Section of Supportive Hospice and Palliative Medicine

Department of Family and Community Medicine

University of the Philippines – Philippine General Hospital
Manila

SHPM PROGRAM DOCUMENT (CFAT 012011-0)

SHPM COMPENDIUM OF FILIPINO ASSESSMENT TOOLS FOR RESEARCH AND PRACTICE

THE FAMILY APGAR

AUTHOR/S: Gabriel Smilkstein, M.D.

FILIPINO VERSION: Philippine Academy of Family Physicians (PAFP)

PURPOSE: To assess general family function.

DESCRIPTION: Family function measures the extent to which a family works as a unit; it denotes the family’s ability to cope and adjust to
different situations based on 5 components: adaptation, partnership, growth, affection and resolve. The Family APGAR (Adaptation,
Partnership, Growth, Affection, and Resolve) was originally designed by Smilkstein to assess family function and is a rapid screening
instrument for the family function-dysfunction. This tool permits qualitative measurement of the family member’s satisfaction about family
relationships, and with the basic components of family function – Adaptation, Partnership, Growth, Affection and Resolve. It would
therefore reflect the caregiver’s view of the functional state of his family. The Family APGAR questionnaire has been used in numerous
studies (mostly clinical studies) investigating family functioning. In the Philippines, it is one of the most common tools used by family
physicians for assessing families in the clinical setting.

SCORING: The Family APGAR consists of statements on five (5) parameters of family functioning: Adaptability, Partnership, Growth,
Affection and Resolve. The family member’s response is based on the frequency of feeling satisfied with each of the five parameters using a
3-point scale ranging from 0 (hardly ever) to 2 (almost always). The higher the score, the higher the level of family function. More
specifically, a higher score can be interpreted as a greater degree of satisfaction with family functioning. Based on Smilkstein’s original
recommendations, the scale is scored by summing the values for the five items for a total score that can range from 0-10. A score of 0-3
denotes a severely dysfunctional family, 4-7 moderately dysfunctional family and 8-10 highly functional family

RELIABILITY: The Family APGAR has excellent internal consistency. Cronbach’s alpha values reported across studies using Family
APGAR have ranged from .80 to .85, and item-to-total correlations ranged from .50 to .65.

VALIDITY: Smilkstein’s original validation study in 1978 established a good correlation between the Family APGAR and a popular
validated tool at the time, the Pless Satterwhite Index (r= 0.80), and actual clinician report (r= 0.64). The Family APGAR has already been
used in many studies. Although not all studies have shown significant associations with various variables, the Family APGAR has been
shown in some studies to be associated with many variables such as compliance, emotional state such as depression, subjective well being,
subjective health rating, and subjective rating of quality of life (this list of associations seen in studies is not exhaustive). The Filipino Family
APGAR has also been used in many studies in the Philippines; and appears to have similar associations with various variables as the original
Family APGAR; unfortunately, documents and results of many of these studies are not readily available. However, there have been recent
studies which showed that the Family APGAR may not adequately measure family dysfunction ion the primary care setting. Future research
has been suggested to further clarify what the Family APGAR measures (Gardner, Nutting et al, 2001).

REFERENCES: Smilkstein G. (1978). The family APGAR: A proposal for a family function test and its use by physicians. J Fam Pract. Jun;
6(6):1231-9. Pineda, A. (1999). Tools for family assessment. In Bugayong R and Pineda A, eds. PAFP Proceedings of the Orientation Course
in Family Medicine (pp. 36-50). Makati City: Philippine Academy of Family Physicians. Gardner W, Nutting PA, Kelleher KJ, Werner JJ,
Farley T, Stewart L, Hartsell M, Orzano AJ. Does the family APGAR effectively measure family functioning? J Fam Pract. 2001
Jan;50(1):19-25

In addition to the primary reference, this document can be cited as follows: M. Medina and the Section of Supportive Hospice and Palliative
Medicine (SHPM). The Family APGAR. SHPM Program Document. Compendium of Filipino Assessment Tools for Research and Practice
(CFAT 012010-0). SHPM, DFCM, UP-PGH. 2011.

AVAILABILITY: The original Family APGAR (Smilkstein) and the Filipino Family APGAR (PAFP, Pineda) are public domain
instruments which are already routinely used in clinical practice and research. Permission to use is not required.

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 FAMILY APGAR – FILIPINO

Palagi Paminsan Halos

Tungkol sa aking pamilya…
-minsan Hindi
Ako’y nasisiyahan dahil nakakaasa ako ng tulong sa aking pamilya sa oras ng
A problema
Ako’y nasisiyahan sa paraang nakikipagtalakayan sa akin ang aking pamilya
P tungkol sa aking problema
Ako’y nasisiyahan at ang aking pamilya ay tinatanggap at sinusuportahan ang
G aking mga nais na gawin patungo sa mga bagong landas para sa aking
ikauunlad
Ako’y nasisiyahan sa paraang ipinadadama ng aking pamilya ang kanilang
A pagmamahal at nauunawaan ang aking damdamin katulad ng galit, lungkot at
pag-ibig.
Ako’y nasisiyahan na ang aking pamilya at ako ay nagkakaroon ng panahon sa
R isa’t isa.

FAMILY APGAR – ENGLISH

Almost Some of Hardly

About my family…
Always the Time Ever
I am satisfied that I can turn to my family for help when something is troubling
A me
I am satisfied with the way my family talks on things with me and shares
P problems with me
I am satisfied that my family accepts and supports my wishes to take on new
G activities or directions
I am satisfied with the way my family expresses affection and responds to my
A emotions such as anger, sorrow and love

R I am satisfied with the way my family and I share time together

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