Initial Data Base for Family :
A. Family Structure Characteristics and Dynamics (table form)
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
B. Socio-economic and Cultural Characteristics (narrative
form)
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
6. Dominant family members in terms of decision making
especially on matters of health care
7. General family relationship/dynamics-presence of any
obvious/readily observable conflict between members;
characteristics, communication/interaction patterns
among members.
C. Home Environment (narrative form)
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 (narrative form)
(Focus only with the health problems/family)
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 Developmental Screening
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. (Narrative form)
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 and protective clothing in malaria and
filariasis endemic areas.,
Relaxation and other stress management activities
4. Use of promotive-preventive health service
5. Health practices (dietary/nutritional practices), health
seeking behaviors (alburlaryo)
6. Compliance / non-compliance/poor compliance
