Interview Questionnaire: Family-focused Functional Assessment

Interview Questionnaire
Name
Institution
Due Date
Interview Questionnaire
Values/
Which religious or ethnic group do you identify with and why?
What are some of the beliefs of your religious or ethnic group towards sickness and visiting a hospital?
Are there instances when your beliefs made you skip a visit to the doctor? Please expound on the said beliefs.
What are some of your family’s health goals and how do you plan to achieve them?
What are some of the inherent health issues in the family and what measures are you taking to ensure future generations are not affected?
Nutrition
How do you think nutrition affects your health?
What would you say is a typical meal for the family?
What is your view on consuming fruits on a daily basis?
Given the option of soft drinks and water, what would you choose and why? What nutritional knowledge informs your decision to pick either option?
What are some of the types of food you consume?
Sleep/Rest
What are some of the family’s relaxing routines before sleep time?
On average, how many hours of sleep does each family member take?
How is the attitude of every family member after they have woken up?
What difficulties does each member of the family experience while trying to sleep?
How do you think the sleeping patterns and hours can be adjusted for every family member?
What is your take on the idea of getting between 6 to 8 hours of sleep every day?
Are there any signs of lethargy in some family members in the morning? If yes, how do you think their sleeping patterns influences this?
Elimination
What do you understand a healthy bowel pattern or bladder to be?
Offer a description of your bowel pattern. Explain the instances when this changes and what happens before you notice the change.
What are some of the surgeries or medical examinations that impacted a member’s bowel pattern?
How often does family members experience constipation and diarrhea issues? Describe the pattern leading to these issues.
Activity/Exercise
What impact do you think activity or exercise has on your health?
Describe some of the activities and exercise routines that the family has to help enhance the members&rs...