Department of Health
Southern Isabela Medical Center
Professional Education, Training and Research Unit
(Title of the Proposal)
Capitalize each word except articles, conjunctions and pronouns. It should be no more than 20 words. A
good title should be short, accurate, and concise. It should specify the study design, study location,
population, intervention, and time/duration of the observation
(Principal Investigator)
Include full names, complete with first and middle names or initials. Departments, units, sections should
also be specified. If several institutions are listed, it should be clearly indicated with which department and
institution each author is affiliated by using corresponding superscript numbers.
(Co-Author/s)
Include full names, complete with first and middle names or initials. Departments, units, sections should
also be specified. If several institutions are listed, it should be clearly indicated with which department and
institution each author is affiliated by using corresponding superscript numbers.
(Study Site)
Include study site of the proposed study.
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[Title of the Proposal][Study Site][Study Period][Version Number]
Department of Health
Southern Isabela Medical Center
Professional Education, Training and Research Unit
(Summary or Abstract) *
Contains key issues, objective/s, and proposed study methodology. Should contain at least 300 words
(Title of the Proposal)
Introduction/Background of the Study:
Methodology:
*Strictly written on this page only.
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[Title of the Proposal][Study Site][Study Period][Version Number]
Department of Health
Southern Isabela Medical Center
Professional Education, Training and Research Unit
I. INTRODUCTION**
(Introduction and Background of the Study)
Specify the reason/s for conducting the research in light of current knowledge. It should include a well-
documented statement of the problem that is the basis of the project, the cause of this problem and its
possible solutions. The statement of the problem is as follows:
a. Ideal/desired situation (or what is known)
b. Current situation (or what is unknown)
c. How the research results will contribute to moving current situation to the ideal/desired
situation
d. Statement of the research question and main research objective. May include research
hypothesis, if applicable.
It should include at least 10 currently cited literature, preferably local studies. Review of related literature
should justify the proposed study. Use APA Citation Version 7.
(Conceptual Framework)
Consider the "grounds" that support the central question of the study.
For conceptual framework: use schematic diagram showing the dependent, independent and confounding or
modifying variables correctly constructed and its brief explanation on the interrelationship among the variables
found in the diagram. (e.g. Input, Process, Output)
For theoretical framework: use diagrammatic representation of the theory/ies, with explanation/s and
appropriate citation/s.
(Significance of the Study) (300 words)
What is the importance and impact of the study? Please indicate the importance of the results of the study to
the identified stakeholders: study participants/patients, health care workers/providers, and/or health care policy
makers or administrators. This constitutes the scientific justification for the study; i.e., the basis of the need for
research to generate further knowledge that will contribute to existing knowledge.
(Objectives of the Study) (200 words)
Objectives are broad statements of what the proposal hopes to accomplish. Objectives should be specific,
measurable, achievable, relevant and time-bound.
(Operational Definitions)
Terms used in the study based on the concepts that may be made explicit in the conceptual/theoretical
framework. The variables should be made operative; i.e. the investigator should clearly describe what is
understood by each variable, what type of variable is being considered, and the way its values are to be
reported. For disease, the case definition of the disease is required.
**Please use another page, if necessary, as long as it follows the sequence.
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[Title of the Proposal][Study Site][Study Period][Version Number]
Department of Health
Southern Isabela Medical Center
Professional Education, Training and Research Unit
II. METHODOLOGY (800 words) ***
Please write in the future tense. The methodology explains the procedures that will be used to achieve the
objectives. In this section the operational definition for the variables used should be specified in detail, along
with the type of variables and the ways to measure them. In addition, the methodology should consider the
study design and the techniques and procedures used to achieve the proposed objectives.
Research Design
Descriptive or Analytical, Retrospective or Prospective, Observational or Experimental, if Observational,
specify if Cross-Sectional, Case-Control, Cohort, etc. If Experimental, specify if Quasi-Experimental,
Randomized Clinical Trial, etc.
Locale of the Study
Single site or Multiple site; indicate where the study will be conducted. Indicate whether the administration of
questionnaire is virtual or face-to-face
Respondents of the Study
The target population and the study population should be identified and defined. Include inclusion and
exclusion criteria.
Sample Size and Sampling Procedure
Indicate the calculated sample size for each objective. Include manual computation of sample size, if
necessary. Sampling method should be appropriate to ensure representativeness. Write “not applicable” if
total enumeration.
Research Instrument
If questionnaire, please indicate validity and reliability of the questionnaire.
Data Gathering/Collection and Data Processing
Data collection methods must include a description of data to be collected. Indicate if data processing done
through computerization. Indicate if questionnaire is pre-coded.
Statistical Treatment of Data
State appropriate statistical methods to be used and how data will be summarized. Indicate the statistical test
for each objective.
***Please use another page, if necessary, as long as it follows the sequence.
III. ETHICAL CONSIDERATIONS **
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[Title of the Proposal][Study Site][Study Period][Version Number]
Department of Health
Southern Isabela Medical Center
Professional Education, Training and Research Unit
Privacy, Confidentiality, Protection of Participants, and other ethical principles applicable in
this research
Include measures on how to protect privacy and confidentiality of participant information and in
compliance with the Data Privacy Act of 2012
Informed Consent
Include application of the principle of respect for persons, who may solicit consent, how and
when it will be done; who may give consent, especially in case of special populations (e.g.
minors, those are not legally competent to give consent, indigenous people).
Assessment of Risks and Benefits
Include level of risk and measures to mitigate risk and measures to mitigate these risks
Do not write “there are no risks”. Identify possible risks. The risks may be physical,
psychological, social, etc.
Include also potential direct benefit to participants and the potential to yield generalizable
knowledge about the participants’ condition/problem.
If there are no direct benefits, do not write “there are no direct benefits”. Instead indicate the
potential indirect benefits of the proposed study.
Incentives and Compensation
Include amount and method of compensations, financial incentives, or reimbursement of study
related expenses (if applicable)
Compensation for study-related injuries
Include amount and method of study-related injuries, including treatment, entitlements, or
certificate of insurance for clinical trial (if applicable)
Transparency and Conflict of interest
Include statement on the declaration of conflicts of interest of the Principal Investigator and other
investigators in this study protocol.
Dissemination/Data Sharing Plan
Include plan to share results which may have implications on the well-being of the participants
and the community and in relation to achieving social value is appropriate and clearly described.
***Strictly written on this page only. Please use another page if necessary.
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[Title of the Proposal][Study Site][Study Period][Version Number]
Department of Health
Southern Isabela Medical Center
Professional Education, Training and Research Unit
IV. APPENDICES
A. INFORMED CONSENT AND/OR ASSENT FORM (IF APPLICABLE)
- English Version
- Filipino Version
B. DUMMY TABLES
C. QUESTIONNAIRES (IF APPLICABLE)
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[Title of the Proposal][Study Site][Study Period][Version Number]
Department of Health
Southern Isabela Medical Center
Professional Education, Training and Research Unit
Schedule of Activities
(Please use Gantt chart)
Activities January February March April May June July August September October Novembe December
r
Writing of
Research
Protocol
Submission of
Protocol to
PETRU
Approval from
TRB and REC
Data Collection
Data Analysis
Writing of final
manuscript
Presentation of
final paper
(mandatory to all
accredited clinical
department)
Revision of final
manuscript
Submission of
revised final
manuscript to
PETRU
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[Title of the Proposal][Study Site][Study Period][Version Number]
Department of Health
Southern Isabela Medical Center
Professional Education, Training and Research Unit
STUDY BUDGET
Personnel Services:
Statistician
Maintenance and other operating expenses:
Travelling expenses
Communication expenses
Supplies and Materials expenses
Representation expenses
Utility expenses
Printing and Publication expenses
Professional services
Other Professional services
TOTAL
V. APPENDICES
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[Title of the Proposal][Study Site][Study Period][Version Number]
Department of Health
Southern Isabela Medical Center
Professional Education, Training and Research Unit
A.
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[Title of the Proposal][Study Site][Study Period][Version Number]
