Cultural Assessment Tool

Student Name____________________________
Consider the following aspects of your client’s culture. Assess each area using the guide
questions.
Health Beliefs and Practices
How do you define health? What practices do you use to stay healthy? What home remedies do you use? What home remedies
did your mother use? What do you believe caused your illness? Give me an example of when you were in a great deal of pain…
(Establish pain scale) How do you treat pain when it occurs? Are their parts of the body that are protected by modesty and must
be respected or avoided? Do you require a health care provider of the same gender, age, ethnic, racial or religious background?

Religious Influences and Special Rituals

Do you practice a religion? How important is religion in your daily life? How important is religion to you as a source of support
and comfort? What are your beliefs about hope? What are your beliefs about the afterlife and miracles?
Do you have any particular religious practices or beliefs that may affect your health or health care?

Language and Communication

What languages do you speak? What language do you speak at home? Are there topics that are considered taboo?
What words or phrases do you use to describe health or illness? Would you like an interpreter when discussing issues relating to
your health? Are there any signs which indicate respect or disrespect when communicating? Is touch appropriate?

Role of the Family

Who is in your immediate family? Who is the head of the household? Who makes the primary decisions concerning your health?
Are their any constraints in discussing death, chronic illness, procedures, or relationships with certain family members?
Are there members of your family who are particularly affected by your illness? Is it important to have family present when
someone is sick?

Sources of Support
Who are your major support people (family members, friends)?
Dietary Practices
What are your food preferences? (List some) Are any particular foods forbidden to eat? Are any foods believed to cause or cure
illness? What types of fluids do you drink throughout the day? Do you usually take ice in your beverages?

Date: