Family Interview Questionnaire

Understanding family structure and style is essential to caring for a family in the

community setting. Conducting a family interview and needs assessment gathers information to

identify strengths, as well as potential barriers to health. This information ultimately helps

develop family-centered strategies for support and guidance.

This family health assessment is a two-part assignment. The information you gather in

the first part of the assignment will be utilized for the second part of the assignment.

Select a family, other than your own, and seek permission from the family to conduct an

interview. Utilize the interview questions complied in your interview questionnaire to conduct a

family-focused functional assessment. Document the responses as you conduct the interview. Do

not put the family’s name, but utilize initials, the gender of each family member, and their age.

The Interview Questionnaire

Develop an interview questionnaire to be used in a family-focused functional assessment. The

questionnaire must include open-ended, family-focused questions to assess functional health

patterns for each of the following:

  1. Collect information about the family’s environment. Is it a single-family dwelling? Are there

hazards in the environment, accident hazards, do they have indoor plumbing and cooking

facilities? What type of heating or cooling system is being used in the home?

  1. Does anyone in the family smoke, use chewing tobacco, consume alcohol, or illegal drug use?
  2. Values/Health Perception – how does the family assess their health status? What do they feel

that they need to work on or trouble areas?

  1. Who is the head of the household? Who has the final say in family decisions?
  2. Does the family operate with specific assigned roles, or are the roles less defined? Who cooks

dinner? Who does chores? Who helps the children with homework, bathes, and feeds them?

  1. How is the family performing in their roles? Are there work or school-related strain? Are the

children performing well in school?

  1. Role Relationship- are the interactions within the family healthy or strained?
  2. What are the family’s health-related behaviors? (Nutrition, Sleep, Activity/Exercise)
  3. How does the family earn their income? Do the parents both work?

Family Interview Questionnaire

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