Problem 1:
CRITERIA WEIGHT SCORE JUSTIFICATION
1. Nature of the 2 1 0.6 According to the World Health Organization
Problem (WHO), a lack of immunization in children
poses a significant global health threat.
- Health Threat Vaccination is one of the most effective public
health interventions, preventing millions of
deaths each year by protecting against
diseases such as measles, polio, and
diphtheria.
2. Modifiability of the 1 2 1 While catch-up immunizations can be
Problem arranged promptly due to the health center
being within walking distance, the community
- Partially faces resource challenges, evidenced by the
unavailability of the PCV vaccine at the health
Modifiable center.
3. Preventive Potential 1
4. Salience 1
Total Score:
Problem 2:
CRITERIA WEIGHT SCORE JUSTIFICATION
1. Nature of the 1
Problem
2. Modifiability of the 2
Problem
3. Preventive Potential 1
4. Salience 1
Total Score:
Problem 3:
CRITERIA WEIGHT SCORE JUSTIFICATION
1. Nature of the 1
Problem
2. Modifiability of 2
the Problem
3. Preventive 1
Potential
4. Salience 1
Total Score:
INITIAL DATA BASE
I. CHARACTERS:
A. What is the type of family structure?
_________ Nuclear ________Extended
_________ Patriarchal _________Matriarchal
B. Who makes decisions regarding health care? __________________
C. What is the present family relationship?
______ with conflicts between members
______ without conflicts between family members
D. Activities of daily living:
1. Sleeping pattern:
Retiring/getting up hours?
Nap during the day?
Do members sleep together?
2. Eating pattern:
How many meals each day? ________
Who appears overweight? __________
Who appears underweight? _________
3. Leisure time activities:
How does each member spend leisure hours?
Is it appropriate for the sex and age group?
What is the effect on the family?
Any joint activity for leisure?
II. FAMILY INFORMATION
Head of the family:________________________
Address:________________________________
Members of the household: _______
Name Relationship Age Educational Attainment
III. SOCIO-ECONOMIC AND CULTURAL FACTORS
A. Income
Name Occupation Place Income
1. Does the working family member meet the basic necessities?
_______Yes _______ No
2. Who makes decisions regarding money matters?
3. Religious affiliation:
4. What roles does the family play in the community?
IV. ENVIRONMENTAL FACTORS
A. Housing
1. Ownership
_____Owned _____Rented _____Rent-Free
2. Construction materials used
_____Light _____Mixed _____Strong
3. Living space
_____Adequate _____Inadequate
4. Sleeping arrangement:
5. Adequacy in furniture
_____Adequate _____Inadequate
6. Water source
_____Private _____Public
7. Food storage
_____Refrigerator _____Jars/container
8. Cooking facility
_____Electric stove _____Gas Stove
_____Firewood _____Kerosene
9. Drainage facility
______Open drainage _____Blind drainage _____None
10. Toilet facilities/type
______Flushed latrine _____Water-Sealed Latrine
______Bored-hole latrine _____Over hung
______Pail System _____None
11. Sanitary condition
_____Fair _____Poor _____Good
12. Neighborhood
______Congested _____Slum _____Other
13. Availability of Health Care Facility
Describe briefly (ex.walking distance): ______________________
14. Garbage disposal
_______Dumped at street corner _______Picked up by garbage collector
_______ Buried _______Burned then buried
V. HEALTH MEDICAL HISTORY
A. Presence of illness
______Diagnosed ______Undiagnosed ______None
Name Past illness Illness state Health Action Taken
VI. VALUE PLACED ON PREVENTION DISEASE
Name Age Complete Incomplete
Preventive practices employed by the family:
Sources of Healthcare:
_________ Health Center __________ Government Hospital
_________ Private Hospital __________ Others
Scale for Ranking Health Problems According to Priorities
Criteria Weight
1. Nature of the problem
Scale: Wellness State 3
Health Deficit 3
1
Health Threat 2
Foreseeable Crisis 1
2. Modifiability of the problem
Scale: Easily Modifiable 2
Partially Modifiable 1 2
Not Modifiable 0
3. Preventive Potential
Scale: High 3
Moderate 2 1
Low 1
4. Salience
Scale: A serious problem, immediate attention 2
needed
1
A problem but not needing immediate attention 1
Not a felt/need problem 0
Problem 1:
CRITERIA WEIGHT SCORE JUSTIFICATION
1. Nature of the 1
Problem
2. Modifiability of the 2
Problem
3. Preventive Potential 1
4. Salience 1
Total Score:
Problem 2:
CRITERIA WEIGHT SCORE JUSTIFICATION
1. Nature of the 1
Problem
2. Modifiability of the 2
Problem
3. Preventive Potential 1
4. Salience 1
Total Score:
Problem 3:
CRITERIA WEIGHT SCORE JUSTIFICATION
1. Nature of the 1
Problem
2. Modifiability of 2
the Problem
3. Preventive 1
Potential
4. Salience 1
Total Score:
INITIAL DATA BASE
I. CHARACTERS:
A. What is the type of family structure?
_________ Nuclear ________Extended
_________ Patriarchal _________Matriarchal
B. Who makes decisions regarding health care? __________________
C. What is the present family relationship?
______ with conflicts between members
______ without conflicts between family members
D. Activities of daily living:
1. Sleeping pattern:
Retiring/getting up hours?
Nap during the day?
Do members sleep together?
2. Eating pattern:
How many meals each day? ________
Who appears overweight? __________
Who appears underweight? _________
3. Leisure time activities:
How does each member spend leisure hours?
Is it appropriate for the sex and age group?
What is the effect on the family?
Any joint activity for leisure?
II. FAMILY INFORMATION
Head of the family:________________________
Address:________________________________
Members of the household: _______
Name Relationship Age Educational Attainment
III. SOCIO-ECONOMIC AND CULTURAL FACTORS
A. Income
Name Occupation Place Income
1. Does the working family member meet the basic necessities?
_______Yes _______ No
2. Who makes decisions regarding money matters?
3. Religious affiliation:
4. What roles does the family play in the community?
IV. ENVIRONMENTAL FACTORS
A. Housing
Ownership
_____Owned _____Rented _____Rent-Free
Construction materials used
_____Light _____Mixed _____Strong
Living space
_____Adequate _____Inadequate
Sleeping arrangement:
Adequacy in furniture
_____Adequate _____Inadequate
Water source
_____Private _____Public
Food storage
_____Refrigerator _____Jars/container
Cooking facility
_____Electric stove _____Gas Stove
_____Firewood _____Kerosene
Drainage facility
______Open drainage _____Blind drainage _____None
Toilet facilities/type
______Flushed latrine _____Water-Sealed Latrine
______Bored-hole latrine _____Over hung
______Pail System _____None
Sanitary condition
_____Fair _____Poor _____Good
Neighborhood
______Congested _____Slum _____Other
Availability of Health Care Facility
Describe briefly (ex.walking distance): ______________________
Garbage disposal
_______Dumped at street corner _______Picked up by garbage collector
_______ Buried _______Burned then buried
V. HEALTH MEDICAL HISTORY
B. Presence of illness
______Diagnosed ______Undiagnosed ______None
Name Past illness Illness state Health Action
Taken
VI. VALUE PLACED ON PREVENTION DISEASE
Name Age Complete Incomplete
Preventive practices employed by the family:
Sources of Healthcare:
_________ Health Center __________ Government Hospital
_________ Private Hospital __________ Others
Scale for Ranking Health Problems According to Priorities
Criteria Weight
5. Nature of the problem
Scale: Wellness State 3
Health Deficit 3
1
Health Threat 2
Foreseeable Crisis 1
6. Modifiability of the problem
Scale: Easily Modifiable 2
Partially Modifiable 1 2
Not Modifiable 0
7. Preventive Potential
Scale: High 3
Moderate 2 1
Low 1
8. Salience
Scale: A serious problem, immediate attention 2
needed
1
A problem but not needing immediate attention 1
Not a felt/need problem 0
Problem 1:
CRITERIA WEIGHT SCORE JUSTIFICATION
1. Nature of the 1
Problem
2. Modifiability of the 2
Problem
3. Preventive Potential 1
4. Salience 1
Total Score:
Problem 2:
CRITERIA WEIGHT SCORE JUSTIFICATION
1. Nature of the 1
Problem
2. Modifiability of the 2
Problem
3. Preventive Potential 1
4. Salience 1
Total Score:
Problem 3:
CRITERIA WEIGHT SCORE JUSTIFICATION
1. Nature of the 1
Problem
2. Modifiability of 2
the Problem
3. Preventive 1
Potential
4. Salience 1
Total Score:
