INITIAL DATA BASE
Pls complete the information given below, use your
family as a basis.
A. Family Structure Characteristics and Dynamics
1. Members of the household and relationship 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
4. Type of family structure-e.g. patriarchal, matriarchal, nuclear or
extended
5. Dominant family members in terms of decision making especially on
matters of health care
6. General family relationship/dynamics-presence of any obvious/readily
observable conflict between members; characteristics,
communication/interaction patterns among members.
B. Socio-economic and Cultural Characteristics
1. Income and expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decision about money and how it is spent
2. Educational Attainment of each Member
3. Ethnic Background and Religious Affiliation
4. Significant others-role (s) they play in family’s life
5. Relationship of the family to larger community-nature and extent of
participation of the family in community activities
C. Home Environment
1. Housing
a. Adequacy of living space
b. Sleeping in arrangement
c. Presence of breathing or resting sites of vector of diseases (e.g.
mosquitoes, roaches, flies, rodents, etc.)
d. Presence of accident hazard
e. Food storage and cooking facilities
f. Water supply-source, ownership, pot ability
g. Toilet facilities-type, ownership, sanitary condition
h. Garbage/refuse disposal-type, sanitary condition
i. 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 Status of Each Family Member
1. Medical Nursing history indicating current or past significant illnesses
or beliefs and practices conducive to health and illness
2. Nutritional assessment (especially for vulnerable or at risk members)
§ Anthropometric data: measures of nutritional status of children-
weight, height, mid-upper arm circumference; risk assessment
measures for obesity : body mass index(BMI=weight in kgs. divided by
height in meters2), waist circumference (WC: greater than 90 cm. in
men and greater than 80 cm. in women), waist hip ration
(WHR=waist circumference in cm. divided by hip circumference in cm.
Central obesity: WHR is equal to or greater than 1.0 cm in men and
0.85 in women)
§ dietary history specifying quality and quantity of food or nutrient per
day
§ Eating/ feeding habits/ practices
3. Developmental assessment of infant, toddlers and preschoolers- e.g.
Metro Manila DevelopmentalScreening Test (MMDST).
4. Risk factor assessment indicating presence of major and contributing
modifiable risk factors for specific lifestyle diseases-e.g. hypertension,
physical inactivity, sedentary lifestyle, cigarette/ tobacco smoking,
elevated blood lipids/ cholesterol, obesity, diabetes mellitus, inadequate
fiber intake, stress, alcohol drinking, and other substance
abuse.
5. Physical Assessment indicating presence of illness state/s (diagnosed or
undiagnosed by medical practitioners )
6. Results of laboratory/diagnostic and other screening procedures
supportive of assessment findings.
E. Values, Habits, Practices on Health Promotion, Maintenance and Disease
Prevention. Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
§ Rest and sleep
§ Exercise/activities
§ Use of protective measure-e.g. adequate footwear in parasite-infested
areas; use of bed nets andprotective clothing in malaria and
filariasis endemic areas.
§ Relaxation and other stress management activities
4. Use of promotive-preventive health services
