CONDUCTING FAMILY HEALTH ASSESSMENT

LINKS for family health assessment: https://www.youtube.com/watch?

v=p77hAbldXvU&t=98s
https://www.youtube.com/watch?v=e_RngyviG0E&t=308s

LEARNING OBJECTIVES:

Using the family assessment guide forms, students should be able to

comprehensively assess your own family
 demographic data;
 home and home environment details;
 health and health practices; and
 awareness on community resources and organizations.

Introduction

ASSESSMENT PHASE
The family health process involves conducting an initial assessment to
determine the presence of any health problem.

The assessment phase includes the collection and analysis of relevant

factual information regarding the client’s current health status, his capacity to
solve health problems and his present environment.

The following are the three sources of data reflecting the family health status:

1. Health status of family members- shows whether there are

deviations in the health condition of individual members.

2. Ability and willingness of the family to promote wellness among

its members- shows the nature and the extent of the family’s
performance of specific tasks to meet the physical, social, and
emotional needs of its members.

3. Family environment- defines the conditions in the home and

environment that interfere with the promotion and/or maintenance of
the family members’ health and recovery from illness.

Please read first the power point and PDF shared before doing this Family Health
assessment Guide activity.
 FAMILY HEALTH ASSESSMENT GUIDE 1
I. GENERAL DATA
Family Name : Pampanga
Name of Barangay : Upper Lumbo
Name of Purok : Purok-3
Household No : 150

II. FAMILY DATA

Length of residency : 20 Years
Place of origin : Valencia City, Bukidnon, 8709
Family size : Small
Religion :
Husband : Roman Catholic
Wife : Roman Catholic
FAMILY MEMBER’S CHART
Marital Highest
Name Relation to Head Sex Date of Birth Age Status Education Occupation
Month Day Year Type of work Place
Geoffrey Noel N. Pampanga Father Male December 25 1970 50 Married College Self-Employed Home
Graduate
Leonor T. Pampanga Wife Female May 28 1973 47 Married College School Nurse Valencia National
Graduate High School
Geno Adrian T. Pampanga Son Male August 27 2000 20 Single Senior High Student Central Mindanao
School University
 GENOGRAM
LINK on how to make a genogram: https://www.youtube.com/watch?v=F1tcrVdIYpw

DIRECTION: Draw a family structure of your family. Outline legends that will explain that the picture
III. FAMILY CHARACTERISTICS
1. Type of Family Structure
( ) Extended ( ) Matriarchal ( ) Dominant family member ( ) Nuclear ( ) Patriarchal
2. General Family Relationship/Dynamics
CRITERIA STATUS ADDITIONAL INFORMATION
Observable conflicts between family members Negative
Characteristics of communication Positive Respectful with Parents
Interaction patterns among members Positive
3. Monthly Family Income Source
Husband: Self-Employed Wife: School Nurse Others: ___________
( ) P 3, 000.00 and below ________ ( ) P16, 000 – P20,000.00 ___________
( ) P 4, 000.00 – P10, 000.00 ________ ( ) P 20, 000 and above ___________
( ) P 11, 000.00 – P15, 000.00 ________

4. Family member heading on decision making? Father and Mother

IV. HOME AND ENVIRONMENT
1. House

A. Ownership: ( ) Owned ( ) Rented ( ) Others

B. Type of housing
( ) wood ( ) concrete ( ) mixed ( ) makeshift ( ) others, specify ___________
C. Number of rooms used for sleeping: __________________________________________
D. Furniture: ( ) None ( ) Limited ( ) Adequate
E. Home appliances present: __________________________________________________
F. Lighting Facilities: ( ) Electricity ( ) Kerosene ( ) Others, specify
G. Safety Hazards: ( ) Loose, rickety stairs ( ) Loose doors, walls, post
Windows: ( ) None ( ) only 1 ( ) more than 1
Sharps and matches within reach of children? ( ) Yes ( ) No
Soft drinks bottles used as kerosene container? ( ) Yes ( ) No
Medicine and poisonous substances kept side by side? ( ) yes ( ) No
H. Is the living space adequate? ( ) yes ( ) no
2. Food Storage/Cooking Facilities
A. Food storage and handling (for left over)
( ) Covered ( ) Given to animals
( ) Not covered ( ) Others, pls. specify _____________________
B. Cooking facilities
( ) Fire wood ( ) LPG fueled
( ) Kerosene/stove ( ) Electric stove
3. Water Facility
A. Source of water supply
( ) spring ( ) water well/closed ( ) bought
( ) water district ( ) open/artesian ( ) others, specify _____
B. Water source ownership
( ) Shared ( ) Owned ( ) Provided by the government ( ) Others
C. Drinking water storage
( ) Covered ( ) Uncovered ( ) faucet
( ) Owned ( ) Shared ( ) refrigerated
D. Containers used
( ) plastic pitchers ( ) bottles ( ) jars, clay pots ( ) others, pls. specify _________
E. Distance of comfort room from the water source: _________________________________
 4. Waste Management
A. Garbage
1. Type of garbage disposal
( ) collected _________ ( ) burning ( ) waste segregation
( ) burying ( ) feeding to animals ( ) open dumping
( ) throw in the river/sewer ( ) garbage can ( ) others, pls. specify _______
2. Waste segregation method: ( ) yes ( ) no
If yes, specify method: __________________________________________________
3. Do you recycle garbage? ( ) yes ( ) no
If yes, specify how: ____________________________________________________
B. Toilet
1. Toilet ownership: ( ) shared ( ) owned ( ) others, pls. specify __________
2. Type of waste disposal:
( ) flush ( ) water-sealed ( ) pit privy ( ) antipolo
( ) cat hole ( ) others, please specify: _________________________________
5. Premises indication
A. Type of drainage system: ( ) open ( ) close
B. Drainage
( ) Present ( ) None ( ) Covered
( ) Uncovered ( ) Others, pls specify _____________________________
Frequency of cleaning
( ) Daily ( ) weekly ( ) Monthly
( ) Yearly ( ) Others, pls specify _____________________________
C. Breeding places
( ) Present ( ) None ( ) others, pls specify________
Methods used to control breeding places
( ) Fogging ( ) Mosquito net ( ) Insecticides
( ) None ( ) Others, pls specify_____________________________
Frequency of method used
( ) Daily ( ) Monthly ( ) weekly
( ) Yearly ( ) Others, please specify ________________________
D. Pets/animals kept in the yard/home
____________________________________________________________________
6. Plants/Vegetation
A. Plants in the surroundings
( ) Vegetable ( ) Herbal ( ) Ornamental
B. List kinds of vegetable/herb plant found in the surroundings
Spearmint, Eucalyptus Mint, Tomatoes, Sayote, Ampalaya, Squash, Patola, Eggplant, Winged
Bean, Chili, Oregano, Rosemary, Sage, Basil, Blue Ternate, Calamansi, Alugbati, Chives,
Peanuts, Cauliflower, Kamote, Strawberries, Corn, Okra, Peas, Peppermint.
C. Information on the herbal plants approved by DOH? ( ) Yes ( ) No
If yes, please fill up the table below:
HERBAL PLANT INDICATION METHOD OF USE
Ampalaya Lower blood sugar levels, and Cooking, Drink as tea.
prevents diabetes mellitus
Yerba Buena (Peppermint) Rheumatism, arthritis, Drink as tea.
headache, cough and cold
 HERBAL PLANT INDICATION METHOD OF USE

V. HEALTH AND HEALTH PRACTICES

1. Common illnesses encountered for the last 6 months and the treatment applied.
NAME COMMON ILLNESS TREATMENT
Geoffrey Noel N. Pampanga Gout, Hypertension Avoiding foods that can cause Gout, Taking
maintenance medication for hypertension.
Leonor T. Pampanga Hypertension Taking maintenance medication for
hypertension.

2. Whom do you consult for health-related problems?

( ) hilot ( ) midwife ( ) doctor ( ) albularyo
( ) barangay health worker ( ) rural health center ( ) nurse ( ) others __________
3. Delivery system: ( ) home ( ) hospital ( ) clinic ( )others ___________
4. Availability/Utilization of health services: ( ) Yes ( ) No, Why________________
5. Health personnel feedback ( ) Friendly ( ) Unfriendly
6. Immunization status of family members
A. Are you aware of immunization program? ( ) Yes ( ) No
If No, specify reasons: _______________________________________________________
B. How were you informed of the program?
( ) Radio ( ) Barangay Health Center ( ) TV
( ) Midwife ( ) others, specify ______________________________________________
C. Are your children immunized? (ages 0 – 2 ) ( ) Yes ( ) No
If no, specify reasons? _______________________________________________________
If yes, fill up the chart below:

COMPLETE/INCOMPLETE OR NO
NAME OF PERSON AGE IMMUNIZATION
Geoffrey Noel N. Pampanga 50 Complete Immunization
Leonor T. Pampanga 47 Complete Immunization
Geno Adrian T. Pampanga 20 Incomplete Immunization

D. Place where the child obtains immunization inoculation?

( ) Barangay Health Center ( ) Clinic ( ) Hospital ( ) Others __________
E. Do you know the diseases a child would acquire if not immunized? ( ) Yes ( ) No
If yes, specify the disease ________________________________________________________
F. Do you know the symptoms and side effects after the child get immunized? ( ) Yes ( ) No If yes,
what measures taken to ease the effect of the vaccines? .
G. Did you pay for the vaccines? ( ) Yes ( ) No
7. NUTRITION
A. Children 0-5 years old; 6 years and above.
 AGE IN NUTRITION
NAME OF CHILD/PERSON MONTHS/YEARS WEIGHT HEIGH BMI STATUS
T
Geoffrey Noel N. Pampanga 50 90 kg
Leonor T. Pampanga 47 65 kg
Geno Adrian T. Pampanga 20 90 kg

B. Food given to children 0-2 years:

( ) breastmilk ( ) milk formula ( ) mixed feeding – (BF +) ( ) Others, specify:__________
C. Type of infant formula used: ___________________________________________________
D. How they clean their feeding bottle? _____________________________________________
E. What supplementary foods do they give to the child? _______________________________
F. Does Vitamin A give to children of 12 – 59 mos.? ( ) Yes ( ) No
If yes, when was the last vitamin given? Month’s __________ Year _____________
G. Type of Food: ________________________________________
How often: ___________________________________________
8. PREGNANCY (NOT APPLICABLE)
LAST NUMBER OF
NAME OF PREGNANT MENSTRUAL AGE OF TETANUS NUMBER OF PRENATAL
WOMAN PERIOD PREGNANCY TOXOID PREGNANCY VISITS

N/A
A. Did you experience miscarriage? ( ) Yes ( ) No
If yes, specify the reason? __________________________________________________
B. Where do you go for prenatal? ( ) Health Center ( ) Therapist
( ) Doctor ( ) Others, specify__________

9. FAMILY PLANNING
A. Were you informed about family planning? ( ) Yes ( ) No
If No, Specify_______________________________________________________________
B. Where did you get the information?
( ) BHW/Health Center
( ) Government offices Name: DepED, DOH
( ) Private Agencies Name: _________________________
( ) Media
[ ] TV
[ ] Radio
[ ] Press
( ) others (please specify) ______________________________________________________
C. What kind of Family planning method did you use?
( ) IUD ( ) Pills ( ) Condom ( ) Ligation ( ) Vasectomy ( ) Injectables
( ) Calendar Method ( ) LAM
( ) others (please specify) ______________________________________________________
D. How long have you been using the family planning method? __________________________
E. Was there any significant effect you felt as you used this kind of method? ( ) Yes ( ) No
If yes, please specify below:
___________________________ ___________________________
___________________________ ___________________________
___________________________ ___________________________
 10. Have you had adequate
A. rest and sleep? ____ (yes) _____ (no)
B. exercise? ____ (yes) _____ (no)
C. relaxation activities? ____ (yes) _____ (no)
D. stress management activities? ____ (yes) _____ (no)

11. Felt Family Needs (Identify and rank according to priority)

FAMILY NEEDS PRIORITY
1. Food Security 2nd
2. Electricity and Water 1st
3. Gas 3rd
4. Entertainment 4th

VI. ENVIRONMENT
1. Kind of Neighbourhood Rural, Peaceful
2. Social and Health facilities available Basketball Court, Church
3. Communication and Transportation facilities Motorela Stop, Gas Station

VII. AWARENESS OF COMMUNITY ORGANIZATION

A. Are you aware of existing organizations in the community? ( ) yes ( ) no
B. Name all the organization/s you know.
Church Group__________________________________________________
C. Are you a member of any of these organizations? ( ) yes ( ) no
D. Are you aware of its activities and projects? ( ) yes ( ) no
E. How are you involved in its activities?
( ) attend meetings ( ) planning ( ) implementation ( ) evaluation
( ) give donations ( ) others, specify _______________________________________
F. Name 5 formal and informal leader of the community whom you think can lead the people.

1. Kagawad Roger
2.
3.
4.
5.

VIII. HEALTH INSURANCE

A. Information about Health Insurance ( ) Yes ( ) No
If yes, where the information obtained
( ) Government agency Name: PhilHealth
( ) Private agency Name: _________________________________________
( ) Media ( ) Others, specify _______________________________
[ ] TV
[ ] Radio
[ ] Barangay Health center

B. Do they have Health Insurance? ( ) Yes ( ) No

If No, please specify reasons and their plan to obtain health insurance: ___________________