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IDB Format

IDB Format

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Published by Isan Lutz

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Published by: Isan Lutz on Feb 18, 2013
Copyright:Attribution Non-commercial


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A. Family Structure and Characteristics 1. Members of the households and relationships to the head of the family. 2. Demographic Data – Age, sex, civil status, position in the family 3. Place of residence of each member (whether living with the family or elsewhere) (1,2,3 Table form) 4. Type of family structure – e.g. matriarchal, patriarchal, nuclear, extended, etc. 5. Dominant family member in terms of decision-making, especially in matters of HC. 6. General Family Relationship – presence of any obvious/readily observable conflict bet. Member 7. ADL: a. Sleeping Pattern 1. Are there regular hours of retiring and getting up, or this dependent on the whims of each individual? 2. Any nap during the day? 3. Do members sleep together? b. Eating Pattern 1. How many meals do the family have each day? 2. Who appears overweight or underweight? c. Leisure Time Activities 1. How does each member spend his/hear leisure hours? 2. Is the use of leisure times appropriate for the sex and age group of the individual? 3. Does any member have an all-consuming hobby? If yes, what effect does this have over the family? 4. Does the family have any point activities for leisure? B. Socio – Economic and Cultural Factors 1. Income and Expenses a. Occupation, place of work, and income of each working member (TABLE FORM) b. Adequacy to meet basic necessities (Food, clothing, and shelter) c. Who makes the decisions about the money and how is it spent? 2. Educational attainment of each member 3. Ethnic background and Religious Affiliation (2,3 table form) 4. Significant others – role/s they play in the family’s life 5. Relationship of the family to larger community – what is th participation of the family in community activities? C. Environment Factors 1. Housing a. Adequacy of living space b. Sleeping arrangement c. Adequacy of furniture d. Presence of insect and rodents e. Presence of accident hazards f. Food storage and cooking facilities g. Water supply – source, ownership, potability h. Toilet facility – type, ownership, sanitary condition i. Garbage/refusal disposal – type, ownership, sanitary condition j. Drainage system – type, sanitary condition 2. Kind of neighborhood; e.g. congested, slum, etc. 3. Social and health facilities available 4. Communication and Transportation facilities available D. Health Assessment of each member 1. Medical History of each member a. Past significant illness

expectations of the services of the community health nurse. Past experience with health professional – previous contacts. Illness states (diagnosed. Utilization of other preventive services 3. Perception of the role of health professional and their services. Value placed on prevention of disease a.b. . general evaluation of results. health actions taken) 2. if satisfactory or not. Source of medical care – is it the same or different for each individual? To whom does the family turn to for help in times of illness or crisis? 4. 5. Immunization status of children b.

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