CULTURAL HERITAGE ASSESSMENT TOOL

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Submit to the Assignment Drop Box found on the home page by the date posted on the course
outline. Directions for submitting it to the Drop box will be found when you click on "Cultural
Heritage Survey" in the Drop box.
Interview someone from a different ethnic or cultural background from your own.
This set of questions is related to a given persons -- ethnic, cultural, and religious background. It
can help you to perform a heritage assessment to determine how deeply a given person identifies
with his traditional heritage. It is most useful in setting the stage so that you can begin to assess
and understand a persons traditional health and illness beliefs and practices and in helping to
determine the community resources that will be appropriate to target for support when necessary.
The greater the number of positive responses, the greater the degree to which the person may
identify with his traditional heritage. The one exception to positive answers is that the questions
about whether or not a persons name was changed may well be negative. Background rationale
for the development of this tool is found in Chapter 4.
Your name: Samantha Johnson
Date : 6/6/16

Person Surveyed: Vanessa Chavez

How do you know this person and why did you decide to interview him/her ?
I have worked with Vanessa full time for four years.

Survey:
To the best of your knowledge, what is your Heritage (ethnic background)?
Hispanic__________________________________________________________________
1. Were you or any of your family (parents, grandparents, great-grandparents etc.) born outside of
the United States? If so, describe who and where you/they were born and the ages you/they
were when immigrating into the U.S. (to the best of your ability)
My parents immigrated to the US when they were 30 years old. I was born in the United
States._____
________________________________________________________________________
2. What is your native language? _Spanish__________________
Do you speak/understand this language?

(1) Prefer ____x___ (2) Occasionally ______

(3) Rarely ________

Do you read your native language? (1) Yes ___x___ (2) No ______
3. Are other languages spoken in your family home and if so which?
__English_____________________

4. What setting did you grown up in? Urban ____x___________ Rural

_______________________
5. When you were growing up, who lived with you? __Parents and
siblings____________________________________

6. Did most of your extended family; grandparents, aunts, uncles, cousins live near your home?
(1) Yes _____ (2) No _x___
7. Approximately how often did you visit your family members who lived outside of your home?
__once every 2 weeks
________________________________________________________________________
8. Was your original family name changed? (1) Yes _______ (2) No __x______
9. What kind of school did you go to? (1) Public __x__ (2) Private ____ (3) Parochial (Religious)
___
10. As an adult, do you live in a neighborhood where the neighbors are primarily the same religion
and ethnic background as yourself? (1) Yes ________ (2) No ___x_____
11. Do you belong to a religious institution? (1) Yes ___x_____ (2) No ________
12. Would you describe yourself as an active member? (1) Yes ___x_____ (2) No ________
13. How often do you attend your religious institution?
(1) Daily _________ (2) Weekly __________ (3) Monthly___x_____
(4) Special holidays only ___________ (5) Never _____________
14. Do you practice your religion in your home? (1) Yes ___x__ (2) No ______
(if yes, please specify how)
(3) Praying __x___ (4) Religious Reading _____ (5) Diet ____x___ (6) observing holy days
_________
(6) Celebrating religious holidays ___x__ (7) Other ________________
15. If you are married, is your spouse the same religion as you? (1) Yes ____ (2) No _x____
16. If married, is your spouse the same ethnic background as you? (1) Yes __x__ (2) No _____

17. Do you prepare foods of your ethnic background? (1) Yes ___x___ (2) No ______
18. Do you participate in ethnic activities? (1) Yes __x___ (2) No _____ (if yes, please specify)
(3) Singing ____ (4) Holiday celebrations __x___ (5) Dancing __x___ (6) Festivals ____
(7) Costumes _____ (8) Other _______________
19. Are your friends from the same religious background as you? (1) Yes ___x__ (2) No _____
20. Are your friends from the same ethnic background as you? (1) Yes ___x_ (2) No _____
21. What rituals/rites are important to you and your family and how do you observe them i.e. the
birth of a child, holidays etc. ___________Christmas, we get closer to the family and spend quality
time together. Also, day of death- remembering friend of family who have died.
_____________________________________________________________
______________________________________________________________
22. List some of your/your families beliefs about keeping healthy and preventing illness.
_____Place an amulet azabache on infants to protect them against mal de ojo evil eye. Also the
use of agave plant in cooking and drinks to prevent high cholesterol.
______________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
23. List some of your/your families "home" or traditional remedies for treating injury or illness.
__My family and everyone I know uses Vicks vapor rub for everything, but mostly cold and chest
pain. Also, Clavo oil of clove is used topically for toothaches. And we use Chamomile tea for colic
and upset stomach.
______________________________________________________________________
______________________________________________________________________________
________________________________________________________________________

24. If this cultural/ethnic population is listed in the textbook contrast the health and illness beliefs
described above with those listed in the book. Are they similar or not? (If this culture is not found in
your book please do research, and cite the source, about this group or population to answer the
question). Please add space if needed below.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

__________________________________________________________________
Taken and adapted from: Spector, R, E., Cultural diversity in health & illness (7th ed., Appendix E),
pp. 365-367.
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