Develop an interview questionnaire to be used in a family-focused functional assessment. The questionnaire must include three open-ended, family-focused questions to assess functional health patterns for each of the following:

Interview Questionnaire for Family-Focused Functional Assessment

Health Perception/Values

  1. Your family defines health in what ways?
  2. Which factors do you consider to be important for good health?
  3. Do you have any cultural or spiritual beliefs that affect your family’s health practices?

Nutrition

  1. Which foods do you and your family eat most often?
  2. Are there any special dietary requirements or preferences you may have?
  3. What can your family do to ensure they get the right nutrition?

Sleep/Rest

  1. What number of hours does each member of the family get sleep per night?
  2. Is there anyone who has trouble falling asleep or not getting enough sleep?
  3. Is there a family bedtime routine?

Elimination

  1. Does anyone have any elimination issues or concerns in their family?
  2. What is the average number of times each member uses the toilet?
  3. How do you and your family eliminate toxins?

Activity/Exercise

  1. Which types of activities do you and your family enjoy?
  2. Do you and your family regularly exercise?
  3. Is there anyone with physical limitations in your family?

Cognitive

  1. What is your family’s way of dealing with stress?
  2. Are there any memory, cognitive, or other problems among the members of your family?
  3. Are there any activities that stimulate cognitive ability?

Sensory-Perception

  1. Is there anyone with sensory impairments in the family?
  2. What can your family do to ensure safety for people with sensory impairments in their home?
  3. Is there a routine in your home that helps you perceive the world differently?

Self-Perception

  1. What does your family think of themselves?
  2. Do any members of the family struggle with self-esteem?
  3. Are you and your family involved in positive self-perception activities?

Role relationship

  1. Which roles does each member of the family play within the household?
  2. Do you see any tensions or conflicts in your household due to expectations about the role of women?
  3. Do you have any family routines that promote communication and positive relationships?

Sexuality

  1. Do you have religious, cultural, or other beliefs about sexuality in your family?
  2. Are there any concerns regarding sexual health in the household?
  3. Do you have any family routines that encourage healthy sexual relationships?

Coping

  1. What is your family’s typical approach to dealing with stress?
  2. Do any members of the family experience difficulties coping with life?
  3. Are there any rituals in your home that encourage effective coping methods?

Family Structure

John and Maria were interviewed along with their three children: Jason, Emily, and Alex. Maria stays at home while John works as an accountant. Their family is of middle-class origin and they identify themselves as Caucasian. They are residents of suburban Atlanta and members of local churches. The family’s religious beliefs guide many of their values and health practices.

All-round Health Behaviors

According to the family, they are very concerned about their health and well-being. They consume healthy foods, exercise often, and get sufficient rest. Family members regularly go to church and take part in community services. Maria and John both noted that Maria tries to teach healthy habits to their children.

Health patterns that promote functional health

They have strong spiritual and community engagement values. They have strong support systems and their religious beliefs help them to make informed health decisions. Healthy eating habits and exercise are also important to the family.

Obstacles to health and Health Problems

Family members identified several problems with their health and obstacles to good health.

  1. Maria is suffering from chronic back pain that limits her ability for physical activity.
  2. Jason
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