A. Family Structure Characteristics and Dynamics
- Members of the household and relationship to the head of the family.
- Demographic data-age, sex, civil status, position in the family
- Place of residence of each member-whether living with the family or elsewhere
- Type of family structure-e.g. patriarchal, matriarchal, nuclear or extended
- Dominant family members in terms of decision making especially on matters of health care
- General family relationship/dynamics-presence of any obvious/readily observable conflict between members; characteristics, communication/interaction patterns among members.
B. Socio-economic and Cultural Characteristics
- Income and expenses
- Occupation, place of work and income of each working member
- Adequacy to meet basic necessities (food, clothing, shelter)
- Who makes decision about money and how it is spent
- Educational Attainment of each Member
- Ethnic Background and Religious Affiliation
- Significant others-role (s) they play in family’s life
- Relationship of the family to larger community-nature and extent of participation of the family in community activities
C. Home Environment
- Adequacy of living space
- Sleeping in arrangement
- Presence of breathing or resting sites of vector of diseases (e.g. mosquitoes, roaches, flies, rodents, etc.)
- Presence of accident hazard
- Food storage and cooking facilities
- Water supply-source, ownership, pot ability
- Toilet facilities-type, ownership, sanitary condition
- Garbage/refuse disposal-type, sanitary condition
- Drainage System-type, sanitary condition
- Kind of Neighborhood, e.g. congested, slum etc.
- Social and Health facilities available
- Communication and transportation facilities available
D. Health Status of Each Family Member
- Medical Nursing history indicating current or past significant illnesses or beliefs and practices conducive to health and illness
- Nutritional assessment (especially for vulnerable or at risk members)
- Anthropometric data: measures of nutritional status of children-weight, height, mid-upper arm circumference; risk assessment measures for obesity : body mass index(BMI=weight in kgs. divided by height in meters2), waist circumference (WC: greater than 90 cm. in men and greater than 80 cm. in women), waist hip ration (WHR=waist circumference in cm. divided by hip circumference in cm. Central obesity: WHR is equal to or greater than 1.0 cm in men and 0.85 in women)
- dietary history specifying quality and quantity of food or nutrient per day
- Eating/ feeding habits/ practices
- Developmental assessment of infant, toddlers and preschoolers- e.g. Metro Manila DevelopmentalScreening Test (MMDST).
- Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyle diseases-e.g. hypertension, physical inactivity, sedentary lifestyle, cigarette/ tobacco smoking, elevated blood lipids/ cholesterol, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking, and other substance abuse.
- Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical practitioners )
- Results of laboratory/diagnostic and other screening procedures supportive of assessment findings.
E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. Examples include:
- Immunization status of family members
- Healthy lifestyle practices. Specify.
- Adequacy of:
- Rest and sleep
- Use of protective measure-e.g. adequate footwear in parasite-infested areas; use of bed nets andprotective clothing in malaria and filariasis endemic areas.
- Relaxation and other stress management activities
- Use of promotive-preventive health services