Introduction: Effective vaccination campaigns have been instrumental in reducing COVID-19 transmission and severe disease outcomes. Despite efforts to improve vaccine accessibility, vaccine literacy and confidence remain important determinants of vaccine uptake. Rural and geographically isolated communities often experience barriers to healthcare access that may affect vaccination coverage. This study aimed to assess COVID-19 vaccination coverage, vaccine literacy, and vaccine confidence among residents of selected Geographically Isolated and Disadvantaged Areas (GIDAs) in Floridablanca, Pampanga. Methods: A descriptive cross-sectional study was conducted among 211 residents of Barangays San Ramon and Nabuclod. Data were collected through face-to-face interviews using a translated and pretested questionnaire on vaccine literacy and vaccine confidence. Vaccination records obtained from the Rural Health Unit were reviewed to determine COVID-19 vaccination coverage. Descriptive statistics, including frequencies and percentages, were used to summarize the data. Results: The majority of respondents demonstrated an average level of vaccine literacy (75.8%), while 17.5% exhibited high vaccine literacy. Most respondents also demonstrated positive to very positive vaccine confidence (71.6%). Among the eligible population, 80.5% had completed the primary COVID-19 vaccination series, whereas 19.5% remained unvaccinated. Among those who completed the primary series, only 24.2% had received at least one booster dose. Conclusion Residents of the selected GIDAs generally demonstrated average vaccine literacy, positive vaccine confidence, and relatively high primary COVID-19 vaccination coverage. However, low booster uptake and the persistence of unvaccinated individuals highlight the need for sustained health education, improved healthcare accessibility, and targeted community-based interventions. These findings underscore the importance of strengthening vaccine literacy and confidence to support future immunization programs in geographically isolated communities.
COVID-19 ; Rural Health ; Vaccination coverage

Introduction: Medical student attrition and poor academic performance have implications for both medical schools and the future healthcare workforce. This study aimed to determine the demographic and academic characteristics of first-year medical students with low academic performance across different instructional modalities—traditional face-to-face, online, and HyFlex learning. Methods: This non-concurrent cohort study included first-year medical students enrolled from School Years (SY) 2018–2019 to 2024–2025. Student characteristics analyzed included sex, pre-medicine degree, pre-medicine general weighted average (GWA), National Medical Admission Test (NMAT) score, and academic performance in annual first-year subjects. Low academic performance was defined as failure in at least one annual subject. Students were grouped according to instructional modality: face-to-face (SY 2018–2020), online (SY 2020–2022), and HyFlex (SY 2022–2025). Demographic and academic characteristics were compared between students with and without low academic performance. Results: A total of 2,936 first-year medical students were included. The proportion of students with low academic performance was 19% during the face-to-face period, 17% during the online period, and 27% during the HyFlex period. Across all instructional modalities, students with low academic performance had significantly poorer pre-medicine GWA than students who passed all annual subjects (p<0.05). During the online and HyFlex periods, students with low academic performance also had significantly lower NMAT scores than students who passed all annual subjects (p<0.05), whereas no significant difference in NMAT scores was observed during the face-to-face period. Conclusion Pre-medicine GWA was consistently associated with academic performance across face-to-face, online, and HyFlex instructional modalities. Lower NMAT scores were associated with low academic performance during online and HyFlex learning. Early identification of students with poorer pre-medicine academic performance and lower NMAT scores may facilitate timely academic support.
Students, Medical ; Academic performance ; Education, Distance ;