Filipino Adults During the COVID-19 Enhanced Community Quarantine: A Necessary Condition Analysis

Desiderio s. camitan, iv.

1 College of Arts and Sciences, Manila Tytana Colleges, Pasay, Philippines

Lalaine N. Bajin

2 Psycli-Nik Psychological Assessment and Intervention Services, Zamboanga City, Philippines

Associated Data

The original contributions presented in the study are included in the article/ Supplementary Material , further inquiries can be directed to the corresponding author.

Nation-wide community quarantines and social distancing are part of the new normal because of the global COVID-19 pandemic. Since extensive and prolonged lockdowns are relatively novel experiences, not much is known about the well-being of individuals in such extreme situations. This research effort investigated the relationship between well-being elements and resiliency of 533 Filipino adults who were placed under the nationwide enhanced community quarantine (ECQ) during the COVID-19 pandemic. Participants comprised of 376 females (70.56%) and 157 males (29.45%). The median and mode ages of the participants is 23 years, while 25 is the mean age. PERMA Profiler was used to measure participants’ well-being elements, while Connor-Davidson Resiliency Scale-10 (CD-RISC-10) was used to measure their resiliency. Collected data were analyzed using the regression model and necessary condition analysis. This study corroborated that all the five pillars of well-being are significant positive correlates of resiliency ( p < 0.00) in quarantined adults. The results shown accomplishment ( β = 0.447, p < 0.01) positively predicts resiliency, while negative emotions ( β = −0.171, p < 0.00) negatively predict resiliency. Lastly, the five pillars of well-being are necessary-but-not-sufficient conditions (ceiling envelopment with free disposal hull, CE-FDH p < 0.00) of resiliency. Our results cast a new light on well-being elements as constraints rather than enablers of resiliency. This novel result shows that optimum resiliency is only possible when all the five pillars of well-being are taken care of and when a person is at least minimally contented with their physical health. The present findings underscore the importance of a holistic as against an atomistic approach to maintaining good mental health, which suggests that deficiencies in certain areas of well-being may not be fully addressed by overcompensating on other areas, as all five pillars of well-being are necessary-but-not-sufficient conditions of resiliency. The study ends with the recommendation for the use of necessary condition analysis to study both classical and novel psychological research problems.

The Importance of Well-Being on Resiliency of Filipino Adults During the COVID-19 Who are Community Quarantined

The infectious Coronavirus disease (COVID-19), which causes respiratory illness includes flu-like symptoms such as cough, fever, and in more severe cases, breathing difficulties. COVID-19 is mainly spread through contact with an infected person who sneezes or coughs. It can be acquired when a person touches their eyes, nose, or mouth after touching objects or surfaces that have the virus on it ( World Health Organization, 2020 ). Starting December 2019, countries imposed travel bans and asked individuals who have possibly been exposed to the contagion to isolate themselves in a dedicated quarantine facility or at home ( Brooks et al., 2020 ) at an unprecedented scale. The Philippines reported its first case of COVID-19 on January 30, 2020. Since then, the number of reported cases exponentially increased by the day ( ABS-CBN Investigative and Research Group, 2020 ). As of December 12, 2020, 447,039 infected cases were reported throughout the country. Of the total number of cases, 409,329 have recovered, and 8,709 have died ( Department of Health, 2020 ).

As a response to the growing threat of the pandemic, the entire Luzon was placed under enhanced community quarantine (ECQ; Medialdea, 2020 ). Shortly, both Visayas and Mindanao followed suit. The said measure involves draconian restrictions: that include the establishment of checkpoints in most cities; the suspension of classes in all levels; the prohibition of mass gatherings; the temporary shutting down of non-essential businesses; the banning of public utilized utility vehicles; and the strict implementation of home isolation. Although it was initially planned to end on April 12, 2020 ( Abueg, 2020 ), several subsequent recommendations both from the national and local governments extended the nationwide community quarantine until December 31, 2020 ( CNN Philippines Staff, 2020 ). As the nation’s Gross Domestic Product (GDP) shrank 16.5% in the second quarter of 2020, the Philippines officially entered recession as an effect of the extended quarantines ( Agence France-Presse, 2020 ). While quarantine is often among the initial responses against an emerging infectious disease ( Parmet and Sinha, 2020 ), it is often unpleasant for those who are required to submit to it and may lead to several harmful conditions for some persons ( Hawryluck et al., 2004 ; Brooks et al., 2020 ). Hence, the psychological effects of quarantine have received considerable attention. Barbisch et al. (2015) reported that losing autonomy, isolation away from loved ones, uncertainty, and boredom could lead to adverse effects on an individual’s well-being. Following the imposition of cordon sanitaire in previous outbreaks, substantial anger, anxiety and even an increase in suicide rates have been reported ( Brooks et al., 2020 ). Similarly, the National Center for Mental Health (NCMH) in the Philippines reported that depression and other mental health issues were on the rise after imposing ECQ in different provinces in the country ( Tenorio, 2020 ).

Well-Being and Its Elements

It is important to note that while quarantines are often unpleasant, their effect on people diverge. While there are individuals who experience mental health issues, there are also those who are more resilient and can move on with their lives. This highlights the importance of studying not only how individuals suffer in light of community quarantines, but also how they cope, and even flourish in the face of such challenging times. Seligman (2011) argued that even in difficult situations, human beings are motivated to thrive and not just merely survive. According to Fredrickson and Losada (2005) , flourishing means living “within an optimal range of human functioning, one that connotes goodness, generativity, growth, and resilience.” Based on this definition, resilience appears to arise from flourishing. Well-being predicts resiliency. For clarity, the terms “flourishing,” “thriving,” and “well-being” are used interchangeably in the literature ( Butler and Kern, 2016 ). Therefore, we also use the terms interchangeably here.

Well-being Theory of Seligman (2011) advocates that flourishing arises from five well-being pillars-Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment, hence PERMA. It is important to note that no single element defines well-being, but each contributes to it. Positive emotions include an extensive variety of feelings, which include excitement, satisfaction, pride, and awe. Previous reviews highlight the important role of these emotions in positive life outcomes ( Butler and Kern, 2016 ). Engagement involves activities that stimulate and develop upon an individual’s interests. Csikszentmihalyi (2009) argues that true engagement leads to a state of deep and effortless involvement where an individual is completely absorbed in an activity that often leads to a sense of joy and lucidity. Relationships are social connections important in stimulating positive emotions. They can either be work-related, familial, romantic, and even platonic. The experiences that contribute to well-being are often amplified through our relationships. Positive relationships have been linked to positive outcomes such as better physical health, healthier behaviors, less psychopathology, and lower mortality risk ( Tay et al., 2013 ). A sense of meaning is derived from having a direction in life, belonging to a cause larger than the self, and serving a purpose greater than one’s immediate needs ( Steger, 2012 ). Such activities provide a sense that life is valuable and worthwhile. Various societal institutions such as religion, politics, justice, and community social causes enable a sense of meaning. Accomplishments are pursuits toward and reaching goals, mastery, and efficacy to complete tasks ( Butler and Kern, 2016 ) in various domains such as the workplace, in sports and games, and even in hobbies and interests. Seligman (2011) argued that people pursue accomplishments even when they do not result in positive emotions, meaning, or relationships. Although PERMA was developed mainly within the Western context, several researches found that PERMA is experienced in culturally consistent manners in non-Western societies such as the United Arab Emirates ( Lambert and Pasha-Zaidi, 2016 ), Hong-Kong ( Lai et al., 2018 ), and the Philippines ( Nebrida and Dullas, 2018 ).

Defining Resilience

Over the past decade, resilience has become a popular concept in both research and clinical practice ( Kumpfer, 2002 ; Walsh-Dilley and Wolford, 2015 ). Despite the lack of consensus in how it is defined ( Vella and Pai, 2019 ), it is accepted that resilience involves the positive adaptation following a stressful or adverse experience ( Porterfield et al., 2010 ). Most definitions acknowledge two key points about resilience ( Herrman et al., 2011 ). First, is that various factors interact with it. For example, personal characteristics such as personality traits ( Oshio et al., 2018 ), self-esteem ( Karatas and Cakar, 2011 ), and even age ( Diehl and Hay, 2010 ) influence resilience. Social and community factors ( Harms et al., 2018 ) such as secure attachments, the presence of a role model ( Levine, 2003 ), family stability ( Grubman, 2018 ), and culture ( Ungar, 2008 ) affect the ability to cope with daily struggles. Second, resilience is time and context-specific and may not be present across all life domains. Resilience appears to be receptive to the influence of specific situations ( Hayman et al., 2017 ) such as unique stressors ( Jex et al., 2013 ) like war and other happenstances ( Besser et al., 2014 ).

While the aforementioned literature provides key insights into the definition, factors, and contexts of resilience, most research focuses on factors are outside the control of the individual. While these researches are important in explaining the development of resilience, they lack emphasis on positive mechanisms, which are behaviors a person can perform to facilitate resilience. While resilience has been studied both in daily and unique stressors, none focused on the novel situation of wide range community quarantines. Therefore, despite the abundance of resilience-related research, the question remains “What positive mechanisms are involved in the resilience of people who are subjected to quarantine?”

The Present Study

In this paper, we introduced a novel approach in understanding the necessary but not sufficient nature of the aforementioned positive aspects of well-being in predicting resiliency. We used Dul (2016) Necessary Condition Analysis (NCA), which seeks to identify necessary-but-not-sufficient conditions in data sets ( Dul, 2018 ). A necessary condition is a crucial factor in an outcome. If it is not in place, the outcome will not be achieved, but its sole presence does not guarantee that the outcome will be obtained. Without the necessary condition, however, there is a certain failure, which may not be compensated by other determinants of the outcome. Necessary (but not sufficient) conditions widely exist in real-life. For example, the novel SARS-CoV-2 coronavirus is a necessary-but-not-sufficient condition for COVID-19 ( World Health Organization, 2020 ). Without SARS-CoV-2 coronavirus, an individual will not acquire COVID-19. However, even with SARS-CoV-2 coronavirus, an individual may or may not acquire COVID-19. In the same light, a college student who wants to pass the course, Introduction to Psychology (the outcome) needs to attend 80% of lecture hours (necessary conditions). However, attending class regularly does not guarantee passing the course as other requirements (examinations, seat-works, research work, and journal critique paper) play a role in a student’s grade. Yet, if the student incurs too many absences and tardiness, failure is guaranteed. As seen in the aforementioned examples, necessary causes are not automatically sufficient. They can be seen as constraints, barriers, or obstacles one needs to deal with to arrive at the desired outcome.

While well-being and resiliency are closely related concepts ( Hu et al., 2015 ) Flourishing model of Seligman’s (2011) perceives resiliency as the result of both “surviving” and “thriving” psychological characteristics. This theoretical relationship between well-being and resilience has gained empirical support in recent years ( Harms et al., 2018 ). For example, Martínez-Martí and Ruch (2017) and Burns and Anstey (2010) demonstrated that measures of well-being are not simply redundant with self-report scales of resilience. At the same time, while the relationship between these two concepts are robust, it is rarely straightforward ( Harms et al., 2018 ). Interestingly, some researchers ( Fredrickson et al., 2003 ; Tugade and Fredrickson, 2004 ; Ong et al., 2006 , 2010 ; Kuntz et al., 2016 ) argued that optimal levels of PERMA elements predict resilience in normal sample.

In the light of the foregoing, the present study aims to investigate how PERMA predicts the resiliency of community quarantined individuals. An explanation of possible necessary-but-not-sufficient conditions of resiliency during quarantine may have both theoretical and practical value. Theoretically, an investigation of this sort allows the advancement of our understanding of how a multitude of variables coalesces to produce resiliency in times of quarantine and social isolation. This is significant as wide-range and prolonged quarantines are relatively novel experiences. Hence, not much is known about its psychological implications for human beings. Psychological interventions may target different necessary-but-not-sufficient variables jointly. Because of NCA’s ability to identify bottleneck variables ( Dul, 2019a ), conditions that must be present for resiliency to be possible, interventions may prioritize bottleneck variables of resiliency to maximize the use of limited resources. Lastly, identifying necessary-but-not-sufficient conditions for resiliency may also help individuals who are quarantined to develop their understanding of the behaviors they need to engage to have resiliency. Following this logic, we hypothesize that:

• H 01 : PERMA elements predict the resiliency of the community-quarantined individuals.
• H 02 : PERMA elements are necessary, but not sufficient conditions, for the resiliency of the community-quarantined individuals.

Methodology

Research design.

To test the assumption that PERMA elements are both sufficient and necessary conditions of resiliency in community quarantined individuals, sufficiency and necessity observational design were used concurrently. In these designs, the conditions (PERMA) and the outcome (resiliency) are observed in real-life context and without the manipulation of the condition. While sufficiency and necessity observational research designs follow the same data gathering procedures, they diverge in data analysis. Dul (2016) argued that NCA is a complement to traditional approaches to analyze relations. As in our research, by using multiple regression we could spot determinants that contribute to resiliency, whereas NCA allowed us to spot critical determinants (constraints) that prevent resiliency from developing. These bottlenecks, when present, prevents resiliency from occurring even when we increase the values of other determinants unless we take away the bottlenecks by increasing the value of the critical determinant. NCA lead us to discover critical determinants that were not part of the determinants identified with the regression model. Using both approaches is critical in adequately understanding the resiliency of individuals who are subjected to the extended ECQ.

Research Participants

Because of the restrictions in both mobility and social interactions as direct consequences of the nationwide ECQ, we used purposive – convenience sampling to recruit Filipino Facebook users who reside in communities placed under the ECQ. The survey was promoted through social media, primarily on Facebook. A total of 541 participants responded to our online survey via Google Form. The minimum age reported was 16 years old, while the maximum age was 64 years old with a median of 23. Because resiliency scores are contingent to age, only those whose ages ranged between emerging adulthood to early middle adulthood (18–40) were included in the study.

Inclusion Criteria

Participants that were considered to partake in the research met the following criteria: first, a participant must be aged 18 to 40 years old. Second, he/she resides in a quarantined area in the Philippines. Third, a participant must be a Filipino citizen as social and cultural factors influence resiliency.

Exclusion Criteria

A participant was excluded in the research because of the following conditions: first, a participant aged less than 18 years old and over 40 years old, a participant who refused to completely answer the online survey questionnaires, and a participant who does not reside in a quarantine area in the Philippines.

Ethical Considerations

In dealing with the participants, respect and protection of the privacy of the participants were prioritized. Thus, privacy and anonymity was of paramount importance. Also, voluntary participation of the chosen participants for said the study was important. Participants had the right to withdraw from the study at any phase of the research if they wished to do so.

Potential participants were fully informed regarding the research, full consent was essential and obtained from the participants. The first page of the online questionnaire required participants to check a box to show consent before having access to the survey. The principle of informed consent involved the researchers providing sufficient information and assurances about taking part to allow potential participants to understand the implications of participation and to reach a fully informed, considered, and freely decided about whether to do so, without the exercise of any pressure or coercion. No incentives were provided in return for their participation.

In collecting data through online surveys, we minimized intrusions on privacy, anonymity, and confidentiality. Before data collection, an adequate level of confidentiality of the research data was ensured to the participants to make them feel secured and protected with the information they shared or contributed. Also, any communication about the research was observed with respect and transparency. Ultimately, research participants are not subjected to harm.

Research Instruments

Google Forms was used to gather sociodemographic variables from the sample and deliver the following self-administered scales, which were used to measure the variables of the current study. Specifically, we used the Connor-Davidson Resiliency Scale-10 (CD-RISC-10) to measure their resiliency, and the PERMA Profiler to measure participants’ well-being elements.

Connor-Davidson Resiliency Scale

The CD-RISC-10 is a 10 item scale that is used to measure resiliency, operationally defined as the ability to “thrive in the face of adversity” ( Connor and Davidson, 2003 ). The unidimensional CD-RISC-10 evaluates several components of psychological pliability: the abilities to adapt to change, manage what comes along, handle stress, stay focused and think clearly, avoid getting discouraged in the face of failure, and handle unpleasant emotions such as pain, sadness, and anger ( Campbell-Sills and Stein, 2007 ). Each item is rated on a five-point range of responses. The total score is computed by getting the sum of all the responses whereby higher scores show high resilience ( Scali et al., 2012 ). Campbell-Sills et al. (2009) maintained that CD-RISC-10 has a median score of 32 with lowest to highest quartiles of 0–29 (Q1), 30–32 (Q2), 33–36 (Q3), and 37–40 (Q4) in general sample. As a widely used scale, CD-RISC-10 has achieved remarkable internal consistency of 0.89 in general population samples. It is both valid and reliable within the context of different cultures, including Filipino samples ( Campbell-Sills and Stein, 2007 ).

PERMA Profiler

The PERMA Profiler is a brief scale that measures the five pillars of well-being: positive emotion, engagement, positive relationships, meaning, and accomplishment, together with negative emotions and health ( Butler and Kern, 2016 ) along a 10-point Likert type scale. Of the 23 items, 15 correspond to the five core elements of well-being (three items per PERMA domain). In addition, eight items were included to test negative emotions (three items), physical health (three items), loneliness (one item), and overall well-being (one item). All items are expressed positively and higher scores denote better well-being except for negative emotions. Subscale scores are calculated by getting the mean of the three items on each subscale, except for loneliness. Overall well-being is calculated by averaging all items except those from the negative emotions subscale. The measure has been used in various samples and was found to have sufficient psychometric properties ( Cobo-Rendón et al., 2020 ). Butler and Kern (2016) reported that adequate reliability is observed for overall well-being and all subscales, α range from 0.71 to 0.94 across eight studies ( N = 31,966). According to Nebrida and Dullas (2018) , the Tagalog version of the PERMA Profiler has a Cronbach’s alpha of 0.842 in 101 Filipino participants.

In the current study ( n = 533), both PERMA Profiler ( α = 0.927) and CD-RISC-10 ( α = 0.915) have an “excellent” internal consistency. These results confirm that the scales are reliable tools for measuring elements of Well-being and Resiliency, respectively, in our sample.

Data Gathering Procedures

Data gathering lasted from March 23 to April 10, 2020, during the first reset of the nationwide extended ECQ. After securing individuals’ interest to take part in the study, we sent potential participants a link to the survey via Facebook Messenger. The first section of the Google Form shows the title of the research and an overview of the current study. After giving consent, participants could fill out the survey. Participants cannot answer the scales without explicitly agreeing to partake in the study. After securing informed consent, each participant was asked to provide their sociodemographic characteristics and then answer the PERMA Profiler and the CD-RSC-10. Answering both scales did not take the participants more than 20 min. After completing the questionnaire, each participant was virtually debriefed.

At any point, should a participant decide not to proceed with the research, they were free to do so with no implications. All the participant has to do was to close the Google Form window and any previously provided data were not recorded.

Data from Google Form were exported to IBM’s Statistical Package for Social Sciences (SPSS) and NCA Software for data analysis.

Data Analysis

Frequency and percentage were used to analyze the sociodemographic characteristics of the participants. We used Cronbach’s alpha to determine the internal reliability of the measuring scales. Correlation and multiple regression analyses were conducted to examine the relationship between PERMA elements and potential predictors of resiliency. Lastly, we used NCA to analyze whether the core elements of well-being are necessary but not sufficient conditions of resiliency.

There are two steps in NCA ( Dul et al., 2019 ), determining ceiling lines and bottleneck tables are the first. Unlike traditional regression models where a line is drawn through the middle of the data in an XY-plot, a ceiling line is created in NCA. This line distinguishes between areas with cases and areas without cases, the zone found in the upper left-hand corner of the plot. However, exceptions such as outliers and errors may be present in a sample so that the empty zone above the ceiling is not empty ( Karwowski et al., 2016 ). The ceiling line is a non-decreasing line (either a linear step function or a straight line) that shows which level of x (well-being elements) is necessary but not sufficient in producing the desired level of y (resiliency).

Dul (2016) identified two techniques in drawing the ceiling line. The first is the non-parametric Ceiling Envelopment with Free Disposal Hull (CE-FDH), which is a piecewise linear line. It is the default ceiling envelopment technique for NCA because it is flexible and intuitive and applies to dichotomous, discrete, and continuous conditions. The second technique is the parametric Ceiling Regression with Free Disposal Hull (CR-FDH), unlike the CE-FDH, this technique smoothens the piecewise linear lines by using a straight line. Because of this, CR-FDH usually has some observations above the ceiling line. Whereas CE-FDH does not. In further comparing the two techniques, CE-FDH is preferred when a straight line does not represent the data because smoothing reduces the size of the ceiling zone as with dichotomous variables and for discrete and continuous variables with relatively low small data sets. CE-FDH is 100% accurate in drawing the demarcation between observations above and observations below the ceiling line.

Quantifying the accuracy of ceiling lines, effect size, and statistical significance of the necessary conditions and necessary inefficiency are the second and final step ( Dul et al., 2020 ). The area of the empty zone above the ceiling line divided by the area where cases would be possible given the minimum and maximum values of X and Y is the effect size of a necessary condition ( Karwowski et al., 2016 ). Therefore, large effect size shows lower ceiling line and greater limitations that well-being elements have on resiliency. On the other hand, if there is a lack of empty space in the scatter plot then well-being elements are not contingents of resiliency. The effect size of a necessary condition can take the values between 0 and 1 where 0–0.1 corresponds to a small effect, 0.1–0.3 a medium effect, 0.3–0.5 a large effect, and d that is greater than 0.5 a very large effect ( Tynan et al., 2020 ). An R package that allows the calculation of various effect size indicators and inferential statistics useful for hypothesis testing is provided by Dul (2016) . The NCA null hypothesis is that the observed effect size is the same as the effect size calculated using random data ( Dul, 2019b ). An estimation of the probability that the observed necessary condition effect size results from comparing two unrelated variables, otherwise known as permutation test, is used to determine statistical significance in NCA ( Dul et al., 2020 ). Observed values of the x and y variables are randomly paired without replacement. Such pairing continues until the sample size is reached and the process is repeated at least 10,000. The resultant value of p is interpreted using traditional thresholds such as α = 0.05 or α = 0.01. Depending on the context of the research, both significance testing and effect size are useful in determining the theoretical and practical importance of an observed outcome ( Tynan et al., 2020 ). We focus our attention on conditions with both d > 0.5 and p < 0.05.

SPSS was used to analyze the frequency and percentage of various sociodemographic variables, the scales’ reliability, and for generating the Regression Model. R Statistical Software with NCA Package was used to conduct NCA.

Profile of the Participants

Participants comprised 376 females (70.56%) and 157 males (29.45%). The median and mode ages of the participants are 23 years, while the mean age is 25. Among the participants 189 (35.46%) were college students, 293 (54.97%) are employed, and 51 (9.57%) are out of work. Lastly, seven (1.31%) participants reported that they had direct contact with someone who was infected with COVID-19, while 100 (18.76%) reside in communities with known COVID-19 cases and 426 (79.92%) have no exposure to the disease.

PERMA as Predictors of Resiliency

Table 1 summarizes the descriptive statistics and analysis results of the study. Results revealed that the mean resiliency score of the participants is 24.83, with a SD of 7.22. PERMA elements including overall well-being are positive and significantly correlated with resiliency. Interestingly, a subjective sense of health (feeling good and healthy each day) showed only a weak, albeit significant positive correlation with resiliency. Negative emotions and loneliness are negatively correlated with resiliency.

Summary statistics, correlations, and coefficient results for regression analysis of study variables.

R, Pearson correlation coefficient with resiliency; R p , p value of R; Loneliness and health R = −0.211, where p = 0.001. β , standardized beta; B , unstandardized beta; p , probability value of PERMA elements as predictors of resiliency. R 2 of five original PERMA elements including four additional subscales = 0.368.

The multiple regression model with all nine predictors produced R 2 = 0.368, F (9, 523) = 33.83, p < 0.001 with adjusted R 2 = 0.357. This means that 36.8% of the variance in resiliency scores is because of the PERMA elements. As seen in Table 1 , accomplishment ( β = 0.447, p < 0.01) and negative emotions ( β = −0.171, p < 0.00) are the only elements of PERMA with significant regression weights, showing scores on these elements predict resiliency. However, negative emotions have significant negative weight as compared to with standardized coefficients of −0.171 vs. 0.477.

The multiple regression model of the four confounders between the relationship of PERMA elements and resiliency produced R 2 = 0.036, F (4, 528) = 4.90, p < 0.001 with adjusted R 2 = 0.028. It shows that the spread of the confounders is 3.6% between the relationship of the variables. As seen in Table 2 , only employment status (student, unemployed, and employed) with β = 0.14, p < 0.00 is a significant predictor of resiliency.

Confounders between the relationship of PERMA and Resiliency.

R , Pearson correlation coefficient with resiliency; β , standardized beta; B , unstandardized beta; p , probability value of confounders with p < 0.001.

PERMA as Necessary-But-Not-Sufficient Conditions of Resiliency

The results of NCA on Resiliency show that all five elements of the original Seligman (2011) PERMA are necessary but not sufficient conditions of Resiliency among individuals who are community quarantined as showed by the size of the empty zone in the XY-plots in Figure 1 . This means that to score 35 in the CD-RISC-10, a score of 1 for positive emotions and engagement, a score of 2 for Positive Relationships, Meaning, and Accomplishment are necessary.

Scatterplots of the original PERMA elements ( x ) as necessary conditions of resiliency ( y ). Note: The dashed lines are ceiling lines. The selected ceiling line technique (CE-FDH) do not allow data points above the ceiling line. The solid line is the ordinary least squares regression line.

Figure 2 contains the scatterplots of the four supplementary subscales of Butler and Kern (2016) PERMA Profiler. Only the xy-plot of Overall Well-being ( x ) and Resiliency ( y ) has a “moderately sized” empty zone in the upper left corner of the plot. This is not surprising considering that Overall Well-being is the composite score of the five PERMA elements and health score. The scatterplots of Health ( x ) and Resiliency ( y ), and Negative Emotions ( x ) and Resiliency ( y ) contain discernibly small empty zones. Lastly, the empty zone is absent in the Loneliness ( x ) – Resiliency ( y ) scatterplot. This assumes that Loneliness is not a necessary condition of Resiliency as the presence and size of an empty zone is a sign that a necessary condition is present ( Dul, 2016 ).

Scatterplots of overall well-being, health, negative emotions, and loneliness ( x ) as necessary conditions of resiliency ( y ). These elements were not in the original Seligman (2011) PERMA model but are supplementary subscales in Butler and Kern (2016) PERMA Profiler. Note: The dashed lines are ceiling lines. The selected ceiling line technique (CE-FDH) does not allow data points above the ceiling line. The solid line is the ordinary least squares regression line.

We summarized the results of the multiple NCA in Table 3 . The observed accuracy of all variables exceeds arbitrary benchmark of Dul (2018) for the desired accuracy of 95%. Dul suggests the use of CR-FDH for interpreting variables with accuracies above 95%. However, since our variables do not follow a normal distribution ( p = 0.00) based on One-Sample Kolmogorov-Smirnov Test, we used the non-parametric CE-FDH ceiling line technique. Necessary-but-not-sufficient relationships between Resiliency and the five original PERMA elements and the auxiliary components are observed. The NCA effect size range between d = 0.09 and 0.12 based on CE-FDH for the original PERMA elements and d = 0.04 to 0.12 on the supplementary elements, excluding Loneliness. According to recommendations, Positive Emotions, Meaning, Accomplishment, and Overall Well-being of Dul (2016) have medium effect sizes on Resiliency. Engagement, Positive Relationships, Negative Emotions, and Health have small effect sizes on Resiliency. The NCA significance test is powerful enough to rule out an effect being the product of randomness ( Dul et al., 2020 ). Lastly, there is no necessary-but-not-sufficient relationship between Loneliness and Resiliency.

Necessary conditions effect size and significance test for PERMA Profiler subscales predicting Connor-Davidson Resiliency Scale-10 (CD-RISC-10) scores.

CE-FDH, ceiling envelopment with free disposal hull; CR-FDH, ceiling regression with free disposal hull. The p value reported was estimated with 10,000 permutations and are treated as significant if <0.05. The threshold for statistical significance is arbitrary but commensurate with the example given by Dul et al. (2020) . Accuracy refers to the percentage of observations under the CR-FDH ceiling line. Skewness p is based on One-Sample Kolmogorov-Smirnov Test. Skewness of resiliency scores is −0.78.

The ability to identify bottleneck variables (constraints) is a useful feature of NCA, especially for interpreting multivariate necessary conditions ( Dul, 2019b ). Table 4 , which is read horizontally, shows for which level of resiliency, which level of PERMA elements is necessary. For a desired value of resiliency, in the first column, it shows the minimum required values of the PERMA elements in the next columns. Levels are expressed in percentage ranges so that 0 is the minimum value, the maximum is 100, and 50 is the point between these two values.

Bottleneck table of PERMA elements as necessary conditions of resiliency based on CE-FDH.

Re, resiliency; P, positive emotions, E, engagement; R, positive relationships; M, meaning; A, accomplishment; OW, overall well-being; H, health; N, negative emotions; L, loneliness; NN, not necessary.

The bottleneck table shows that no minimum value of any PERMA element is necessary to score 30% in Resiliency. This means that at 30% no PERMA element is a bottleneck for resiliency. However, for a resiliency level of 40%, the minimum required level of Positive Emotions is 6.9%, the necessary level of Accomplishment is 3.7, 7.1% for Overall Well-being, and none of the over PERMA elements are necessary. As observed in the bottleneck table, when Resiliency increases from 0 to 100%, more PERMA elements become necessary, and required levels of the PERMA elements become higher. At 90% level of Resiliency, the necessary level of Positive Emotions is 34.5%, Engagement is 18.6%, Positive Relationships is 25.9%, Meaning is 26.7%, Accomplishment is 25.9%, Overall Well-being is 34.2%, Health is 6.7%, and Negative Emotions is 42.9%. No level of Loneliness is necessary for any level of Resiliency. Not achieving any of these minimum levels means that attaining a 90% level in resiliency is impossible. Since each condition is a bottleneck, scoring higher in other elements does not compensate for the deficiency in others.

Wide range community quarantines and social distancing are elements that are increasingly becoming the new normal as a result of the global COVID-19 pandemic. Previous research ( Hawryluck et al., 2004 ; Barbisch et al., 2015 ; Brooks et al., 2020 ; Parmet and Sinha, 2020 ) offer invaluable insights into the psychological consequences of restrictions. Moreover, while there has been an interest in the psychological impact of COVID-19 and community quarantine in the Philippines (for example, Nicomedes and Avila, 2020 ; Tee et al., 2020 ), most focus on the negative psychological impact of COVID-19. This raises the question of what protective factors are important in the midst of prolonged community quarantines. To test this properly, we used a combination of the traditional regression model and the novel multivariate necessary-but-not-sufficient conditions analysis to investigate how resiliency is contingent on well-being elements in Filipinos who are community quarantined.

Participants of this study were predominantly female, around the age of 23 and who are employed. While, we specifically targeted individuals between the ages of 18–40, most of our sample are emergent adults (mean age = 25, median, and mode ages = 23). The disproportional representation of young adult females can be attributed to several factors. First, previous studies ( Smith, 2008 ; Yetter and Capaccioli, 2010 ; Slauson-Blevins and Johnson, 2016 ) have reported that young adult females take part in online surveys at a higher frequency compared with their male counterparts. There are more female Facebook users than males ( Lee et al., 2016 ), which is significant because we invited potential participants through Facebook. Lastly, the Philippines has a young population. The median age in the Philippines is 25.7 ( United Nations Statistics Division, 2019 ; Plecher, 2020 ). Taken together, it can be assumed that the sociodemographic characteristics of our study are similar to the Filipino Facebook population.

Based on the CD-RISC-10 quartiles for community sample provided by Campbell-Sills et al. (2009) , the mean resilience score (24.83) of the current sample belongs to the lowest 25%. This implies that the participants of the current study have lower resiliency scores than the general population. This result ties well with the notion that resilience is stress-context specific ( Jex et al., 2013 ; Wood and Bhatnagar, 2015 ; Hayman et al., 2017 ) and that the nature of the sample influences resiliency scores ( Connor and Davidson, 2003 ). Specifically, people with psychiatric problems and those who are experiencing significant stress score lower than the general population ( Li et al., 2012 ; Ye et al., 2017 ). In the context of COVID-19, Nicomedes and Avila (2020) found that Filipinos in community quarantine experience significant stress and scored high on both health anxiety and panic.

While resiliency and well-being have become commonplace terms and construct central in positive psychology ( Jeste et al., 2015 ), they are often studied using correlational methods ( Schultze-Lutter et al., 2016 ), and traditional approaches via the sufficiency paradigm. In line with previous studies ( Souri and Hasanirad, 2011 ; Khawaja et al., 2017 ; van Agteren et al., 2018 ), we found that all elements of well-being are positively correlated with resiliency. Although the multiple regression test shows that among the original PERMA elements, only accomplishment is a significant predictor of resilience. This means that the subjective sense of competence, having a structure each day, i.e., identifying, setting, and achieving daily goals enable resiliency in individuals subjected to quarantine. We also observed that negative emotions significantly, although negatively predict resilience. This suggests the significant predicting function of individuals’ tendency to experience anxiety and anger for lower levels of resilience. These findings support the previously reported ( Tugade and Fredrickson, 2004 ; Chen et al., 2018 ) link between negative emotions and low levels of resilience.

In this paper, we identified elements of well-being that are necessary-but-not-sufficient for resiliency to occur in individuals who are community quarantined. Specifically, Positive Emotions, Meaning, and Accomplishment are significant and moderately necessary conditions of Resiliency, as suggested by their medium effect size. This finding suggests that positive feelings like interest, joy, and contentment and pursuing a daily purpose, and regularly experiencing a sense of accomplishment are essential to quarantined individuals’ ability to thrive in their present predicament. Such necessary conditions not only allow individuals to enjoy everyday experiences ( Abiola et al., 2017 ) but also provide a sense that life matter, which replenishes depleted energy from adverse experiences, and are required in the development of resiliency.

Engagement and Positive Relationships have small yet significant effect sizes on Resiliency. This infers that experiencing a state of “flow,” or being absorbed in an activity ( Nakamura and Csikszentmihalyi, 2014 ) and feeling loved, supported, and valued by others are also necessary to the quarantined individuals’ capacity to recover quickly from their daily difficulties. This ties well with previous studies ( Eaude, 2009 ; Svence et al., 2015 ; Abiola et al., 2017 ; Gerino et al., 2017 ; Roncaglia, 2017 ; Cobo-Rendón et al., 2020 ), where well-being elements were observed to be related with the occurrence of resiliency in individuals from a different context. Well-being elements allow quarantined individuals to focus their attention on alleviating harm, preventing negative mental health consequences, and finding positive outcomes in the presence of difficulty.

A unique finding, we encountered is that PERMA elements are bottleneck variables of resiliency. This highlights the little-known capacity of well-being to serve as a constraint to attaining higher levels of resiliency in community-quarantined individuals. This novel result shows two things. First, low levels of resiliency (30% and less) do not necessitate even the slightest well-being elements. Second, higher levels of resiliency require certain levels of all the original PERMA elements and physical health. However, health remains a constant, albeit weak, necessary condition. This means that optimum resiliency is only possible when all the five pillars of well-being are taken care of and when one is at least minimally content with their physical health. When comparing our results to those of older studies ( Sanders et al., 2015 ; Svence et al., 2015 ; Abiola et al., 2017 ). It must be pointed out that while the link between well-being and resiliency has been suggested in these studies, none could establish the necessary-but-not-sufficient relationship between the concepts. The present findings underpin the importance of holistic rather than an atomistic approach to mental health as noted by Mario (2012) and contradicts the compensation hypothesis of well-being. NCA revealed that deficiencies in certain areas of well-being may not be addressed by overcompensating in other areas, as all five pillars of well-being are necessary-but-not-sufficient conditions of resiliency.

Our findings show that loneliness is inversely correlated with the subjective perception of health. This basic result is consistent with the research ( Balter et al., 2019 ) showing that loneliness predicts poor immune systems in healthy young adults. This is important since maintaining good health is vital amidst a growing viral pandemic. We observed that loneliness is a significant negative predictor of resiliency and not a necessary condition for any level of resiliency in individuals who are community quarantined. A similar conclusion was reached by Perron et al. (2014) where individuals who feel resilient also experience less loneliness. This further highlights the importance of the elements of well-being as necessary conditions of resiliency, which may lessen the effects of or serve as a buffer against loneliness and other negative psychological consequences of quarantine.

The overall results of our study have theoretical and practical implications. At a theoretical level, our results found clear support to PERMA concept of Seligman (2011) as necessary ingredients of resiliency even for socially isolated individuals such as those placed in ECQ. This goes beyond previous reports wherein PERMA elements were observed as predictors of resiliency, as only NCA can identify a necessary-but-not-sufficient relationship between the said variables. Despite experiencing segregation like lockdowns, the conditions that will allow people to thrive in the face of adversity are the same as when they are not undergoing such a predicament. Therefore, this finding can help us understand how the five elements of well-being constrain the negative psychological consequences of community quarantine by providing a buffer against these harms, reducing their effects, and promoting individual capacity to cope with such unsettling conditions. From this standpoint, we speculate that PERMA should be inversely correlated with negative indicators of mental health and correspondingly with other elements of positive psychological health, as noted by Hu et al. (2015) . At a practical level, this opens an opportunity to develop evidence-based interventions such as telepsychology ( Zhou et al., 2020 ) for quarantined individuals that help clients understand behaviors they need to engage to have resiliency, and target multiple necessary-but-not-sufficient variables jointly, and not just focus on certain elements of well-being. This provides support for eclectic approaches to therapy especially the ones that incorporate positive psychology as Bolier et al. (2013) noted empirical support for the effectiveness of such interventions. Lastly, our findings agree with the call to a more inclusive psychology in the Philippines. This paradigm shift involves incorporating such approaches as critical ( Paredes-Canilao et al., 2015 ) and positive ( Datu et al., 2018 ) psychology to the prevailing traditional pathology-based perspective.

One fundamental limitation of this study is that the use of multiple regression and NCA cannot guarantee causality ( Dul, 2016 ). While our data is consistent with the causal hypothesis, it is not evidence of a causal connection. Therefore, causal necessary-but-not-sufficient relations should not be inferred from our data. Another important caveat in interpreting our results is that we used the Facebook population as compared to the actual geographical population. It is not a perfect representative since Facebook users are usually younger females who have better educational attainment compared to the general population ( Kosinski et al., 2015 ). Resiliency and well-being were measured during the ECQ, a far from normal situation. Therefore, although we took obligatory safety measures to increase the trustworthiness of the findings, we suggest that care be exercised when generalizing our findings into the general population and normal circumstances.

Many questions remain to be answered concerning the well-being of people who are community quarantined and the utility of NCA in psychological research. Further work is needed to identify the negative consequences of prolonged quarantine on individuals, especially those who have preexisting mental health problems and those who experience a disruption in access to their mental health-care providers. Moreover Odacı and Kalkan (2010) reported that internet use, specifically social media ( Maglunog and Dy, 2019 ) exacerbates loneliness and that social media usage is expected to rise during the ECQ. Another important question, therefore, is how does the ongoing quarantine affects rates and levels of loneliness. Finally, while necessary conditions are traditionally studied using regression analysis in psychological research, NCA proved to be a more useful tool in understanding necessary-but-not-sufficient relationships because of its ability to understand bottleneck variables. We, therefore, recommend the use of NCA in both classical and novel psychological research problems.

Resiliency grants us the capacity to flourish in the face of difficulty. For resiliency to result, the pillars of well-being are essential. Our research reveals, however, that well-being elements could be enablers or constraints. Accomplishment, for example, could predict resiliency. All pillars are necessary to attain it. Compensating in certain aspects cannot address the deficiency in others. Herein lies the importance and significance of holistic well-being. Those who can attain this are better equipped to thrive in the ECQ, a situation that affects the lives of so many Filipinos.

Data Availability Statement

Ethics statement.

The studies involving human participants were reviewed and approved by Manila Tytana Colleges Research Ethics Committee. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

DC wrote the introduction, results, and discussion and conducted the necessary condition analysis. LB wrote the methods, contributed in the results and discussion, and conducted the correlation analysis, regression analysis, and reliability check of the scales. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.558930/full#supplementary-material

• Abiola T., Olorukooba H. O., Afolayan J. (2017). Wellbeing elements leading to resilience among undergraduate nursing students . IJANS 7 , 1–3. 10.1016/j.ijans.2017.05.001 [ CrossRef ] [ Google Scholar ]
• ABS-CBN Investigative and Research Group (2020). Tracking COVID-19 cases in the Philippines [News Site]. ABS-CBN News. Available at: https://news.abs-cbn.com/news/multimedia/infographic/03/17/20/tracking-covid-19-cases-in-the-philippines (Accessed March 17, 2020).
• Abueg L. (2020). Extended, enhanced, and extreme: Macroeconomic implications of the community quarantine in the Philippines due to the COVID-19 pandemic. Report No.: 2020-01.
• Agence France-Presse (2020). Philippines plunges into recession as coronavirus devastates economy, GDP plummets [News Site]. South China Morning Post. Available at: https://www.scmp.com/news/asia/southeast-asia/article/3096258/philippines-plunges-recession-coronavirus-devastates (Accessed August 6, 2020).
• Balter L. J. T., Raymond J. E., Aldred S., Drayson M. T., Veldhuijzen van Zanten J. J. C. S., Higgs S., et al.. (2019). Loneliness in healthy young adults predicts inflammatory responsiveness to a mild immune challenge in vivo . Brain Behav. Immun. 82 , 298–301. 10.1016/j.bbi.2019.08.196, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Barbisch D., Koenig K. L., Shih F. -Y. (2015). Is there a case for quarantine? Perspectives from SARS to Ebola . Disaster Med. Public Health Prep. 9 , 547–553. 10.1017/dmp.2015.38, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Besser A., Weinberg M., Zeigler-Hill V., Neria Y. (2014). Acute symptoms of posttraumatic stress and dissociative experiences among female israeli civilians exposed to war: the roles of intrapersonal and interpersonal sources of resilience . J. Clin. Psychol. 70 , 1227–1239. 10.1002/jclp.22083, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bolier L., Haverman M., Westerhof G. J., Riper H., Smit F., Bohlmeijer E. (2013). Positive psychology interventions: a meta-analysis of randomized controlled studies . BMC Public Health 13 :119. 10.1186/1471-2458-13-119, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brooks S. K., Webster R. K., Smith L. E., Woodland L., Wessely S., Greenberg N., et al.. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence . Lancet 395 , 912–920. 10.1016/S0140-6736(20)30460-8, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Burns R. A., Anstey K. J. (2010). The Connor–Davidson resilience scale (CD-RISC): testing the invariance of a uni-dimensional resilience measure that is independent of positive and negative affect . Personal. Individ. Differ. 48 , 527–531. 10.1016/j.paid.2009.11.026 [ CrossRef ] [ Google Scholar ]
• Butler J., Kern M. L. (2016). The PERMA-profiler: a brief multidimensional measure of flourishing . Inter. J. Wellbeing 6 , 1–48. 10.5502/ijw.v6i3.526 [ CrossRef ] [ Google Scholar ]
• Campbell-Sills L., Forde D. R., Stein M. B. (2009). Demographic and childhood environmental predictors of resilience in a community sample . J. Psychiatr. Res. 43 , 1007–1012. 10.1016/j.jpsychires.2009.01.013, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Campbell-Sills L., Stein M. B. (2007). Psychometric analysis and refinement of the connor–Davidson resilience scale (CD-RISC): validation of a 10-item measure of resilience . J. Trauma. Stress. 20 , 1019–1028. 10.1002/jts.20271, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chen D., Wu J., Yao Z., Lei K., Luo Y., Li Z. (2018). Negative association between resilience and event-related potentials evoked by negative emotion . Sci. Rep. 8 :7149. 10.1038/s41598-018-25555-w, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• CNN Philippines Staff (2020). Metro Manila retains GCQ status until year-end [News Site]. CNN Philippines. Available at: https://www.cnnphilippines.com/news/2020/11/30/PH-quarantine-classifications-December.html (Accessed November 30, 2020).
• Cobo-Rendón R., Pérez-Villalobos M. V., Páez-Rovira D., Gracia-Leiva M. (2020). A longitudinal study: affective wellbeing, psychological wellbeing, self-efficacy and academic performance among first-year undergraduate students . Scand. J. Psychol. 61 , 518–526. 10.1111/sjop.12618, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Connor K. M., Davidson J. R. T. (2003). Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC) . Depress. Anxiety 18 , 76–82. 10.1002/da.10113, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Csikszentmihalyi M. (2009). Flow: The psychology of optimal experience (Nachdr.) . New York: Harper and Row. [ Google Scholar ]
• Datu J. A., Bernardo A., King R. (2018). Positive psychology research in the Philippines: an introduction . Philipp. J. Psychol. 51 , 21–32. 10.31710/pjp/0051.01.02 [ CrossRef ] [ Google Scholar ]
• Department of Health (2020). Updates on Novel Coronavirus Disease (COVID-19) [Government Agency]. Department of Health Website. Available at: https://www.doh.gov.ph/2019-nCov (Accessed December 12, 2020).
• Diehl M., Hay E. L. (2010). Risk and resilience factors in coping with daily stress in adulthood: the role of age, self-concept incoherence, and personal control . Dev. Psychol. 46 , 1132–1146. 10.1037/a0019937, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dul J. (2016). Necessary condition analysis (NCA): logic and methodology of “necessary but not sufficient” causality . Organ. Res. Methods 19 , 10–52. 10.1177/1094428115584005 [ CrossRef ] [ Google Scholar ]
• Dul J. (ed.) (2018). “ Necessary condition analysis ” in Oxford research Encyclopedia of business and management . Oxford: Oxford University Press. [ Google Scholar ]
• Dul J. (2019a). Conducting necessary condition analysis: For business and management students. 1st Edn . California: SAGE Publications. [ Google Scholar ]
• Dul J. (2019b). Necessary Condition Analysis (NCA) with R (Version 3.0.2): A Quick Start Guide (SSRN Scholarly Paper ID 2624981). Social Science Research Network. Available at: https://papers.ssrn.com/abstract=2624981 (Accessed May 1, 2020).
• Dul J., van der Laan E., Kuik R. (2020). A statistical significance test for necessary condition analysis . Organ. Res. Methods 23 , 385–395. 10.1177/1094428118795272 [ CrossRef ] [ Google Scholar ]
• Dul J., van der Laan E., Kuik R., Karwowski M. (2019). Necessary condition analysis: type I error, power, and over-interpretation of test results. A reply to a comment on NCA. Commentary: predicting the significance of necessity . Front. Psychol. 10 :1493. 10.3389/fpsyg.2019.01493, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ]
• Eaude T. (2009). Happiness, emotional well-being and mental health – what has children’s spirituality to offer? Int. J. Children’s Spiritual. 14 , 185–196. 10.1080/13644360903086455 [ CrossRef ] [ Google Scholar ]
• Fredrickson B. L., Losada M. F. (2005). Positive affect and the complex dynamics of human flourishing . Am. Psychol. 60 , 678–686. 10.1037/0003-066X.60.7.678, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fredrickson B. L., Tugade M. M., Waugh C. E., Larkin G. R. (2003). What good are positive emotions in crisis? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001 . J. Pers. Soc. Psychol. 84 , 365–376. 10.1037/0022-3514.84.2.365, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gerino E., Rollè L., Sechi C., Brustia P. (2017). Loneliness, resilience, mental health, and quality of life in old age: a structural equation model . Front. Psychol. 8 :2003. 10.3389/fpsyg.2017.02003, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Grubman J. (2018). “ How do you balance family stability with resilience over the generations? ” in Wealth of wisdom . eds. McCullougha T., Whitaker K. (Hoboken, New Jersey: John Wiley and Sons, Ltd.), 351–354. [ Google Scholar ]
• Harms P., Brady L., Wood D. (2018). “ Resilience and Well-Being ” in Handbook of well-being . eds. Diener E., Oishi S., Tay L. (Salt Lake City: DEF Publishers; ). [ Google Scholar ]
• Hawryluck L., Gold W. L., Robinson S., Pogorski S., Galea S., Styra R. (2004). SARS control and psychological effects of quarantine, Toronto, Canada . Emerg. Infect. Dis. 10 , 1206–1212. 10.3201/eid1007.030703, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hayman K. J., Kerse N., Consedine N. S. (2017). Resilience in context: the special case of advanced age . Aging Ment. Health 21 , 577–585. 10.1080/13607863.2016.1196336, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Herrman H., Stewart D. E., Diaz-Granados N., Berger E. L., Jackson B., Yuen T. (2011). What is resilience? Can. J. Psychiatr. 56 , 258–265. 10.1177/070674371105600504, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hu T., Zhang D., Wang J. (2015). A meta-analysis of the trait resilience and mental health . Personal. Individ. Differ. 76 , 18–27. 10.1016/j.paid.2014.11.039 [ CrossRef ] [ Google Scholar ]
• Jeste D. V., Palmer B. W., Rettew D. C., Boardman S. (2015). Positive psychiatry: its time has come . J. Clin. Psychiatry 76 , 675–683. 10.4088/JCP.14nr09599, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jex S. M., Kain J., Park Y. (2013). “ Situational factors and resilience: facilitating adaptation to military stressors ” in Building psychological resilience in military personnel: Theory and practice . eds. Britt T. W., Sinclair R. R. (Washington, DC: American Psychological Association; ), 67–84. [ Google Scholar ]
• Karatas Z., Cakar F. S. (2011). Self-esteem and hopelessness, and resiliency: an exploratory study of adolescents in Turkey . Int. Educ. Stud. 4 :p84. 10.5539/ies.v4n4p84 [ CrossRef ] [ Google Scholar ]
• Karwowski M., Dul J., Gralewski J., Jauk E., Jankowska D. M., Gajda A., et al.. (2016). Is creativity without intelligence possible? A necessary condition analysis . Intelligence 57 , 105–117. 10.1016/j.intell.2016.04.006 [ CrossRef ] [ Google Scholar ]
• Khawaja N. G., Ibrahim O., Schweitzer R. D. (2017). Mental wellbeing of students from refugee and migrant backgrounds: the mediating role of resilience . Sch. Ment. Heal. 9 , 284–293. 10.1007/s12310-017-9215-6 [ CrossRef ] [ Google Scholar ]
• Kosinski M., Matz S. C., Gosling S. D., Popov V., Stillwell D. (2015). Facebook as a research tool for the social sciences: opportunities, challenges, ethical considerations, and practical guidelines . Am. Psychol. 70 , 543–556. 10.1037/a0039210, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kumpfer K. L. (2002). “ Factors and processes contributing to resilience ” in Resilience and development: Positive life adaptations . eds.Glantz M. D., Johnson J. L. (US: Springer; ), 179–224. [ Google Scholar ]
• Kuntz J. R. C., Näswall K., Malinen S. (2016). Resilient employees in resilient organizations: flourishing beyond adversity . Ind. Organ. Psychol. Perspect. Sci. Pract. 9 , 456–462. 10.1017/iop.2016.39 [ CrossRef ] [ Google Scholar ]
• Lai M. K., Leung C., Kwok S. Y. C., Hui A. N. N., Lo H. H. M., Leung J. T. Y., et al.. (2018). A multidimensional PERMA-H positive education model, general satisfaction of school life, and character strengths use in Hong Kong senior primary school students: confirmatory factor analysis and path analysis using the APASO-II . Front. Psychol. 9 :1090. 10.3389/fpsyg.2018.01090, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lambert L., Pasha-Zaidi N. (2016). Using the PERMA model in the United Arab Emirates . Soc. Indic. Res. 125 , 905–933. 10.1007/s11205-015-0866-0 [ CrossRef ] [ Google Scholar ]
• Lee R. B., Baring R. V., Sta Maria M. A. (2016). Gender variations in the effects of number of organizational memberships, number of social networking sites, and grade-point average on global social responsibility in Filipino University students . Eur. J. Psychol. 12 , 191–202. 10.5964/ejop.v12i1.1040, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Levine S. (2003). Psychological and social aspects of resilience: a synthesis of risks and resources . Dialogues Clin. Neurosci. 5 , 273–280. 10.31887/DCNS.2003.5.3/slevine, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Li Y., Cao F., Cao D., Wang Q., Cui N. (2012). Predictors of posttraumatic growth among parents of children undergoing inpatient corrective surgery for congenital disease . J. Pediatr. Surg. 47 , 2011–2021. 10.1016/j.jpedsurg.2012.07.005, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Maglunog G. P. A., Dy M. F. R. (2019). Facebook usage and depression levels of selected Filipino college students . IJPES 6 , 35–50. 10.17220/ijpes.2019.02.004 [ CrossRef ] [ Google Scholar ]
• Mario B. (2012). Complementary treatments and holistic perspective: experience in a public mental health service . Eur. J. Integr. Med. 4 :83. 10.1016/j.eujim.2012.07.666 [ CrossRef ] [ Google Scholar ]
• Martínez-Martí M. L., Ruch W. (2017). Character strengths predict resilience over and above positive affect, self-efficacy, optimism, social support, self-esteem, and life satisfaction . J. Posit. Psychol. 12 , 110–119. 10.1080/17439760.2016.1163403 [ CrossRef ] [ Google Scholar ]
• Medialdea S. (2020). Community Quarantine Over the Entire Luzon and Guidelines for the Management of the Coronavirus Disease 2019 (COVID-19) Situation. Official Gazette of the government of the Republic of the Philippines. Available at: https://www.officialgazette.gov.ph/downloads/2020/03mar/20200316-MEMORANDUM-FROM-ES-RRD.pdf (Accessed March 16, 2020).
• Nakamura J., Csikszentmihalyi M. (2014). “ The concept of flow ” in Flow and the foundations of positive psychology: The collected works of Mihaly Csikszentmihalyi . ed.Csikszentmihalyi M. (Netherlands: Springer; ), 239–263. [ Google Scholar ]
• Nebrida J. D., Dullas A. (2018). “I’m perfectly imperfect”: exploring the relationship between PERMA model of wellbeing with self-esteem among persons with disabilities . IJRSP 7 , 27–44. 10.5861/ijrsp.2018.3005 [ CrossRef ] [ Google Scholar ]
• Nicomedes C. J. C., Avila R. M. A. (2020). An analysis on the panic during COVID-19 pandemic through an online form . J. Affect. Disord. 276 , 14–22. 10.1016/j.jad.2020.06.046, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Odacı H., Kalkan M. (2010). Problematic internet use, loneliness and dating anxiety among young adult university students . Comp. Educ. 55 , 1091–1097. 10.1016/j.compedu.2010.05.006 [ CrossRef ] [ Google Scholar ]
• Ong A. D., Bergeman C. S., Bisconti T. L., Wallace K. A. (2006). Psychological resilience, positive emotions, and successful adaptation to stress in later life . J. Pers. Soc. Psychol. 91 , 730–749. 10.1037/0022-3514.91.4.730, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ong A. D., Zautra A. J., Reid M. C. (2010). Psychological resilience predicts decreases in pain catastrophizing through positive emotions . Psychol. Aging 25 , 516–523. 10.1037/a0019384, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Oshio A., Taku K., Hirano M., Saeed G. (2018). Resilience and big five personality traits: a meta-analysis . Personal. Individ. Differ. 127 , 54–60. 10.1016/j.paid.2018.01.048 [ CrossRef ] [ Google Scholar ]
• Paredes-Canilao N., Babaran-Diaz M. A., Florendo M. N. B., Salinas-Ramos T. (2015). “ Indigenous psychologies and critical-emancipatory psychology ” in Handbook of critical psychology . ed.Mendoza S. L.(Oxfordshire: Routledge/Taylor and Francis Group; ), 356–365. [ Google Scholar ]
• Parmet W. E., Sinha M. S. (2020). Covid-19—the law and limits of quarantine . N. Engl. J. Med. 382 :e28. 10.1056/NEJMp2004211, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Perron J. L., Cleverley K., Kidd S. A. (2014). Resilience, loneliness, and psychological distress among homeless youth . Arch. Psychiatr. Nurs. 28 , 226–229. 10.1016/j.apnu.2014.05.004, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Plecher H. (2020). Median age of the population in the Philippines 2015. Statistica. Available at: https://www.statista.com/statistics/578796/average-age-of-the-population-in-philippines/#:~:text=Median%20age%20of%20the%20population%20in%20the%20Philippines%202015&text=In%202020%2C%20the%20average%20age,was%20under%2020%20years%20old (Accessed September 23, 2020).
• Porterfield K., Akinsulure-Smith A. M., Benson M. A., Betancourt T., Heidi Ellis B., Kia-Keating M., et al.. (2010). Resilience and recovery after war: Refugee children and families in the United States.
• Roncaglia I. (2017). The role of wellbeing and wellness: a positive psychological model in supporting young people with ASCs . PSYCT 10 , 217–226. 10.5964/psyct.v10i1.203 [ CrossRef ] [ Google Scholar ]
• Sanders J., Munford R., Thimasarn-Anwar T., Liebenberg L., Ungar M. (2015). The role of positive youth development practices in building resilience and enhancing wellbeing for at-risk youth . Child Abuse Negl. 42 , 40–53. 10.1016/j.chiabu.2015.02.006, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Scali J., Gandubert C., Ritchie K., Soulier M., Ancelin M. -L., Chaudieu I. (2012). Measuring resilience in adult women using the 10-items Connor-Davidson resilience scale (CD-RISC). Role of trauma exposure and anxiety disorders . PLoS One 7 :e39879. 10.1371/journal.pone.0039879, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Schultze-Lutter F., Schimmelmann B. G., Schmidt S. J. (2016). Resilience, risk, mental health and well-being: associations and conceptual differences . Eur. Child Adolesc. Psychiatry 25 , 459–466. 10.1007/s00787-016-0851-4, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Seligman M. E. P. (2011). Flourish: A visionary new understanding of happiness and well-being. 1st Edn . New York: Free Press. [ Google Scholar ]
• Slauson-Blevins K., Johnson K. M. (2016). Doing gender, doing surveys? Women’s gatekeeping and men’s non-participation in multi-actor reproductive surveys . Sociol. Inq. 86 , 427–449. 10.1111/soin.12122 [ CrossRef ] [ Google Scholar ]
• Smith W. G. (2008). Does Gender Influence Online Survey Participation? A Record-Linkage Analysis of University Faculty Online Survey Response Behavior. Available at: https://eric.ed.gov/?id=ED501717 (Accessed June 2020).
• Souri H., Hasanirad T. (2011). Relationship between resilience, optimism and psychological well-being in students of medicine . Procedia Soc. Behav. Sci. 30 , 1541–1544. 10.1016/j.sbspro.2011.10.299 [ CrossRef ] [ Google Scholar ]
• Steger M. F. (2012). “ Experiencing meaning in life: optimal functioning at the nexus of well-being, psychopathology, and spirituality ” in The human quest for meaning: Theories, research, and applications . 2nd Edn. ed. Wong P. T. P. (Abingdon, Oxfordshire: Routledge/Taylor and Francis Group; ), 165–184. [ Google Scholar ]
• Svence G., Majors M., Majors M., Majors M. (2015). Correlation of Well-Being with Resiliency and Age. Problems of Psychology in the 21st Century, 9, Continuous.
• Tay L., Tan K., Diener E., Gonzalez E. (2013). Social relations, health behaviors, and health outcomes: a survey and synthesis . Appl. Psychol. Health Well-Being 5 , 28–78. 10.1111/aphw.12000, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tee M. L., Tee C. A., Anlacan J. P., Aligam K. J. G., Reyes P. W. C., Kuruchittham V., et al.. (2020). Psychological impact of COVID-19 pandemic in the Philippines . J. Affect. Disord. 277 , 379–391. 10.1016/j.jad.2020.08.043, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tenorio B. D. (2020). Depression on the rise due to ECQ. Available at: https://www.philstar.com/headlines/2020/04/29/2010543/depression-rise-due-ecq (Accessed April 29, 2020).
• Tugade M. M., Fredrickson B. L. (2004). Resilient individuals use positive emotions to bounce Back from negative emotional experiences . J. Pers. Soc. Psychol. 86 , 320–333. 10.1037/0022-3514.86.2.320, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tynan M. C., Credé M., Harms P. D. (2020). Are individual characteristics and behaviors necessary-but-not-sufficient conditions for academic success?: a demonstration of Dul’s (2016) necessary condition analysis . Learn. Individ. Differ. 77 :101815. 10.1016/j.lindif.2019.101815 [ CrossRef ] [ Google Scholar ]
• Ungar M. (2008). Resilience across Cultures . Br. J. Soc. Work. 38 , 218–235. 10.1093/bjsw/bcl343 [ CrossRef ] [ Google Scholar ]
• United Nations Statistics Division (2019). 2018 Demographic Yearbook. United Nations. Available at: https://unstats.un.org/unsd/demographic-social/products/dyb/dybsets/2018.pdf (Accessed January 13, 2021).
• van Agteren J., Iasiello M., Lo L. (2018). Improving the wellbeing and resilience of health services staff via psychological skills training . BMC Res. Notes 11 :924. 10.1186/s13104-018-4034-x, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Vella S. -L., Pai N. B. (2019). A theoretical review of psychological resilience: defining resilience and resilience research over the decades . Arch. Med. Health Sci. 7 :233. 10.4103/amhs.amhs_119_19 [ CrossRef ] [ Google Scholar ]
• Walsh-Dilley M., Wolford W. (2015). (Un)Defining resilience: subjective understandings of ‘resilience’ from the field . Resilience 3 , 173–182. 10.1080/21693293.2015.1072310 [ CrossRef ] [ Google Scholar ]
• Wood S. K., Bhatnagar S. (2015). Resilience to the effects of social stress: evidence from clinical and preclinical studies on the role of coping strategies . Neurobiol. Stress 1 , 164–173. 10.1016/j.ynstr.2014.11.002, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• World Health Organization (2020). Coronavirus disease 2019 (COVID-19) Situation Report (Situation Report No. 62; pp. 1–10). World Health Organization. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200322-sitrep-62-covid-19.pdf?sfvrsn=f7764c46_2 (Accessed May 1, 2020).
• Ye Z. J., Qiu H. Z., Li P. F., Chen P., Liang M. Z., Liu M. L., et al.. (2017). Validation and application of the Chinese version of the 10-item Connor-Davidson resilience scale (CD-RISC-10) among parents of children with cancer diagnosis . Eur. J. Oncol. Nurs. 27 , 36–44. 10.1016/j.ejon.2017.01.004, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Yetter G., Capaccioli K. (2010). Differences in responses to web and paper surveys among school professionals . Behav. Res. Methods 42 , 266–272. 10.3758/BRM.42.1.266, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Zhou X., Snoswell C. L., Harding L. E., Bambling M., Edirippulige S., Bai X., et al.. (2020). The role of Telehealth in reducing the mental health burden from COVID-19 . Telemed, E-Health 26 , 377–379. 10.1089/tmj.2020.0068, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]

Mental Health Equity of Filipino Communities in COVID-19: A Framework for Practice and Advocacy

Volume 11 - Issue 1

Christian D. Chan, Stacey Diane Arañez Litam

The emergence and global spread of COVID-19 precipitated a massive public health crisis combined with multiple incidents of racial discrimination and violence toward Asian American and Pacific Islander (AAPI) communities. Although East Asian communities are more frequently targeted for instances of pandemic-related racial discrimination, multiple disparities converge upon Filipino communities that affect their access to mental health care in light of COVID-19. This article empowers professional counselors to support the Filipino community by addressing three main areas: (a) describing how COVID-19 contributes to racial microaggressions and institutional racism toward Filipino communities; (b) underscoring how COVID-19 exacerbates exposure to stressors and disparities that influence help-seeking behaviors and utilization of counseling among Filipinos; and (c) outlining how professional counselors can promote racial socialization, outreach, and mental health equity with Filipino communities to mitigate the effects of COVID-19.

Keywords : Asian American, Filipino, mental health equity, COVID-19, discrimination

     Asian Americans represent the fastest-growing ethnic group in the United States (Budiman et al., 2019). Following the global outbreak of COVID-19, many Asian Americans and Pacific Islanders (AAPIs) have experienced a substantial increase in race-based hate incidents. These incidents of racial discrimination have included verbal harassment, physical attacks, and discrimination against Asian-owned businesses (Jeung & Nham, 2020), which multiply the harmful effects on psychological well-being and life satisfaction among AAPIs (Litam & Oh, 2020). According to Pew Research Center trends (Ruiz et al., 2020), about three in 10 Asian adults reported they experienced racial discrimination since the outbreak began. Proliferation of anti-Chinese and xenophobic hate speech from political leaders, news outlets, and social media, which touted COVID-19 as the “Chinese virus,” further exacerbate instances of race-based discrimination (U.S. Department of Justice, 2020) and echo the Yellow Peril discourse from the late 19th century (Litam, 2020; Poon, 2020).

Although the community is often aggregated, Asian Americans are not a monolithic entity (Choi et al., 2017; Jones-Smith, 2019; Sue et al., 2019). The term Asian American encompasses over 40 distinct subgroups, each with distinct languages, cultures, beliefs, and migration histories (Pew Research Center, 2013; Sue et al., 2019). It is no surprise, therefore, that specific ethnic subgroups would be more affected by the pandemic than others. For example, instances of COVID-19–related racial discrimination disproportionately affect East Asian communities, specifically Chinese migrants and Chinese Americans. An analysis of nearly 1,500 reports of anti-Asian hate incidents indicated approximately 40% of Chinese individuals reported experiences of discrimination as compared to 16% of Korean individuals and 5.5% of Filipinos (Jeung & Nham, 2020). Although Chinese individuals disproportionately experience overt forms of COVID-19–related discrimination, Filipino migrants and Filipino Americans are not immune to the deleterious effects of the pandemic.

With over 4 million people of Filipino descent residing in the United States (Asian Journal Press, 2018), it is of paramount importance for professional counselors to recognize how the Filipino American experience may compound with additional COVID-19 exposure and related stressors in unique ways that distinctively impact their experiences of stress and mental health. The current article identifies how the racialized climate of COVID-19 influences Filipino-specific microaggressions and the presence of systemic and institutional racism toward Filipino communities. The ways in which COVID-19 exacerbates existing racial disparities across social determinants of health, help-seeking behaviors, and utilization of counseling services are described. Finally, the implications for counseling practice and advocacy are presented in ways that can embolden professional counselors to promote racial socialization, outreach, and health equity with Filipino communities to mitigate the effects of COVID-19.

Health Disparities Among Filipino Americans

The unprecedented emergence of COVID-19 has affected the global community. As of January 5, 2021, a total of 21,382,296 cases were confirmed and 362,972 deaths had been reported in the United States (Worldometer, n.d.). Although information about how racial and ethnic groups are affected by the pandemic is forthcoming, emerging data suggests that specific groups are disproportionately affected. Professional counselors must be prepared to support communities that may be more vulnerable to pandemic-related stress and face challenges related to medical and mental health care access because of intersecting marginalized identities, such as age, race, ethnicity, gender identity, sexual identity, social class, and migration history (Chan & Henesy, 2018; Chan et al., 2019; Litam & Hipolito-Delgado, 2021). For example, the AAPI population may be especially in need of mental health support because of ongoing xenophobic sentiments from political leaders that combine with intergenerational trauma, racial discrimination, and racial trauma (Litam, 2020).

Underutilization of Mental Health Services      Compared to other Asian American subgroups, Filipinos are the least likely to seek professional mental health services. In a study of 2,230 Filipinos, approximately 73% had never used any type of mental health service and only 17% sought help from friends, community members, peers, and religious or spiritual leaders (Gong et al., 2003). Since the Gong et al. (2003) study, a multitude of researchers have documented the persistent disparity of mental health usage and unfavorable attitudes toward professional help-seeking among Filipinos (David & Nadal, 2013; David et al., 2019; Nadal, 2021; Tuazon et al., 2019), despite high rates of psychological distress (Martinez et al., 2020).

     The experiences of Filipino communities uniquely influence aspects of mental health and wellness. Compared to other subgroups of Asian Americans, Filipino Americans with post-traumatic stress experiences tend to exhibit poorer health (Kim et al., 2012; Klest et al., 2013), and report higher rates of racial discrimination (Li, 2014). As a subgroup, Filipino Americans present to mental health counseling settings with high rates of depression, suicide, HIV, unintended pregnancy, eating disorders, and drug use (David et al., 2017; Klest et al., 2013; Nadal, 2000, 2021). Compared to other Asian subgroups, Filipinos may experience lower social class and employment statuses, which may increase the prevalence of mental health issues (Araneta, 1993). Among Filipinos, intergenerational cultural conflicts and experiences of racial discrimination were identified as significant contributors to depression and suicidal ideation (Choi et al., 2020). The underutilization of professional mental health services and help-seeking among Filipino communities is unusual because of their familiarity with Western notions, systems, and institutions, which surface as traits that are typically associated with mental health help-seeking within the broader AAPI community (Abe-Kim et al., 2002, 2004; Shea & Yeh, 2008).

Distinct Experiences of Oppression      Aspects of Filipino history are characterized by colonization, oppression, and intergenerational racial trauma (David & Nadal, 2013) and have been rewritten by White voices in ways that communicate how America saved the Philippines from Spanish rule through colonization (Ocampo, 2016). These sentiments remain deeply entrenched within the mindset of many Filipinos in the form of colonial mentality (David & Nadal, 2013; Tuazon et al., 2019). Colonial mentality refers to the socialized and oppressive mindset characterized by beliefs about the superiority of American values and denigration of Filipino culture and self (David & Okazaki, 2006a, 2006b). Colonial mentality is the insidious aftermath galvanized through years of intergenerational trauma, U.S. occupation, and socialization under White supremacy (David et al., 2017). Professional counselors must recognize the interplay between colonial mentality and the mental health and well-being of Filipino clients to best support this unique population.

The internalized experiences of oppression perpetuate the denigration of Filipinos by Filipinos as a result of the internalized anti-Black sentiments and notions of White supremacy that remain at the forefront of American history (Ocampo, 2016). The Filipino experience is one that is characterized by forms of discrimination by individuals who reside both within and outside of the Filipino community (Nadal, 2021). For example, Filipinos who espouse a colonial mentality disparage those with Indigenous Filipino traits (i.e., dark skin and textured hair) as unattractive, undesirable, and worthy of shame (Angan, 2013; David, 2020; Mendoza, 2014). Filipinos also experience a sense of otherness within the AAPI community and from other communities of color because their history, culture, and phenotype combine in ways that “break the rules of race” (Ocampo, 2016, p. 13). Although Filipinos are sometimes confused with individuals from Chinese communities, they are not typically perceived as Asian or East Asian (Lee, 2020) and are often mistaken for Black or Latinx (Ocampo, 2016; Sanchez & Gaw, 2007). These pervasive experiences render the Filipino identity invisible (Nadal, 2021). Ultimately, Filipinos remain among the most mislabeled and culturally marginalized of Asian Americans (Sanchez & Gaw, 2007). Professional counselors who work with Filipino clients must obtain a deeper understanding of how these unique experiences of invisibility and colonial mentality continue to affect the minds and the worldviews of Filipinos and Filipino Americans.

Risk Factors for COVID-19 Exposure      The burgeoning rate of COVID-19 cases has devastated hospitals and medical settings. The overwhelming strain faced by medical communities uniquely affects Filipino migrants and Filipino Americans who are overrepresented in health care and disproportionately at risk of COVID-19 exposure (National Nurses United, 2020). The overrepresentation of Filipinos in health care, particularly within the nursing profession, is directly tied to the history of U.S. colonization. Following the U.S. occupation of the Philippines from 1899 to 1946, the Filipino zeitgeist became imbued with profound cultural notions of American superiority and affinity for Westernized attitudes, behaviors, and values (David et al., 2017). For example, the introduction of the American nursing curricula by U.S. Army personnel during the Spanish-American war (McFarling, 2020) instilled pervasive cultural influences that positioned the nursing profession as a viable strategy to escape political and economic instability in pursuit of a better life in the United States (Choy, 2003). These cultural notions have culminated to make the Philippines the leading exporter of nurses in the world (Choy, 2003; Espiritu, 2016). Of the immigrant health care workers across the United States, an estimated 28% of registered nurses, 4% of physicians and surgeons, and 12% of home health aides are Filipinos (Batalova, 2020). About 150,000 registered nurses in the United States are Filipino, equating to about 4% of the overall nursing population (McFarling, 2020; National Nurses United, 2020). According to the National Nurses United (2020) report, 31.5% of deaths among registered nurses and 54% of deaths among registered nurses of color were Filipinos. Based on these statistics, Filipinos face disproportionate exposure to pandemic-related stressors and death that may increase the risk for mental health issues.

Individuals of Filipino descent may also face significant COVID-19–related challenges, as they are predisposed to several health conditions that have been linked with poorer treatment prognosis and outcomes (Ghimire et al., 2018; Maxwell et al., 2012). Compared to other racial and ethnic subgroups, Filipinos residing in California had higher rates of type II diabetes, asthma, and cardiovascular disease (Adia et al., 2020). High rates of hypertension, cholesterol, and diabetes were also noted in studies of Filipino Americans residing in the greater Philadelphia region (Bhimla et al., 2017) and in Las Vegas, Nevada (Ghimire et al., 2018). One study of Filipinos residing in the New York metropolitan area indicated rates of obesity significantly increased the longer Filipino immigrants resided in the United States (Afable et al., 2016). The Centers for Disease Control and Prevention (2021) associated each of these underlying medical conditions with a greater likelihood for hospitalization, intensive care, use of a ventilator, and increased mortality. Filipino Americans also tend to report lower social class and employment statuses as compared to other Asian Americans, which may contribute to higher rates of mental health issues and create barriers to health care access (Adia et al., 2020; Sue et al., 2019).

Cultural Barriers to Professional Mental Health Services      Filipinos face culturally rooted barriers to seeking professional mental health services that may include fears related to reputation, endorsement of fatalistic attitudes, religiousness, communication barriers, and lack of culturally competent services (Gong et al., 2003; Nadal, 2021; Pacquiao, 2004). The presence of mental illness stigma is also deeply entrenched within Filipino communities (Appel et al., 2011; Augsberger et al., 2015; Tuazon et al., 2019). In many traditional Filipino families, mental illness is mitigated by addressing personal and emotional problems with family and close friends, and through faith in God (David & Nadal, 2013). Rejection of mental illness is based on the belief that individuals who receive counseling or therapy are crazy, dangerous, and unpredictable (de Torres, 2002; Nadal, 2021).

Connection and Kinship      Given the central prominence of family, it is no surprise that Filipino individuals’ mental health begins to suffer when their connection to community and kinship is compromised. Although relatively few studies on Filipino mental health exist, Filipinos and Filipino Americans consistently report family-related issues as among the most stressful. In one study of Filipino and Korean families in the Midwest ( N = 1,574), the presence of intergenerational family conflict significantly contributed to an increase in depressive symptoms and suicidal ideation (Choi et al., 2020). In another study of Filipino Americans, quality time with family, friends, and community was identified as an important factor in mitigating the effects of depression (Edman & Johnson, 1999). The centralized role of Filipino families uniquely combines with a group mentality in ways that may additionally hinder rates of professional help-seeking.

Hiya and Amor Propio      Notions of hiya and amor propio each represent culturally specific barriers to seeking mental health care. According to Gong and colleagues (2003), hiya and amor propio are related to the East Asian notions of saving face. While hiya emphasizes the more extensive experience of shame that arises from fear of losing face, amor propio is associated with concepts of self-esteem linked to the desire to maintain social acceptance. A loss of amor propio would result in a loss of face and may compromise the cherished position of community acceptance (Gong et al., 2003). Filipino Americans may thus avoid seeking professional mental health services because of combined feelings of shame ( hiya ) linked to beliefs that one has failed or is unable to overcome their problems independently, and fears of losing social positioning within one’s community ( amor propio ). To experience amor propio would put a Filipino—or worse, their family—at risk for tsismis , or gossip. Indeed, avoiding behaviors that may lead others within the Filipino community to engage in tsismis about the client or their family is a significant factor that guides choices and behaviors. Engaging in behaviors that result in one’s family becoming the focus of tsismis is considered highly shameful and reprehensible among Filipino communities.

Bahala Na      The Tagalog term bahala na refers to the sense of optimistic fatalism that characterizes the shared experiences of many Filipinos and Filipino Americans. Bahala na can be evidenced through Filipino cultural expectations to endure emotional problems and avoid discussion of personal issues. This core attitude may have deleterious effects on mental health and help-seeking, as many Filipinos are socialized to deny or minimize stressful experiences or to simply endure emotional problems (Araneta, 1993; Sanchez & Gaw, 2007). A qualitative analysis of 33 interviews and 18 focus groups of Filipino Americans indicated bahala na may combine with religious beliefs to create additional barriers to addressing mental health problems (Javier et al., 2014). For example, virtuous and religious Filipinos and Filipino Americans may endorse bahala na attitudes by believing their higher power has instilled purposeful challenges that can be overcome by sufficient faith and endurance (Javier et al., 2014).

Hindi Ibang Tao      Moreover, many Filipinos and Filipino Americans demonstrate hesitance to trust individuals who are considered outsiders. When interactions with those considered other cannot be avoided, traditional Filipinos tend to be reticent, conceal their real emotions, and avoid disclosure of personal thoughts, needs, and beliefs (Pasco et al., 2004). Filipino community members place a large value on in-group versus out-group members and largely prefer to seek support from helping professionals within the Filipino community, rather than from others outside of the group (Gong et al., 2003). Individuals who are hindi ibang tao (in Tagalog, “one of us”) are differentiated from those who are ibang tao (in Tagalog, “not one of us”), which influences interactions and amount of trust given to health care providers (Sanchez & Gaw, 2007). White counselors may be able to bridge the cultural gap with Filipino clients to become hindi ibang tao by exhibiting respect, approachability, and a willingness to consider the specific influences of Filipino history and the importance of family (Sanchez & Gaw, 2007). Professional counselors who overlook, minimize, or disregard these cultural values risk higher rates of early termination and may experience their Filipino clients as exhibiting little emotion (Nadal, 2021). Filipino clients who are not yet comfortable with professional counselors may interact in a polite, yet superficial manner because culturally responsive relationships and trust have not been developed (Gong et al., 2003; Pasco et al., 2004; Tuazon et al., 2019).

Pakikisama and Kapwa      Another Filipino cultural barrier is pakikisama , or the notion that when one belongs to a group, one should be wholly dedicated to pleasing the group (Bautista, 1999; Nadal, 2021). Filipino core values extend beyond the general notion of collectivism and include kapwa, an Indigenous worldview in which the self is not distinguished from others (David et al., 2017; Enriquez, 2010). Thus, Filipinos do not solely act in ways that benefit the group; they are also expected to make decisions that please other group members, even at the expense of their own desires, needs, or mental health (Nadal, 2021). The cultural notions of pakikisama and kapwa interplay with amor propio in ways that have detrimental effects on Filipinos in dire need of mental health support. For example, a second-generation Filipino American may recognize that their suicidal thoughts and experiences of depression may be worthy of mental health support, but recognition of cultural mistrust toward those deemed other may risk their family’s social acceptance ( amor propio ). Risking the family’s social acceptance could ultimately violate group wishes ( pakikisama ) and may subject their family to stigma and gossip ( tsismis ).

Implications for Practice and Advocacy in Professional Counseling

The COVID-19 pandemic and increased visibility to discrimination against Asian Americans illuminates the importance of addressing the presence of mental health barriers among Filipino communities. Filipino communities face complex barriers rooted in colonialism, racism, and colorism that negatively affect their overall mental health (David & Nadal, 2013; Tuazon et al., 2019; Woo et al., 2020). The combination of educational, health, and welfare disparities culminate in poorer health outcomes for Filipino American communities compared to other ethnic Asian groups (Adia et al., 2020). Many of these identifiable barriers and forces of oppression increase the racial trauma narratives incurred among Filipino communities (David et al., 2017; Klest et al., 2013); deny the impact of microaggressions and discrimination (Nadal et al., 2014); divest resources that support economic, educational, and social well-being (Nadal, 2021; Smith & Weinstock, 2019); and discourage the utilization of needed counseling spaces (Tuazon et al., 2019).

Cultivating cultural sensitivity in health care providers can buffer the psychological toll and emotional consequences of negative health care encounters for historically marginalized communities (Flynn et al., 2020), including Filipinos. Findings associated with health equity and help-seeking behaviors (e.g., Flynn et al., 2020; Ghimire et al., 2018) have significant ramifications for Filipino communities that face a litany of barriers to counseling services (Gong et al., 2003; Tuazon et al., 2019). In light of COVID-19, professional counselors are encouraged to employ culturally responsive interpersonal and systemic interventions that promote the sustainable mental health equity of Filipino communities.

Promoting Racial Socialization and Critical Consciousness       Reducing barriers for mental health access is connected to protective factors, actions, and cultural capital instilled across generations of Filipino communities (David et al., 2017). Filipino communities draw from several generations of colonization, which continues to affect second-generation Filipinos living in the United States (David & Okazaki, 2006a, 2006b). Experiences of historical colonization, forced assimilation into other cultures, and the erasure of Filipino cultural values have resulted in a range of Eurocentrically biased and historically oppressive experiences (Choi et al., 2020; David & Nadal, 2013). These experiences have prepared Filipino communities, intergenerationally and collectively, to respond to experiences of discrimination in ways that preserve their cultural values (David et al., 2017). The preservation of Filipino cultural values across generations has bolstered a type of protective factor through racial socialization, where parents and families teach future generations of children about race and racism (Juang et al., 2017). Ultimately, preparing future generations of Filipinos to respond to racial oppression can protect cultural assets (David et al., 2017). In fact, a study by Woo and colleagues (2020) indicated Filipino parents who prepared their children to respond to racial discrimination prepared them for bias and strengthened their ethnic identity.

One strategy that professional counselors can use to infuse social justice in their work is to help Filipino clients raise their critical consciousness. Critical consciousness is an approach that helps clients to recognize the systemic factors contributing to their barriers with mental health utilization and mental health stressors (David et al., 2019; Diemer et al., 2016; Ratts & Greenleaf, 2018; Seider et al., 2020) and to feel empowered to take part in action (Ratts et al., 2016; Watts & Hipolito-Delgado, 2015). Professional counselors can raise Filipino clients’ critical consciousness by engaging in conversations about how the history of colonization, endorsement of colonial mentality, and systemic factors continue to marginalize Filipinos (David et al., 2019). Connecting critical consciousness to COVID-19, professional counselors can highlight how public anti-Asian discourse echoes centuries of oppression and leads to cultural mistrust of health care providers, particularly professional counselors (Litam, 2020; Ratts & Greenleaf, 2018; Tuazon et al., 2019). Similarly, professional counselors can raise the critical consciousness of Filipino clients by discussing the effects of race-based trauma and racial violence as a result of COVID-19 (Litam, 2020; Nadal, 2021). Including these topics during counseling can be instrumental for detecting the effects of race-based trauma, such as somatic symptoms, while grasping the manifestation of pandemic stress (Taylor et al., 2020). As health care providers focus predominantly on wellness, professional counselors play a significant part in deconstructing the connections and nuances among race-based traumatic stress and pandemic stress (Ratts & Greenleaf, 2018).

Additionally, professional counselors can raise the critical consciousness of Filipino clients by examining the intersection of underlying health disparities, Filipino core values, and overrepresentation of Filipinos working in health care positions during COVID-19 through a trauma-informed lens. Aligned with this perspective, professional counselors can identify and discuss how intergenerational trauma narratives may have persisted across generations of Filipino communities (David & Okazaki, 2006b; David et al., 2019; Nadal, 2021; Tuazon et al., 2019) in ways that have adverse effects on mental health. For example, professional counselors may support Filipino clients to critically reflect on how socialized messages from parents and elders with intergenerational trauma may have contributed to the internalization of colonial mentality. Professional counselors may also broach these cultural factors by promoting discussions within clients’ families and communities about the cultural preservation of Filipino identities (Choi et al., 2017, 2020; David et al., 2017).

Culturally Congruent Coping Responses Among Filipino Clients      Professional counselors can help Filipino clients who seek counseling during COVID-19 by empowering them to engage in coping responses that cultivate their cultural assets and strengthen their ethnic identity (David et al., 2017, 2019; Woo et al., 2020). Before implementing these culturally sensitive strategies, professional counselors must reflect on whether they hold individualistic notions and Western attitudes about which coping responses are deemed helpful or unhelpful to mitigate the effects of racial discrimination (Oh et al., in press; Sue et al., 2019). Following experiences of racial discrimination and stress, Filipinos tend to use disengagement coping responses (Centeno & Fernandez, 2020; Tuason et al., 2007). Following an assessment of coping responses, professional counselors can support Filipino clients by reinforcing culturally responsive disengagement coping strategies, such as tiyaga (Tagalog for “patience and endurance”) and lakas ng loob (Tagalog for “inner strength and hardiness”), to promote resilience and demonstrate flexibility.

Given these central cultural values, professional counselors must be cautioned from solely using emotion-centered counseling strategies that center experiences of stress, racial trauma, or COVID-19–related discrimination (Litam, 2020). Instead, Filipino clients may benefit from interventions that draw from their cultural values of endurance ( tiyaga ) and inner strength ( lakas ng loob ) to refocus energy toward cultivating meaningful relationships and roles (David & Nadal, 2013; David et al., 2017). For example, Filipino clients who are concerned about the wellness of their community may experience a heightened sense of purpose and inner strength by reflecting on how their actions have already benefitted their families rather than focusing on their fears. Indeed, when stressful experiences occur, Filipinos have a long history of demonstrating resilience. Empowering Filipino clients to reflect on the historical ways that the Filipino community has evidenced resilience and inner strength may cultivate a strong sense of Filipino pride and strengthen ethnic identity as protective factors to mental health distress (Choi et al., 2020; David et al., 2019; Tuazon et al., 2019).

Filipinos may also benefit from engagement coping strategies, such as prayer, employing religious and spiritual resources, and responding with humor, to promote health and wellness (Nadal, 2021; Sanchez & Gaw, 2007). Counselors can help Filipino clients leverage engagement coping strategies by reflecting on existing responses to stress. Counselors may ask, “How have you intentionally responded to stressful events in the past?” and “How did these ways of coping impact your levels of stress?” Counselors can also demonstrate culturally sensitive strategies and lines of questioning that move from general, shared Filipino values to specific client experiences. For example, counselors can state: “Many Filipinos find peace of mind through prayer, religious practices, and humor. I’m wondering if this is true for you?” Because of the community orientation and collectivism embedded within Filipino culture, it may be helpful for counselors to elaborate on cultural contexts and relationships that inform coping strategies: “I am wondering how you may have seen some of these coping strategies in your home, family, or community. How might you have experienced a coping strategy like humor within your own community?” This statement communicates a familiarity with Filipino cultural values and creates an invitation for clients to explore their coping resources.  

Creating Outreach Initiatives and Partnerships      For counselors placed in school and community settings, challenging the systemic effects of COVID-19 among Filipino communities necessitates community partnerships and integrated care settings to achieve health equity (Adia et al., 2019). Health equity initiatives call for two types of overarching efforts to sustain long-term benefits and changes. One aspect of health equity relates to developing community partnerships as a method to intentionally increase health literacy within the community (Guo et al., 2018). Increasing mental health literacy, including education about counseling services and a comprehensive approach to wellness, operates as a direct intervention to cultural and linguistic barriers that precede negative health care experiences (Flynn et al., 2020). Increasing mental health literacy in Filipino communities may also normalize the process of professional mental health services, challenge the cultural notion that those who seek mental health care are crazy , and offer strength-based language related to counseling services (Ghimire et al., 2018; Maxwell et al., 2012; Nadal, 2021). Expanding on recommendations by Tuazon and colleagues (2019), professional counselors can challenge the systemic effects of COVID-19 in Filipino communities by helping community stakeholders understand culturally responsive practices for seeking professional mental health services. Professional counselors employed in community settings can leverage opportunities to liaise with Filipino community organizations and leaders to increase the utilization of counseling services as a preventive method (Graham et al., 2018; Maxwell et al., 2012), especially in response to the increased mental health issues in Filipinos following COVID-19. Professional counselors employed in community settings are therefore uniquely positioned to broach cultural factors of colonialism and systemic racism while addressing the urgency of mental health services for Filipino communities during COVID-19 (Day-Vines et al., 2018, 2020).

Increasing Visibility of Filipino Counselors      The second aspect of health equity initiatives focuses on increasing representation in the pipeline of providers. Although Flynn and colleagues (2020) documented the importance of culturally responsive practices to buffer negative health care experiences, public health scholars have generally identified that the representation of professional counselors is crucial for encouraging historically marginalized communities to seek services (Campbell, 2019; Graham et al., 2018; Griffith, 2018). According to Campbell (2019), historically marginalized clients are more likely to pursue services and demonstrate an openness to speak with professional counselors who are representative of their communities. In addition to increasing Filipino counselors and counselor educators in the pipeline (Tuazon et al., 2019), professional counselors can enact community-based initiatives that position Filipino leaders to support the larger Filipino community (Guo et al., 2018; Maxwell et al., 2012; Nadal, 2021). For example, professional counselors can train Filipino leaders and community members to share information about coping responses (e.g., mindfulness, yoga, and diaphragmatic breathing) that mitigate the deleterious effects of racism, colonialism, and COVID-19–related stress. Professional counselors can also work with community members to establish Filipino-led wellness groups that frame discussions about stress within the broader context of health and wellness. Assessing for previous assumptions about mental health literacy may be helpful to normalize group discussions about stress and mental health. As outreach initiatives and community partnerships are established within the context of COVID-19, professional counselors must consider how they develop marketing materials for counseling services that appropriately reflect the cultural and linguistic diversity of Filipinos and invite input from Filipino community leaders (Campbell, 2019; Graham et al., 2018).

The cumulative effects of colonialism and racism continue to influence the mental health and visibility of Filipino communities within the global crisis of COVID-19. Unlike other AAPI subgroups, experiences of pandemic-related distress in Filipinos are additionally compounded by their distinct history of colonization, cultural values, and low levels of help-seeking behaviors. Specific interventions for culturally responsive counseling and outreach for Filipino communities are critical (Choi et al., 2017; David & Nadal, 2013; David et al., 2017; Tuazon et al., 2019) and were outlined in this article. Professional counselors, especially those in community settings, have numerous opportunities to enact a systematic plan of action that integrates culture, health, and policy (Chan & Henesy, 2018; Nadal, 2021). These interventions illuminate a longstanding and never more urgent call to action for extending efforts and initiatives to increase the visibility of Filipino communities and support individuals of Filipino descent in counseling.

Conflict of Interest and Funding Disclosure The authors reported no conflict of interest or funding contributions for the development of this manuscript.

Abe-Kim, J., Gong, F., & Takeuchi, D. (2004). Religiosity, spirituality, and help-seeking among Filipino Americans: Religious clergy or mental health professionals? Journal of Community Psychology , 32 (6), 675–689. https://doi.org/10.1002/jcop.20026

Abe-Kim, J., Takeuchi, D. T., & Hwang, W.-C. (2002). Predictors of help seeking for emotional distress among Chinese Americans: Family matters. Journal of Consulting and Clinical Psychology , 70 (5), 1186–1190. https://doi.org/10.1037/0022-006X.70.5.1186

Adia, A. C., Nazareno, J., Operario, D., & Ponce, N. A. (2020). Health conditions, outcomes, and service access among Filipino, Vietnamese, Chinese, Japanese, and Korean adults in California, 2011–2017. American Journal of Public Health , 110 (4), 520–526. https://doi.org/10.2105/AJPH.2019.305523

Adia, A. C., Ng, M. J., Quilantang, M. I., Restar, A. J., Hernandez, L. I., Imperial, R. H., Nazareno, J., & Operario, D. (2019). Collective coping strategies for HIV-related challenges among men who have sex with men in Manila, Philippines. AIDS Education and Prevention , 31 (5), 479–490. https://doi.org/10.1521/aeap.2019.31.5.479

Afable, A., Ursua, R., Wyatt, L. C., Aguilar, D., Kwon, S. C., Islam, N. S., & Trinh-Shevrin, C. (2016). Duration of US residence is associated with overweight risk in Filipino immigrants living in New York metro area. Family and Community Health , 39 (1), 13–23. https://doi.org/10.1097/FCH.0000000000000086

Angan, J. (2013). Beyond the beach: The untold story of Boracay’s Ati tribe . GMA News Online. https://www.gmanet work.com/news/lifestyle/artandculture/313920/beyond-the-beach-the-untold-story-of-boracay-s-ati-tribe/story

Appel, H. B., Huang, B., Ai, A. L., & Lin, C. J. (2011). Physical, behavioral, and mental health issues in Asian American women: Results from the National Latino Asian American Study. Journal of Women’s Health , 20 (11), 1703–1711. https://doi.org/10.1089/jwh.2010.2726

Araneta, E. G. (1993). Psychiatric care of Filipino Americans. In A. C. Gaw (Ed.), Culture, Ethnicity, and Mental Illness (pp. 377–411). American Psychiatric Association.

Asian Journal Press. (2018). New census data shows more than four million Filipinos in the US. https://www.asian journal.com/usa/dateline-usa/new-census-data-shows-more-than-four-million-filipinos-in-the-us

Augsberger, A., Yeung, A., Dougher, M., & Hahn, H. C. (2015). Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide. BMC Health Services Research , 15 (1), 1–11. https://doi.org/10.1186/s12913-015-1191-7

Batalova, J. (2020). Immigrant health-care workers in the United States . Migration Policy Institute. https://www.migrationpolicy.org/article/immigrant-health-care-workers-united-states-2018

Bautista, V. (1999). The Filipino Americans: From 1763 to the present: Their history, culture, and traditions . Bookhaus.

Bhimla, A., Yap, L., Lee, M., Seals, B., Aczon, H., & Ma, G. X. (2017). Addressing the health needs of high-risk Filipino Americans in the greater Philadelphia region. Journal of Community Health , 42 (2), 269–277. https://doi.org/10.1007/s10900-016-0252-0

Budiman, A., Cilluffo, A., & Ruiz, N. G. (2019). Key facts about Asian origin groups in the U.S. Pew Research Center. https://www.pewresearch.org/fact-tank/2019/05/22/key-facts-about-asian-origin-groups-in-the-u-s

Campbell, K. M. (2019). Race, gender, and health equity. Journal of Best Practices in Health Professions Diversity , 11 (2), 155–157.

Centeno, R. P. R., & Fernandez, K. T. G. (2020). Effect of mindfulness on empathy and self-compassion: An adapted MBCT program on Filipino college students. Behavioral Sciences , 10 (3), 1–15. https://doi.org/10.3390/bs10030061

Centers for Disease Control and Prevention. (2021). People with certain medical conditions . Retrieved March 14, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fgroups-at-higher-risk.html

Chan, C. D., & Henesy, R. K. (2018). Navigating intersectional approaches, methods, and interdisciplinarity to health equity in LGBTQ+ communities. Journal of LGBT Issues in Counseling , 12 (4), 230–247. https://doi.org/10.1080/15538605.2018.1526157

Chan, C. D., Henesy, R. K., & Erby, A. N. (2019). Toward praxis, promise, and futures of intersectionality in multimethod counseling research. Counseling Outcome Research and Evaluation , 10 (1), 12–18. https://doi.org/10.1080/21501378.2018.1562845

Choi, Y., Park, M., Lee, J. P., Kim, T. Y., & Tan, K. (2017). Culture and family process: Examination of culture-specific family process via development of new parenting measures among Filipino and Korean American families with adolescents. In Y. Choi & H. C. Hahm (Eds.), Asian American parenting: Family process and intervention (pp. 37–68). Springer. https://doi.org/10.1007/978-3-319-63136-3_3

Choi, Y., Park, M., Noh, S., Lee, J. P., & Takeuchi, D. (2020). Asian American mental health: Longitudinal trend and explanatory factors among young Filipino- and Korean Americans. SSM – Population Health , 10 , 1–10. https://doi.org/10.1016/j.ssmph.2020.100542

Choy, C. C. (2003). Empire of care: Nursing and migration in Filipino American history. Duke University Press.

David, E. J. R. (2020). Addressing anti-Black microaggressions in Filipino families. Psychology Today. https://www.psychologytoday.com/us/blog/unseen-and-unheard/202006/addressing-anti-black-microaggressions-in-filipino-families-0

David, E. J. R., & Nadal, K. L. (2013). The colonial context of Filipino American immigrants’ psychological experiences. Cultural Diversity and Ethnic Minority Psychology , 19 (3), 298–309. https://doi.org/10.1037/a0032903

David, E. J. R., & Okazaki, S. (2006a). Colonial mentality: A review and recommendation for Filipino American psychology. Cultural Diversity and Ethnic Minority Psychology , 12 (1), 1–16. https://doi.org/10.1037/1099-9809.12.1.1

David, E. J. R., & Okazaki, S. (2006b). The Colonial Mentality Scale (CMS) for Filipino Americans: Scale construction and psychological implications. Journal of Counseling Psychology , 53 (2), 241–252. https://doi.org/10.1037/0022-0167.53.2.241

David, E. J. R., Sharma, D. K. B., & Petalio, J. (2017). Losing kapwa: Colonial legacies and the Filipino American family. Asian American Journal of Psychology , 8 (1), 43–55. https://doi.org/10.1037/aap0000068

David, E. J. R., Schroeder, T. M., & Fernandez, J. (2019). Internalized racism: A systematic review of the psychological literature on racism’s most insidious consequence. Journal of Social Issues , 75 (4), 1057–1086. https://doi.org/10.1111/josi.12350

Day-Vines, N. L., Booker Ammah, B., Steen, S., & Arnold, K. M. (2018). Getting comfortable with discomfort: Preparing counselor trainees to broach racial, ethnic, and cultural factors with clients during counseling. International Journal for the Advancement of Counselling , 40 (2), 89–104. https://doi.org/10.1007/s10447-017-9308-9

Day-Vines, N. L., Cluxton-Keller, F., Agorsor, C., Gubara, S., & Otabil, N. A. A. (2020). The multidimensional model of broaching behavior. Journal of Counseling & Development , 98 (1), 107–118. https://doi.org/10.1002/jcad.12304

de Torres, S. (2002). Understanding persons of Philippine origin: A primer for rehabilitation service providers . Center for Institutional Rehabilitation Research Information and Exchange. http://cirrie-sphhp.webapps.buffalo.edu/culture/monographs/philippines.php

Diemer, M. A., Rapa, L. J., Voight, A. M., & McWhirter, E. H. (2016). Critical consciousness: A developmental approach to addressing marginalization and oppression. Child Development Perspectives , 10 (4), 216–221. https://doi.org/10.1111/cdep.12193

Edman, J. L., & Johnson, R. C. (1999). Filipino American and Caucasian American beliefs about the causes and treatment of mental problems. Cultural Diversity and Ethnic Minority Psychology , 5 (4), 380–386. https://doi.org/10.1037/1099-9809.5.4.380

Enriquez, V. G. (2010). From colonial to liberation psychology: The Philippine experience (2nd ed.). University of the Philippines Press.

Espiritu, Y. L. (2016). Gender, migration, and work: Filipina health care professionals to the United States. In M. Zhou & A. C. Ocampo (Eds.), Contemporary Asian America: A multidisciplinary reader (3rd ed., pp. 236–256). New York University Press.

Flynn, P. M., Betancourt, H., Emerson, N. D., Nunez, E. I., & Nance, C. M. (2020). Health professional cultural competence reduces the psychological and behavioral impact of negative healthcare encounters. Cultural Diversity and Ethnic Minority Psychology , 26 (3), 271–279. https://doi.org/10.1037/cdp0000295

Ghimire, S., Cheong, P., Sagadraca, L., Chien, L.-C., & Sy, F. S. (2018). A health needs assessment of the Filipino American community in the greater Las Vegas area. Health Equity , 2 (1), 334–348. https://doi.org/10.1089/heq.2018.0042

Gong, F., Gage, S.-J. L., & Tacata, L. A., Jr. (2003). Helpseeking behavior among Filipino Americans: A cultural analysis of face and language. Journal of Community Psychology , 31 (5), 469–488. https://doi.org/10.1002/jcop.10063

Graham, L. F., Scott, L., Lopeyok, E., Douglas, H., Gubrium, A., & Buchanan, D. (2018). Outreach strategies to recruit low-income African American men to participate in health promotion programs and research: Lessons from the Men of Color Health Awareness (MOCHA) project. American Journal of Men’s Health , 12 (5), 1307–1316. https://doi.org/10.1177/1557988318768602

Griffith, D. M. (2018). “Centering the margins”: Moving equity to the center of men’s health research. American Journal of Men’s Health , 12 (5), 1317–1327. https://doi.org/10.1177/1557988318773973

Guo, M., Quensell, M., Chang, A., Miyamura, J., & Sentell, T. (2018). Understanding of key obstetric quality terminology by Asian and Pacific Islander subgroups: Implications for patient engagement and health equity. Maternal and Child Health Journal , 22 (11), 1543–1549. https://doi.org/10.1007/s10995-018-2597-8

Javier, J. R., Supan, J., Lansang, A., Beyer, W., Kubicek, K., & Palinkas, L. A. (2014). Preventing Filipino mental health disparities: Perspectives from adolescents, caregivers, providers, and advocates. Asian American Journal of Psychology , 5 (4), 316–324. https://doi.org/10.1037/a0036479

Jeung, R., & Nham, K. (2020). Incidents of Coronavirus-related discrimination. Asian Pacific Policy & Planning Council. http://www.asianpacificpolicyandplanningcouncil.org/wp-content/uploads/STOP_AAPI_HATE_MONTHLY_REPORT_4_23_20.pdf

Jones-Smith, E. (2019). Culturally diverse counseling: Theory and practice . SAGE.

Juang, L. P., Yoo, H. C., & Atkin, A. (2017). A critical race perspective on an empirical review of Asian American parental racial-ethnic socialization. In Y. Choi & H. C. Hahm (Eds.), Asian American parenting: Family process and intervention (pp. 11–35). Springer. https://doi.org/10.1007/978-3-319-63136-3_2

Kim, G., Chiriboga, D. A., Bryant, A., Huang, C.-H., Crowther, M., & Ma, G. X. (2012). Self-rated mental health among Asian American adults: Association with psychiatric disorders. Asian American Journal of Psychology , 3 (1), 44–52. https://doi.org/10.1037/a0024318BB

Klest, B., Freyd, J. J., Hampson, S. E., & Dubanoski, J. P. (2013). Trauma, socioeconomic resources, and self-rated health in an ethnically diverse adult cohort. Ethnicity & Health , 18 (1), 97–113. https://doi.org/10.1080/13557858.2012.700916

Li, M. (2014). Discrimination and psychiatric disorder among Asian American immigrants: A national analysis by subgroups. Journal of Immigrant and Minority Health , 16 , 1157–1166. https://doi.org/10.1007/s10903-013-9920-7

Litam, S. D. A. (2020). “Take your Kung-Flu back to Wuhan”: Counseling Asians, Asian Americans, and Pacific Islanders with race-based trauma related to COVID-19. The Professional Counselor , 10 (2), 144–156. https://doi.org/10.15241/sdal.10.2.144

Litam, S. D. A., & Hipolito-Delgado, C. P. (2021). When being “essential” illuminates disparities: Counseling clients affected by COVID-19. Journal of Counseling & Development , 99 (1), 3–10. https://doi.org/10.1002/jcad.12349

Litam, S. D. A., & Oh, S. (2020). Ethnic identity and coping strategies as moderators of COVID-19 racial discrimination experiences among Chinese Americans. Counseling Outcome Research and Evaluation. Online publication. https://doi.org/10.1080/21501378.2020.1814138

Martinez, A. B., Co, M., Lau, J., & Brown, J. S. L. (2020). Filipino help-seeking for mental health problems and associated barriers and facilitators: A systematic review. Social Psychiatry and Psychiatric Epidemiology , 55 , 1397–1413.  https://doi.org/10.1007/s00127-020-01937-2

Maxwell, A. E., Danao, L. L., Cayetano, R. T., Crespi, C. M., & Bastani, R. (2012). Evaluating the training of Filipino American community health advisors to disseminate colorectal cancer screening. Journal of Community Health , 37 (6), 1218–1225. https://doi.org/10.1007/s10900-012-9557-9

McFarling, U. L. (2020). Nursing ranks are filled with Filipino Americans. The pandemic is taking an outsized toll on them . Stat. https://www.statnews.com/2020/04/28/coronavirus-taking-outsized-toll-on-filipino-american-nurses

Mendoza, R. L. (2014). The skin whitening industry in the Philippines. Journal of Public Health Policy , 35 (2), 219–238. https://doi.org/10.1057/jphp.2013.50

Nadal, K. L. (2000). F/Pilipino American substance abuse: Sociocultural factors and methods of treatment. Journal of Alcohol and Drug Education , 46 (2), 26–36.

Nadal, K. L. (2021). Filipino American psychology: A handbook of theory, research, and clinical practice (2nd ed.). Wiley.                          https://doi.org/10.1002/9781119677109

Nadal, K. L., Griffin, K. E., Wong, Y., Hamit, S., & Rasmus, M. (2014). The impact of racial microaggressions on mental health: Counseling implications for clients of color. Journal of Counseling & Development , 92 (1), 57–66. https://doi.org/10.1002/j.1556-6676.2014.00130.x

National Nurses United. (2020). Sins of omission: How government failures to track COVID-19 data have led to more than 1,700 health care worker deaths and jeopardize public health. https://www.nationalnursesunited.org/sites/default/files/nnu/graphics/documents/0920_Covid19_SinsOfOmission_Data_Report.pdf

Ocampo, A. C. (2016). The Latinos of Asia: How Filipino Americans break the rules of race . Stanford University Press.

Oh, S., Litam, S. D. A., & Chang, C. (in press). COVID-19 fueled subtle and blatant racism and stress-related growth among international Asians in the United States: The roles of ethnic identity, resiliency, and coping. Asian American Journal of Psychology .

Pacquiao, D. (2004). Overcoming stigma and mental illness among Filipinos. Presentation at the National Conference of the New York Coalition for Asian Mental Health. New York Academic of Medicine, New York.

Pasco, A. C. Y., Morse, J. M., & Olson, J. K. (2004). Cross-cultural relationships between nurses and Filipino Canadian patients. Journal of Nursing Scholarship , 36 (3), 239–246. https://doi.org/10.1111/j.1547-5069.2004.04044.x

Pew Research Center. (2013). The rise of Asian Americans . https://www.pewsocialtrends.org/2012/06/19/the-rise-of-asian-americans

Poon, L. (2020, April 7). What bigotry looks like during social distancing . Citylab. https://www.citylab.com/equity/ 2020/04/coronavirus-racism-hate-crimes-asian-americans-xenophobia/609517

Ratts, M. J., & Greenleaf, A. T. (2018). Counselor–advocate–scholar model: Changing the dominant discourse in counseling. Journal of Multicultural Counseling and Development , 46 (2), 78–96. https://doi.org/10.1002/jmcd.12094

Ratts, M. J., Singh, A. A., Nassar-McMillan, S., Butler, S. K., & McCullough, J. R. (2016). Multicultural and social justice counseling competencies: Guidelines for the counseling profession. Journal of Multicultural Counseling and Development , 44 (1), 28–48. https://doi.org/10.1002/jmcd.12035

Ruiz, N. G., Horowitz, J. M., & Tamir, C. (2020). Many Black and Asian Americans say they have experienced discrimination amid the COVID-19 outbreak . Pew Research Center. https://www.pewsocialtrends.org/2020/07/01/many-black-and-asian-americans-say-they-have-experienced-discrimination-amid-the-covid-19-outbreak

Sanchez, F., & Gaw, A. (2007). Mental health care of Filipino Americans. Psychiatric Services , 58 (6), 810–815. https://doi.org/10.1176/ps.2007.58.6.810

Seider, S., Clark, S., & Graves, D. (2020). The development of critical consciousness and its relation to academic achievement in adolescents of color.  Child Development ,  91 (2), e451–e474. https://doi.org/10.1111/cdev.13262

Shea, M., & Yeh, C. (2008). Asian American students’ cultural values, stigma, and relational self-construal: Correlates of attitudes toward professional help-seeking. Journal of Mental Health Counseling , 30 (2), 157–172. https://doi.org/10.17744/mehc.30.2.g662g5l2r1352198

Smith, M. J., & Weinstock, D. (2019). Reducing health inequities through intersectoral action: Balancing equity in health with equity for other social goods. International Journal of Health Policy and Management , 8 (1), 1–3. https://doi.org/10.15171/IJHPM.2018.103

Sue, D. W., Sue, D., Neville, H. A., & Smith, L. (2019). Counseling the culturally diverse: Theory and practice (8th ed.). Wiley.

Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T. A., McKay, D., & Asmundson, G. J. G. (2020). Development and initial validation of the COVID Stress Scales. Journal of Anxiety Disorders , 72 (2020), 1–7. https://doi.org/10.1016/j.janxdis.2020.102232

Tuason, M. T. G., Taylor, A. R., Rollings, L., Harris, T., & Martin, C. (2007). On both sides of the hyphen: Exploring the Filipino-American identity. Journal of Counseling Psychology , 54 (4), 362–372. https://doi.org/10.1037/0022-0167.54.4.362

Tuazon, V. E., Gonzalez, E., Gutierrez, D., & Nelson, L. (2019). Colonial mentality and mental health help-seeking of Filipino Americans. Journal of Counseling & Development , 97 (4), 352–363. https://doi.org/10.1002/jcad.12284

U.S. Department of Justice. (2020). Coronavirus is no excuse for hate: Remembering Vincent Chin . Department of Justice, U.S. Attorneys’ Office, District of Idaho. https://www.justice.gov/usao-id/pr/coronavirus-no-excuse-hate

Watts, R. J., & Hipolito-Delgado, C. P. (2015). Thinking ourselves to liberation? Advancing sociopolitical action in critical consciousness. The Urban Review , 47 (5), 847–867. https://doi.org/10.1007/s11256-015-0341-x

Woo, B., Maglalang, D. D., Ko, S., Park, M., Choi, Y., & Takeuchi, D. T. (2020). Racial discrimination, ethnic-racial socialization, and cultural identities among Asian American youths.  Cultural Diversity & Ethnic Minority Psychology , 26 (4), 447–459. https://doi.org/10.1037/cdp0000327

Worldometer. (n.d.). Covid-19 coronavirus pandemic. https://www.worldometers.info/coronavirus/#countries

Christian D. Chan, PhD, NCC, is an assistant professor at the University of North Carolina at Greensboro. Stacey Diane Arañez Litam, PhD, NCC, CCMHC, LPCC-S, is an assistant professor at Cleveland State University. Correspondence may be addressed to Christian D. Chan, Department of Counseling and Educational Development, The University of North Carolina at Greensboro, P.O. Box 26170, Greensboro, NC 27402, [email protected] .

Recent Publications

• Bridging the Gap: From Awareness to Action Introduction to the Special Issue March 18, 2024
• “A Learning Curve”: Counselors’ Experiences Working With Sex Trafficking January 17, 2024
• Ableist Microaggressions, Disability Characteristics, and Nondominant Identities January 17, 2024
• Using the Cultural Formulation Interview With Afro Latinx Immigrants in Counseling: A Practical Application January 17, 2024

By providing an email address. I agree to the Terms of Use and acknowledge that I have read the Privacy Policy .

COVID-19 vaccines in the Philippine context

Several months and over 400,000 COVID-19 cases later, the Philippines has begun its long-awaited and promised process of acquiring vaccines as a means to end the pandemic. As early as April, President Duterte spoke optimistically of the prospects of a vaccine. Realistically, however, we must be aware of the realities of vaccination in the recent past in order to truly ensure its success.

Before looking at the advances of COVID-19 vaccine technology, it is important to look at the role immunization has played in the Philippine health care system. Indeed, this has been one of the cornerstones of preventive care for disease not just of childhood (mumps, chickenpox) but eventual adult concerns (HPV, pneumonia) as well. Yet despite the government’s Expanded Program on Immunization (EPI) and the National Immunization Program (NIP), the country has seen a drop in population coverage, leading to the resurgence of vaccine-preventable illnesses such as measles, diphtheria, and even poliomyelitis in the past decade. The Philippines’ circulating vaccine-derived polio cases in 2019-2020 placed us on a list with African countries struggling to end the transmission of this disease.

Many attribute the dismal immunization coverage to the dengue vaccine scandal, but while it doubtless eroded vaccines confidence in the Philippines, our immunization programs have actually been problematic long before Dengvaxia, failing to reach the coverage goal of 95 percent for many years now. The scandal only represented the nadir of what’s already been an alarming trend.

In fact, when it comes to timeliness of vaccination, the 2017 National Demographic and Health Survey showed only a 10.6 percent rate for all vaccines (ranging from 38 to 67 percent per vaccine). The gaps in delivery boil down to the quality and accessibility of our public health system, which, during the recent polio vaccinations, for instance, relied heavily on private sector support. It also faces a lot of challenges when it comes to maintaining the cold chain.

Looking forward to the COVID-19 vaccines, there have been major breakthroughs, the speed and complexity of which have never been encountered before. Of those nearing approval, there are two mRNA vaccines from Moderna and Pfizer—both requiring negative temperatures in their delicate handling. There are also the vector-based vaccines from Astra-

Zeneca and Gamaleya’s Sputnik V, as well as China’s inactivated vaccines developed by Sinopharm and Sinovac, all of which will only need normal refrigerated temperature.

Beyond the vaccine type, its corresponding handling, and the limitations of our health infrastructure, a major concern is the potential politicization of the acquisition, prioritization, and distribution protocols that will be put in place. There have been conflicting reports on who will be vaccinated first—health workers, vulnerable individuals, the poor, and uniformed personnel—according to different government agencies. There is also a need to address people’s concerns about the vaccines, from fears of being made “guinea pigs” to misconceptions about side effects and efficacy.

Surprisingly, there are reports of politicians having already received the vaccine, even if no emergency use authorizations have been granted by the local FDA. The vaccine “czar,” Gen. Carlito Galvez Jr., also mentioned that equitable access to the vaccine will only be achieved by 2022—an election year, which may bring about a predicament not unlike that of Dengvaxia in 2016, which some quarters allege was funded and launched for political considerations. These issues once again raise the danger of politicizing vaccination, especially if the process for prioritization will have potential interference from vested interests. With the urgency called for by the still uncontrolled pandemic, the success of not just the COVID-19 vaccine, but also of the entire vaccination institution in our country, hangs in the balance.

In the end, however, the solution for COVID-19 goes beyond vaccination. The World Health Organization reminds governments of the continuous need to strengthen their countries’ health system to provide for adequate testing, tracing, quarantine, treatment, and monitoring, aside from the provision of essential services. States must invest in public health to strengthen the infrastructure for pandemic preparedness, and to ensure the well-being of all, now more than ever.

Joshua San Pedro, MD, and Gideon Lasco, MD, PhD, are both physicians and anthropologists.

Subscribe to our daily newsletter

For more news about the novel coronavirus click here. What you need to know about Coronavirus. For more information on COVID-19, call the DOH Hotline: (02) 86517800 local 1149/1150.

The Inquirer Foundation supports our healthcare frontliners and is still accepting cash donations to be deposited at Banco de Oro (BDO) current account #007960018860 or donate through PayMaya using this link .

Fearless views on the news

Disclaimer: Comments do not represent the views of INQUIRER.net. We reserve the right to exclude comments which are inconsistent with our editorial standards. FULL DISCLAIMER

© copyright 1997-2024 inquirer.net | all rights reserved.

We use cookies to ensure you get the best experience on our website. By continuing, you are agreeing to our use of cookies. To find out more, please click this link.

Sákit Pighati and Pag-asa: A Pastoral Reflection on Suffering During the COVID-19 Pandemic in the Philippines

Affiliation.

• 1 Theology and Religious Education Department, De La Salle University, 2401 Taft Avenue, Manila, Philippines. [email protected].
• PMID: 33772688
• PMCID: PMC8000686
• DOI: 10.1007/s10943-021-01234-5

This article explores the concept of suffering as experienced by Filipinos during the COVID-19 pandemic. It draws inspiration from their narratives about how they faced, managed, and struggled during this tragic event. Their experiences were interpreted and analyzed concerning Filipino culture and tradition using a modified form of thematic analysis. Findings revealed three contextualized themes: sákit (pain), pighati (grief), and pag-asa (hope). These themes are then discussed in the light of John Paul II's Salvifici Doloris. A meaningful pastoral reflection on the basic realities of suffering is formulated to clarify our understanding of such a crisis.

Keywords: COVID-19; Filipino; Hope; Redemption; Suffering.

• Philippines

• Coronavirus Disease 2019

Filipino Responses to COVID-19

Research documents filipino panic responses to the global pandemic..

Posted April 30, 2020 | Reviewed by Kaja Perina

• What Is Anxiety?
• Find counselling to overcome anxiety

By Georgina Fairbrother

A recent study explored panic responses to COVID-19 in the Philippines. COVID-19 has been declared a global pandemic and has caused mass lockdowns and closures across the globe. An angle relatively unexplored amidst this global pandemic is the impact of COVID-19 on mental health. The survey conducted was a mixed-method study that gathered qualitative and quantitative data in order to better explore the different dimensions of panic responses.

The survey was conducted through convenience sampling by online forms due to government-mandated limitations of social contact and urgency. The online survey ran for three days and gathered 538 responses. The average age of a survey participant was 23.82, with participants ranging in ages from 13-67. 47% of those who completed the survey were working, 45.4% were students and 7.6% were not working. Of those who completed the survey, 1.3% had witnessed direct exposure to a COVID-19 patient, while 26% had witnessed exposure within their community, and 72.7% had not been exposed.

For purposes of the survey, the Health Anxiety Inventory (HAI) Short Week was adapted in order to test illness anxiety on COVID-19 amongst Filipinos. The HAI had four main sections used in this survey: 1) Symptoms of health anxiety (hypochondriasis), 2) Attitudes towards how awful it would be to develop COVID-19, 3) Avoidance, and 4) Reassurance. Responses to questions answered within these areas were scored on a 0-3 basis, compromising the quantitative portion of the study. To complete the qualitative section of the survey three open-ended questions were used. The open-ended questions used for qualitative purposes in this survey were:

“1. What came to your mind when you knew the existence of COVID-19? 2. How do you feel when you know the existence of COVID-19? 3. What actions have you done with the knowledge of existence of COVID-19?”

Upon completion of the survey, researchers were able to analyze data in regard to five different areas. First, researchers discovered that it was very evident that respondents were experiencing moderate illness anxiety in all four aspects listed by HAI. Secondly, by comparing locations, researchers also discovered that respondents residing in Metro Manilla exhibited less avoidance behavior compared to respondents residing outside Metro Manilla. While there is no definitive reason for this result, speculation looms around education , awareness, and proximity to COVID-19 cases. Thirdly, researchers looked at occupation, but determined illness anxiety was present regardless of occupation. Fourthly, researchers determined that respondents who had been in direct contact with those having COVID-19 were more likely to exhibit symptoms of hypochondriasis compared to respondents who had not witnessed or contacted anyone with COVID-19.

The fifth area that researchers explored upon completion of this survey was that of feeling, thinking, and behavior in response to COVID-19. Nineteen different themes were ranked by 100 experts based on their positivity and negativity. The themes included items such as the following: Health Consciousness, Optimism , Cautiousness, Protection, Compliance, Composure, Information Dissemination, Worry on self/family/others, Relating to Past Pandemics, Anxiety, Government Blaming, Shock, Transmission of Virus, Fear, Sadness, Paranoia , Nihilism, Annihilation, and Indifference. Upon completion of the survey, the highest-scoring themes amongst respondents included Fear, Social Distancing, Health Consciousness, and Information Dissemination. Meanwhile, the lowest-scoring themes included Indifference and Nihilism.

Overall, COVID-19 has become a global pandemic that is continuing to move and spread across the world. In the aftermath of this pandemic, it will be interesting to compare the panic responses of different countries. The Philippines approaches this study from a more socially collectivist perspective. With that being said, it was reported that the Philippines leaned towards more individualistic tendencies in times of fear. Another area to look deeper into would include how panic responses change from the initial shock of COVID-19 to lockdown phases to re-emergence phases.

Georgina Fairbrother is a current master’s student in the Humanitarian and Disaster Leadership program at Wheaton College. Prior to her master’s degree, she received a bachelor’s degree in Global Security and Intelligence studies from Embry-Riddle Aeronautical University.

Nicomedes, C. J., & Avila, R. (2020). An Analysis on the Panic of Filipinos During COVID-19 Pandemic in the Philippines. https://doi.org/10.13140/RG.2.2.17355.54565

Jamie Aten , Ph.D. , is the founder and executive director of the Humanitarian Disaster Institute at Wheaton College.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Online Therapy
• International
• New Zealand
• South Africa
• Switzerland
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Therapy Center NEW
• Diagnosis Dictionary
• Types of Therapy

Understanding what emotional intelligence looks like and the steps needed to improve it could light a path to a more emotionally adept world.

• Affective Forecasting
• Neuroscience

We currently offer language translations on our site primarily through Google Translate. This helps visitors find and use information in the languages they speak, but the tool is not perfect. Automated translation may be inaccurate or errors may display on translated pages.

Google Translate is an external website. King County does not control the quality or accuracy of translated content.

Language and region

Please choose a language

About King County expand_more

• Departments
• Employee resources
• King County TV (KCTV)

Animals Pests & Pets expand_more

• Pet adoption
• Regional Animal Services (RASKC)
• Pet licenses
• Animal Control
• Diseases from animals
• Getting rid of rats and mice

Buildings And Property expand_more

• Parcel viewer property search
• Property tax payment information
• iMap - interactive mapping tool
• Property research
• GIS maps and applications
• Property tax assessments (residential)
• Parcel sales search
• Property information - eReal property
• Plumbing and gas piping
• Property Tax Advisor

Certificates, Permits, And Licenses expand_more

• Marriage licenses
• Birth certificates
• Death certificates
• Gun (concealed pistol) licenses
• Car, truck, and boat licenses
• Food business permits

Courts, Jails, & Legal System expand_more

• Adult jails
• Apply for a passport
• Find someone in jail
• Sex offender registry

Data and information services expand_more

• Online records search
• Recorder's office

Governance And Leadership expand_more

• Elected officials (all)
• King County Council members
• King County Executive Dow Constantine

Health And Safety expand_more

• Environmental Health Services
• Restaurant safety ratings
• Mental health services

Human And Social Services expand_more

• Eviction Prevention and Rent Assistance Program
• Crisis services
• Best Starts for Kids
• Homeless Housing Program
• Veterans Program
• Behavioral health and recovery

Nature and Recreation expand_more

• Noxious weeds
• Marymoor Park
• Parks and recreation
• Facility rentals
• Climate change
• Flood service warning system

Transit, Transportation, and Roads expand_more

• Metro schedules and maps
• Transit GO ticket
• Metro fares
• Traffic cameras
• Road closures
• Rail travel

Waste Services expand_more

• Solid waste facilities
• Mattress disposal/recycling
• Reducing food waste
• Wastewater capacity charge
• Paint recycling
• Garbage, recycling, and compost services
• Compost and yard waste

Mga rekomendasyon ng pampublikong kalusugan para pahintuin ang COVID-19 (Tagalog)

• Public Health — Seattle & King County
• COVID-19 resources
• In-language materials
• Wikang Tagalog/Filipino – Tagalog/Filipino

Mga rekomendasyon ng pampublikong kalusugan para pahintuin ang COVID-19

Public health recommendations to stop covid-19 in tagalog/filipino.

Abril 28, 2023, Inirerekomenda ang isang na-update (bivalent) na bakuna para sa lahat ng may edad na 6 buwan pataas

Ang mga na-update (bivalent) na mga bakuna ay tina-target ang mga baryants ng Omicron na patuloy na kumakalat sa ating mga komunidad. Ang bakuna ay tina-target din ang orihinal na strain ng COVID bayrus. Ang mga taong nanatiling napapanahon (Ingles lamang) sa lahat ng inirerekomendang dosis ng bakuna ay may pinakamahusay na proteksyon laban sa malubhang COVID-19.

Mga rekomendasyon ng bakuna sa COVID-19 ng CDC mula Abril 19, 2023:

Ang lahat ng may edad na 6 taong gulang pataas ay dapat makakuha ng 1 na na-update na bakuna ng Pfizer o Moderna sa COVID-19 upang maituring na napapanahon (Ingles lamang).

Ang ilang mga tao ay maaaring makakuha ng karagdagang mga booster ng COVID-19:

• Ang mga taong may edad na 65 taong gulang pataas ay maaaring makakuha ng 1 karagdagang dosis ng na-update na booster ng COVID-19, 4 o higit pang buwan pagkatapos ng unang na-update na bakuna
• Ang mga taong may katamtaman o malubhang immunocompromised ay maaaring makakuha ng 1 karagdagang dosis ng na-update na booster ng COVID-19, 2 o higit pang buwan pagkatapos ng unang update ng bakuna ng COVID-19.

Ang mga bata na may edad na 6 na buwan-5 taon ay nangangailangan ng maraming dosis ng bakuna ng COVID-19 upang maging napapanahon, kabilang ang hindi bababa sa 1 na na-update na dosis ng Pfizer o Moderna. Depende ito sa bilang ng mga dosis na natanggap nila dati at sa kanilang edad.

Mangyaring makipag-usap sa iyong tagapagbigay ng pangangalagang pangkalusugan kung mayroon kang mga katanungan tungkol sa kung ilang dosis ang kailangan mo.

Para sa karagdagang impormasyon sa pagbabakuna, bisitahin ang Pahina ng bakuna sa COVID-19 mula sa Washington State Department of Health.

Gawin ang mga aksyong ito upang makatulong na supilin ang pagkalat ng coronavirus at panatilihing ligtas ang bawat isa.

Ang pinakamahusay na proteksyon ay ang mabakunahan . Ang mga taong ganap na nabakunahan ay maaari na ngayong gumawa ng mas maraming bagay nang ligtas at nakakatulong silang mabawasan ang COVID-19 sa komunidad.

Ang pagsusuot ng maskara sa mga lugar na may mataas na peligro (gaya ng mga mataong lugar) ay nakakatulong na protektahan ang lahat. Lalong mahalaga na protektahan ang mga taong hindi makakakuha ng buong proteksyon mula sa bakuna, tulad ng mga bata at mga taong may kondisyong medikal na hindi gaanong kayang labanan ang bayrus.

Magpasuri kung mayroon kang mga sintomas ng COVID-19 o nakisalamuha sa isang taong nagpositibo sa pagsusuri.

Kung nagpositibo ka sa COVID-19 o nasa mas mataas na panganib na magkasakit, ang pagkuha ng maagang paggamot sa COVID-19 (impormasyon sa Ingles lamang) ay makakatulong upang maprotektahan mula sa matinding karamdaman at pagpapaospital. Tanungin ang iyong tagapagbigay ng pangangalagang pangkalusugan upang makita kung ang paggamot ay inirerekomenda para sa iyo.

Panatilihing maliit at sa labas ang mga aktibidad kung sasali ang mga taong hindi nabakunahan. Ang bayrus ay madaling kumalat sa loob ng bahay, kaya ang mga negosyo at organisasyon ay maaaring mabawasan ang bayrus sa hangin sa pamamagitan ng pagkakaroon ng magandang daloy ng hangin sa panloob at paggamit ng mga air filter (website sa Ingles).

Pangangalaga ng iyong mga sintomas ng COVID-19 sa tahanan

Ang Test to Treat ay isang bagong programang makakatulong sa mga nangangailangan ng pagsusuri at pangmadaliang libreng paggamot kung magpositibo sila sa COVID-19.

Karagdagang Kaalaman

Pagsusuri sa COVID-19

Pantakip sa mukha

May makukuha kang tulong

Kung kailangan mo ng serbisyong interpretasyon o tulong online, tawagan ang hotline ng impormasyon sa ng Estado ng Washington. Hindi kami nagtatanong tungkol sa iyong katayuan ng imigrasyon.

Para humiling ng interpreter:

• 1-800-525-0127
• May mensahe kang maririnig. Maghintay kang sagutin ng operator ng call center.
• Sabihin ang nais mong wika.
• Tatawag ang operator ng call center sa isang serbisyo ng interpreter. Huwag mong ibababa. Manatili ka sa telepono hanggang sa konektado ka sa isang interpreter.

Kung mayroon kang kapansanan at kailangan mo ng tulong upang makakuha ng bakuna ng COVID-19, email [email protected] .

Patnubay sa COVID-19

• Sangguniang Gabay para sa Booster na Dosis ng Bakuna sa COVID-19 para sa Lahat ng Edad , Kagawaran ng Kalusugan ng Estado ng Washington
• Maghanap ng mga lokasyong may bakuna sa COVID-19 , Kagawaran ng Kalusugan ng Estado ng Washington
• COVID-19 , Kagawaran ng Kalusugan ng Estado ng Washington
• Bakuna sa COVID-19 , Kagawaran ng Kalusugan ng Estado ng Washington
• COVID-19 , Mga Sentro para sa Pagkontrol sa Sakit

Infographic

Mga tagapag-empleyo: paano lumikha ng mas ligtas sa covid sa kapaligiran ng trabaho

Ang pinalawak na COVID-19 na saklaw ng medikal para sa mga walang dokumentong residente ng estado ng Washington

Bakit kailangan nating kumuha ng COVID booster?

Ano ang mga dapat asahan kapag magpapabakuna sa COVID ang iyong batang anak

Bakit kailangan ng mga maliliit na bata ang magpabakuna laban sa COVID?

Paano paghandaan ang pagpapabakuna laban sa COVID ng iyong batang anak

Kinakailangan ang mga maskara dito

English version: Masks are required here

Opsyonal ang mga maskara

English version: Masks optional

Humandang tumulong sa isa't isa. Ang malakas na pandama ng komunidad ang makakatulong sa atin sa isang mahirap na panahon.

Link/share our site at www.kingcounty.gov/covid/filipino

Numbers, Facts and Trends Shaping Your World

Read our research on:

Full Topic List

Regions & Countries

• Publications
• Our Methods
• Short Reads
• Tools & Resources

Read Our Research On:

Discrimination Experiences Shape Most Asian Americans’ Lives

4. asian americans and discrimination during the covid-19 pandemic, table of contents.

• Key findings from the survey
• Most Asian Americans have been treated as foreigners in some way, no matter where they were born
• Most Asian Americans have been subjected to ‘model minority’ stereotypes, but many haven’t heard of the term
• Experiences with other daily and race-based discrimination incidents
• In their own words: Key findings from qualitative research on Asian Americans and discrimination experiences
• Discrimination in interpersonal encounters with strangers
• Racial discrimination at security checkpoints
• Encounters with police because of race or ethnicity
• Racial discrimination in the workplace
• Quality of service in restaurants and stores
• Discrimination in neighborhoods
• Experiences with name mispronunciation
• Discrimination experiences of being treated as foreigners
• In their own words: How Asian Americans would react if their friend was told to ‘go back to their home country’
• Awareness of the term ‘model minority’
• Views of the term ‘model minority’
• How knowledge of Asian American history impacts awareness and views of the ‘model minority’ label
• Most Asian Americans have experienced ‘model minority’ stereotypes
• In their own words: Asian Americans’ experiences with the ‘model minority’ stereotype
• Asian adults who personally know an Asian person who has been threatened or attacked since COVID-19
• In their own words: Asian Americans’ experiences with discrimination during the COVID-19 pandemic
• Experiences with talking about racial discrimination while growing up
• Is enough attention being paid to anti-Asian racism in the U.S.?
• Acknowledgments
• Sample design
• Data collection
• Weighting and variance estimation
• Methodology: 2021 focus groups of Asian Americans
• Appendix: Supplemental tables

Following the coronavirus outbreak, reports of discrimination and violence toward Asian Americans increased. A previous Pew Research Center survey of English-speaking Asian adults showed that as of 2021, one-third said they feared someone might threaten or physically attack them. English-speaking Asian adults in 2022 were also more likely than other racial or ethnic groups to say they had changed their daily routines due to concerns they might be threatened or attacked. 19

In this new 2022-23 survey, Asian adults were asked if they personally know another Asian person in the U.S. who had been attacked since the pandemic began.

About one-third of Asian adults (32%) say they personally know an Asian person in the U.S. who has been threatened or attacked because of their race or ethnicity since the COVID-19 pandemic began in 2020.

Whether Asian adults know someone with this experience varies across Asian ethnic origin groups:

• About four-in-ten Chinese adults (39%) say they personally know another Asian person who has been threatened or attacked since the coronavirus outbreak. Similar shares of Korean adults (35%) and those who belong to less populous Asian origin groups (39%) – those categorized as “other” in this report – say the same.
• About three-in-ten Vietnamese (31%), Japanese (28%) and Filipino (28%) Americans and about two-in-ten Indian adults (21%) say they know another Asian person in the U.S. who has been the victim of a racially motivated threat or attack. 

Additionally, there are some differences by regional origin groups:

• Overall, similar shares of East and Southeast Asian adults say they know another Asian person who’s been threatened or attacked because of their race or ethnicity (36% and 33%, respectively).
• A somewhat smaller share of South Asian adults say the same (24%).

There are also differences across nativity and immigrant generations:

• U.S.-born Asian adults are more likely than Asian immigrants to say they know another Asian person who has been threatened or attacked during the COVID-19 pandemic  (40% vs. 28%, respectively).
• Among immigrants, those who are 1.5 generation – those who came to the U.S. as children – are more likely than the first generation – those who immigrated as adults – to say they know someone with this experience (37% vs. 25%).
• And among U.S.-born Asian Americans, 44% of second-generation adults say this, compared with 28% of third- or higher-generation Asian adults.

Whether Asian Americans personally know another Asian person who was threatened or attacked because of their race or ethnicity since the beginning of the pandemic also varies across other demographic groups:

• Age: 44% of Asian adults under 30 years old say they know someone who has been threatened or attacked during the pandemic, compared with 18% of those 65 and older.
• Gender: Asian women are somewhat more likely than men to say they know an Asian person in the U.S. who has been threatened or attacked during the COVID-19 pandemic (35% vs. 28%, respectively).
• Party: 36% of Asian Democrats and Democratic leaners say they know another Asian person who has been threatened or attacked because of their race or ethnicity, higher than the share among Republicans and Republican leaners (25%).

Heightened anti-Asian discrimination during the COVID-19 pandemic

These survey findings follow a spike in reports of discrimination against Asian Americans during the COVID-19 pandemic. The number of federally recognized hate crime incidents of anti-Asian bias increased from 158 in 2019 to 279 in 2020 and 746 in 2021, according to hate crime statistics published by the FBI . In 2022, the number of anti-Asian hate crimes decreased for the first time since the coronavirus outbreak, to 499 incidents. Between March 2020 and May 2023, the organization Stop AAPI Hate received more than 11,000 self-reported incidents of anti-Asian bias, the vast majority of which involved harassment, bullying, shunning and other discrimination incidents.

Additionally, previous research found that calling COVID-19 the “Chinese Virus,” “Asian Virus” or other names that attach location or ethnicity to the disease was associated with anti-Asian sentiment in online discourse. Use of these phrases by politicians or other prominent public officials, such as by former President Donald Trump , coincided with greater use among the general public and more frequent instances of bias against Asian Americans.

In the 2021 Pew Research Center focus groups of Asian Americans, participants discussed their experiences of being discriminated against because of their race or ethnicity during the COVID-19 pandemic.

Participants talked about being shamed in both public and private spaces. Some Asian immigrant participants talked about being afraid to speak out because of how it might impact their immigration status:

“I was walking in [the city where I live], and a White old woman was poking me in the face saying, ‘You are disgusting,’ and she was trying to hit me. I ran away crying. … At the time, I was with my boyfriend, but he also just came to the U.S., so we ran away together thinking that if we cause trouble, we could be deported.”

–Immigrant woman of Korean origin in late 20s (translated from Korean)

“[A very close friend of mine] lived at [a] school dormitory, and when the pandemic just happened … his room was directly pasted with the adhesive tape saying things like ‘Chinese virus quarantine.’”

–Immigrant man of Chinese origin in early 30s (translated from Mandarin)

Many participants talked about being targeted because others perceive them as Chinese , regardless of their ethnicity:

“I think the crimes [that happened] against other Asian people can happen to me while going through COVID-19. When I see a White person, I don’t know if their ancestors are Scottish or German, so they will look at me and think the same. It seems that they can’t distinguish between Korean and Chinese and think that we are from Asia and the onset of COVID-19 is our fault. This is something that can happen to all of us. So I think Asian Americans should come together and let people know that we are also human and we have rights. I came to think about Asian Americans that they shouldn’t stay still even if they’re trampled on.”

–Immigrant woman of Korean origin in early 50s (translated from Korean)

“Even when I was just getting on the bus, [people acted] as if I was carrying the virus. People would not sit with me, they would sit a bit far. It was because I look Chinese.”

–Immigrant woman of Bhutanese origin in early 30s (translated from Dzongkha)

Amid these incidents, some participants talked about feeling in community and kinship with other Asian people:

“[When I hear stories about Asian people in the news,] I feel like automatically you just have a sense of connection to someone that’s Asian. … [I]t makes me and my family and everyone else that I know that is Asian super mad and upset that this is happening. [For example,] the subway attacks where there was a mother who got dragged down the stairs for absolutely no reason. It just kind of makes you scared because you are Asian, and I would tell my mom, ‘You’re not going anywhere without me.’ We got pepper spray and all of that. But there is definitely a difference because you just feel a connection with them no matter if you don’t know them.”

–U.S.-born woman of Taiwanese origin in early 20s

“[A]s a result of the pandemic, I think we saw an increase in Asian hate in the media. I think that was one time where I realized as an Asian person, I felt a lot of pain. I felt a lot of fear, I felt a lot of anger and frustration for my community. … I think it was just at that specific moment when I saw the Asian hate, Asian hate crimes, and I realized, ‘Oh, they’re targeting my people.’  I don’t know how to explain it exactly. I never really referred to myself just plainly as an Asian American, but when I saw it in that media and I saw people who looked like me or people who I related with getting hurt and mistreated, I felt anger for that community, for my community.””

–U.S.-born woman of Korean origin in late teens

Some connected discrimination during the pandemic to other times of heightened anti-Asian discrimination . For example, one woman connected anti-Asian discrimination during COVID-19 to the period after Sept. 11:

“[T]he hate crimes I’m reading about now are towards Chinese [people] because of COVID, but I remember after 9/11, that was – I remember the looks that people would give me on the subway but also reading the violent acts committed towards Indians of all types, just the confusion – I mean, I say confusion but I mean really they wanted to attack Muslims, but they didn’t care, they were just looking for a brown person to attack. So there’s always something that happens that then suddenly falls on one community or another.”

–U.S.-born man of Indian origin in late 40s

• Pew Research Center’s American Trends Panel surveys of Asian adults were conducted only in English and are representative of the English-speaking Asian adult population. In 2021, 70% of Asian adults spoke only English or said they speak English “very well,” according to a Pew Research Center analysis of the 2021 American Community Survey. By contrast, the Center’s 2022-23 survey of Asian Americans was conducted in six languages, including Chinese (Simplified and Traditional), English, Hindi, Korean, Tagalog and Vietnamese. ↩

Sign up for our weekly newsletter

Fresh data delivery Saturday mornings

Sign up for The Briefing

Weekly updates on the world of news & information

• Asian Americans
• Discrimination & Prejudice
• Immigration Issues
• Race Relations
• Racial Bias & Discrimination

Key facts about Asian Americans living in poverty

Methodology: 2023 focus groups of asian americans, 1 in 10: redefining the asian american dream (short film), the hardships and dreams of asian americans living in poverty, key facts about asian american eligible voters in 2024, most popular, report materials.

1615 L St. NW, Suite 800 Washington, DC 20036 USA (+1) 202-419-4300 | Main (+1) 202-857-8562 | Fax (+1) 202-419-4372 |  Media Inquiries

Research Topics

• Age & Generations
• Coronavirus (COVID-19)
• Economy & Work
• Family & Relationships
• Gender & LGBTQ
• Immigration & Migration
• International Affairs
• Internet & Technology
• Methodological Research
• News Habits & Media
• Non-U.S. Governments
• Other Topics
• Politics & Policy
• Race & Ethnicity
• Email Newsletters

ABOUT PEW RESEARCH CENTER  Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of  The Pew Charitable Trusts .

Copyright 2024 Pew Research Center

Terms & Conditions

Privacy Policy

Cookie Settings

Reprints, Permissions & Use Policy

• International edition
• Australia edition
• Europe edition

'Bating Filipino': MPs in Philippines pass bill to create new Covid-safe greeting

Contactless greeting will help fight pandemic, say MPs of worst-hit country in south-east Asia, though some people would prefer more action on a vaccine

• Coronavirus – latest updates
• See all our coronavirus coverage

House lawmakers in the Philippines have passed a bill to legislate a new, Covid-safe form of greeting in an effort to reduce contact during the pandemic.

According to the bill approved by the House of Representatives, the new gesture will involve “gracefully laying the palm of the right hand over the centre of one’s chest while simultaneously lowering the head, with eyes either closed or cast down”.

The traditional handshake, while well meaning, was a risk to public health, said Representative Bayani Fernando, who proposed the bill. He called the new greeting “Bating Filipino”.

Across the world, countries have looked for new forms of greetings , from elbow bumps to footshakes, in an effort to reduce transmission of the coronavirus. In France, the health minister, Olivier Véran, told people in March last year to avoid hugs and kisses, while Italians were advised to be “a bit less expansive” when greeting one another.

In Thailand, which has managed to keep case numbers below 13,000, some have speculated that the wai – where the palms are pressed together in a prayer-like gesture – might have contributed to the country’s success in reducing local transmissions.

The bill in the Philippines needs to be passed by the senate and signed by the president before it is passed into law. It doesn’t specify any punishment for people who don’t adopt the greeting.

The Philippines has struggled to control the coronavirus and is one of the worst-affected countries in south-east Asia, despite imposing a harsh lockdown last year.

On Thursday, the department of health announced 1,783 new cases, while the death toll rose to 10,115.

In some areas of the country, restrictions have been eased so that, from February, children aged 10 years and over will be allowed to go outside. Previously, they were only allowed to leave their homes for essentials such as exercise or to access medical care. Children under 10 and people over 65 are still required to stay home.

Some have questioned the need for legislation on hand gestures, given that many are already living with restrictions on their movement, and have argued that politicians should instead focus on speeding up the rollout of a Covid-19 vaccine.

The Philippines announced plans to buy 20m doses of the Moderna vaccine this week, adding to its supply of 72m doses from AstraZeneca, Novavax and Sinovac.

• Philippines
• Coronavirus
• Asia Pacific

Most viewed

• Share full article

Advertisement

Supported by

NPR in Turmoil After It Is Accused of Liberal Bias

An essay from an editor at the broadcaster has generated a firestorm of criticism about the network on social media, especially among conservatives.

By Benjamin Mullin and Katie Robertson

NPR is facing both internal tumult and a fusillade of attacks by prominent conservatives this week after a senior editor publicly claimed the broadcaster had allowed liberal bias to affect its coverage, risking its trust with audiences.

Uri Berliner, a senior business editor who has worked at NPR for 25 years, wrote in an essay published Tuesday by The Free Press, a popular Substack publication, that “people at every level of NPR have comfortably coalesced around the progressive worldview.”

Mr. Berliner, a Peabody Award-winning journalist, castigated NPR for what he said was a litany of journalistic missteps around coverage of several major news events, including the origins of Covid-19 and the war in Gaza. He also said the internal culture at NPR had placed race and identity as “paramount in nearly every aspect of the workplace.”

Mr. Berliner’s essay has ignited a firestorm of criticism of NPR on social media, especially among conservatives who have long accused the network of political bias in its reporting. Former President Donald J. Trump took to his social media platform, Truth Social, to argue that NPR’s government funding should be rescinded, an argument he has made in the past.

NPR has forcefully pushed back on Mr. Berliner’s accusations and the criticism.

“We’re proud to stand behind the exceptional work that our desks and shows do to cover a wide range of challenging stories,” Edith Chapin, the organization’s editor in chief, said in an email to staff on Tuesday. “We believe that inclusion — among our staff, with our sourcing, and in our overall coverage — is critical to telling the nuanced stories of this country and our world.” Some other NPR journalists also criticized the essay publicly, including Eric Deggans, its TV critic, who faulted Mr. Berliner for not giving NPR an opportunity to comment on the piece.

In an interview on Thursday, Mr. Berliner expressed no regrets about publishing the essay, saying he loved NPR and hoped to make it better by airing criticisms that have gone unheeded by leaders for years. He called NPR a “national trust” that people rely on for fair reporting and superb storytelling.

“I decided to go out and publish it in hopes that something would change, and that we get a broader conversation going about how the news is covered,” Mr. Berliner said.

He said he had not been disciplined by managers, though he said he had received a note from his supervisor reminding him that NPR requires employees to clear speaking appearances and media requests with standards and media relations. He said he didn’t run his remarks to The New York Times by network spokespeople.

When the hosts of NPR’s biggest shows, including “Morning Edition” and “All Things Considered,” convened on Wednesday afternoon for a long-scheduled meet-and-greet with the network’s new chief executive, Katherine Maher , conversation soon turned to Mr. Berliner’s essay, according to two people with knowledge of the meeting. During the lunch, Ms. Chapin told the hosts that she didn’t want Mr. Berliner to become a “martyr,” the people said.

Mr. Berliner’s essay also sent critical Slack messages whizzing through some of the same employee affinity groups focused on racial and sexual identity that he cited in his essay. In one group, several staff members disputed Mr. Berliner’s points about a lack of ideological diversity and said efforts to recruit more people of color would make NPR’s journalism better.

On Wednesday, staff members from “Morning Edition” convened to discuss the fallout from Mr. Berliner’s essay. During the meeting, an NPR producer took issue with Mr. Berliner’s argument for why NPR’s listenership has fallen off, describing a variety of factors that have contributed to the change.

Mr. Berliner’s remarks prompted vehement pushback from several news executives. Tony Cavin, NPR’s managing editor of standards and practices, said in an interview that he rejected all of Mr. Berliner’s claims of unfairness, adding that his remarks would probably make it harder for NPR journalists to do their jobs.

“The next time one of our people calls up a Republican congressman or something and tries to get an answer from them, they may well say, ‘Oh, I read these stories, you guys aren’t fair, so I’m not going to talk to you,’” Mr. Cavin said.

Some journalists have defended Mr. Berliner’s essay. Jeffrey A. Dvorkin, NPR’s former ombudsman, said Mr. Berliner was “not wrong” on social media. Chuck Holmes, a former managing editor at NPR, called Mr. Berliner’s essay “brave” on Facebook.

Mr. Berliner’s criticism was the latest salvo within NPR, which is no stranger to internal division. In October, Mr. Berliner took part in a lengthy debate over whether NPR should defer to language proposed by the Arab and Middle Eastern Journalists Association while covering the conflict in Gaza.

“We don’t need to rely on an advocacy group’s guidance,” Mr. Berliner wrote, according to a copy of the email exchange viewed by The Times. “Our job is to seek out the facts and report them.” The debate didn’t change NPR’s language guidance, which is made by editors who weren’t part of the discussion. And in a statement on Thursday, the Arab and Middle Eastern Journalists Association said it is a professional association for journalists, not a political advocacy group.

Mr. Berliner’s public criticism has highlighted broader concerns within NPR about the public broadcaster’s mission amid continued financial struggles. Last year, NPR cut 10 percent of its staff and canceled four podcasts, including the popular “Invisibilia,” as it tried to make up for a $30 million budget shortfall. Listeners have drifted away from traditional radio to podcasts, and the advertising market has been unsteady.

In his essay, Mr. Berliner laid some of the blame at the feet of NPR’s former chief executive, John Lansing, who said he was retiring at the end of last year after four years in the role. He was replaced by Ms. Maher, who started on March 25.

During a meeting with employees in her first week, Ms. Maher was asked what she thought about decisions to give a platform to political figures like Ronna McDaniel, the former Republican Party chair whose position as a political analyst at NBC News became untenable after an on-air revolt from hosts who criticized her efforts to undermine the 2020 election.

“I think that this conversation has been one that does not have an easy answer,” Ms. Maher responded.

Benjamin Mullin reports on the major companies behind news and entertainment. Contact Ben securely on Signal at +1 530-961-3223 or email at [email protected] . More about Benjamin Mullin

Katie Robertson covers the media industry for The Times. Email:  [email protected]   More about Katie Robertson