Republic of the Philippines

UNIVERSITY OF SOUTHERN MINDANAO

Kabacan, Cotabato
____________________________________________________
USM RESEARCH ETHICS COMMITTEE - Form 3
RESEARCH PROPOSAL TEMPLATE (Based on DOST-PCHRD)

Level of Awareness, Attitudes, and Practices in Dealing with

the Potential Risks Associated with Antibiotic Use among
Selected Students in the University of
Southern Mindanao

Bea Diane F. Reyes

Adviser: Marianne I. Meriales, MSPharm, RPh

University of Southern Mindanao

<<<Signature of primary investigator/student research>>>
[email protected]

<<<MONTH YEAR (submitted to the RECO)>>>

1. TABLE OF CONTENTS Contains list of all appendices and supporting documents

[List your appendices and supporting documents here (e.g., questionnaire, informed consent form, etc]

2. INTRODUCTION Contains a summary of the background information relevant to the research design
and protocol methodology. Sufficient information includes description of disease/condition of interest
and present knowledge of the subject matter of the research. This information is necessary in order to
understand the rationale for the research.

[Maximum number of words: 300]

3. TITLE OF THESIS OR PROGRAM/PROJECT The title is the distinctive name given to the research proposal
(program or project), which describes the work scope in specific, clear, and concise terms.

4. STUDENT RESEARCHER OR PROGRAM/PROJECT LEADER

Field of specialization:

Email Address (this is where you will receive feedback and the Notice to Conduct): [email protected]

Email Address of Adviser or DRC (for students):

Mobile Number: 09756861981

Percentage of time to be devoted to research (for program/project leaders only):

5. IMPLEMENTING AGENCY This refers to the agency(ies) implementing the research proposal.

USM (University of Southern Mindanao)

6. COOPERATING AGENCY This refers to the agency/ies which is/are expected to cooperate or contribute
to the research work.

N/A

7. SIGNIFICANCE OF THE PROPOSAL This is the rationale of the research. It answers the question, “what is
the research for?”

8. LITERATURE REVIEW This section should discuss literatures relevant and specific to the topic of the
research proposal. It should be complete enough so the reader can be convinced that the research
proposal being presented is built upon sound information base, addresses current country health
 priorities and will contribute something new to health and/or allied health sciences.

9. OBJECTIVES This section enumerates the goals that the program or project would attempt to achieve. If
possible, delineate the general from the specific objectives. Research objectives should be: Specific,
Measurable, Attainable, Relevant and Time-bound. If the proposal is a program, the program objectives
as well as specific project objectives should be indicated.

10. EXPECTED OUTPUT(S) This refers to the end results (e.g., production technology or knowledge)
expected upon completion of the research. The output(s) needs to be identified to highlight
impact/importance of the research.

11. END-USERS OR TARGET BENEFICIARIES This refers to the probable end-users or beneficiaries of the
research output, the number and locality of beneficiaries, if applicable.

12. DURATION OF THESIS/PROGRAM OR PROJECT This refers to the planned start date, completion date,
and duration in months.

Planned Start Date:

Completion Date:

Duration in Months:

13. METHODOLOGY

Research Design – this section indicates how the research objectives will be achieved. It includes a
description of the type of research design (e.g., cross sectional, case control, cohort, etc.)
 Research Population – this is required for studies involving animals and humans.

Description of Target Population: _________________________________________________

Projected number of participants: ____

Age of participants: ____

Inclusion Criteria – this section describes the criteria each research participant must satisfy to enter
the research. These criteria may include, but are not limited to the following: age, sex, race, diagnosis
or condition, method of diagnosis, and diagnostic test.

Exclusion Criteria – this section details the criteria that would eliminate a participant from
participation in the research.

Sample Size Computation – this section describes the type of sampling design, and the assumptions
used to compute the sample size.

Research Site – this section details the location, station, or unit where research will be conducted.

Research Plan – this section explains the plan of action, procedures and methods to be used during
the research. Detailed methodology is described for laboratory, diagnostic, interviews, and manner of
data collection. Special instrumentation may be described in a subsection (instrumentation or data
collection tools, special equipment, etc.

Case Report Form – The Case Report Form (CRF) should be attached to the research proposal. If the
CRF is in electronic format, a printed copy should be attached as an appendix, if applicable.

Write N/A for new applications or if not applicable.

Variables to be Investigated – dependent/outcome and independent variables.

Ethical Considerations – Is there a section on Ethical Considerations (the steps you will take to ensure
ethical standards are followed) in your thesis outline?
 ____ Yes

____ No

If you answered “No,” please make sure that a section on Ethical Considerations is included in your final
manuscript.

14. PLANS FOR DATA PROCESSING AND ANALYSIS

- Computer facilities to be used, software packages
- Statistical tools or tests to be used
- Dummy tables

15. WORK PLAN SCHEDULE This is brief description in chronological order of each activity to be undertaken.
The plan of work of a project should reflect the schedule of the study components. For the program,
individual schedules of each of the projects should be supplied. A Gantt chart of activities should be
given. This chart will indicate the relative time frame and schedule of the major activities of the
proposal, including plans for research utilization, if available.

For USM student researchers, skip this part.

16. ETHICAL AND BIOSAFETY CLEARANCE Ethical clearance from the agency’s Research Ethics Committee
(REC) is required for research involving the use of human participants. In the absence of the REC, the
implementing agency may submit their research proposal for ethical review to the National Ethics
Committee (NEC). An ethical clearance is required prior to review of the proposal.

If not applicable, skip this part.

17. RESEARCH UTILIZATION This section should indicate the strategies to be used in disseminating and
ensuring utilization of the expected research results. For product-based research, proposal should
include the prospective technology user, as well as plans for technology transfer.

For USM student researchers, skip #17 and proceed to #18.

18. ESTIMATED BUDGETARY REQUIREMENTS Indicate the annual budget of the proposal according to
source of funds. For the first year, specify the budget for major expense items. For succeeding years,
only the total annual budget is required initially. The detailed breakdown of financial assistance
requested should be in accordance with the New Government Accounting System (NGAS); the
counterpart funding of the implementing agency as well as other agencies cooperating in the project
should also be reflected. Details of the financial requirements per expense item and source of funds are
illustrated at the end page.
 19. CURRICULUM VITAE This portion provides relevant information regarding the proponent’s research
capability. Please write all relevant trainings and subjects/courses that you took that
make you capable of conducting the research. For example, trainings that you may
include (depending on your topic and methodology) are research, statistics,
physico-chemical analysis, etc. If you do not possess the training that is required for
your study, you are required to involve a co-adviser whose expertise can address
the requirements of the thesis. If this is not possible, please include your action
plans (like consult with an expert, send your samples to a third party for analysis,
etc).

20. ENDORSEMENT FROM THE AGENCY HEAD This can be the project proposal endorsed by the Head of
Agency, or a copy of the signed MOA for the project.

For USM student researchers, skip this part and move to the next.

21. BIBLIOGRAPHY An alphabetical, numerical list referencing or of source of relevant information or

literature as used in referred medical journals or other international journals, should be followed.

For USM students:

By submitting this form, you confirm that your responses and attachments have been checked by my
Department Research Coordinator (or College Research Coordinator if your department does not have a
DRC).