Heritage Assessment
BOX 6 – 1 Heritage Assessment Tool 16. Is your spouse the same ethnic background as you? (1) Yes (2) No 17. What kind of school did you go to? (1) Public (2) Private (3) Parochial 18. As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself? (1) Yes (2) No 19. Do you belong to a religious institution? (1) Yes (2) No 20. Would you describe yourself as an active member? (1) Yes (2) No 21. How often do you attend your religious institution? (1) More than once a week (2) Weekly (3) Monthly (4) Special holidays only (5) Never 22. Do you practice your religion at home? (1) Yes (2) No (If yes, please specify) (3) Praying (4) Bible reading A Note: The greater the number of positive responses, the greater the person’s identification with a traditional heritage. The one exception to positive answers is the question about family name change. This question may be answered negatively, 1. Where was your mother born? India 2. Where was your father born? India 3. Where were your grandparents born? (1) Your mother’s mother? Indis (2) Your mother’s father? India (3) Your father’s mother? Indis (4) Your father’s father? andia 4. How many brothers 2 and sisters 0 do you have? 5. What setting did you grow up in? Urban Rural Suburban 6. What country did your parents grow up in? Father Indis Mother Indis 7. How old were you when you came to the United States? 23 8. How old were your parents when they came to the United States? Mother Father 9. When you were growing up, who lived with you? parents a brothers. 10. Have you maintained contact with a. Aunts, uncles, cousins? (1)
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Yes (2) No b. Brothers and sisters? (1) Yes c. Parents? (1) Yes d. Your own children? (1) Yes 11. Did most of your aunts, uncles, cousins live near your home? (1) Yes ___ (2) No 12. Approximately how often did you visit your family members who lived outside your home? (1) Daily (2) Weekly (3) Monthly (4) Once (5) Never 13. Was your original family name changed? (1) Yes 7 (2) NO 14. What is your religious preference? (1) Catholic (2) Jewish (3) Protestant (4) Denomination (5) Other – (6) None 15. Is your spouse the same religion as you? (2) No they both live in andis (5) Diet < (6) Celebrating religious holidays (2) No (2) No Z (2) No 23. Do you prepare foods of your ethnic background? (1) Yes (2) No 24. Do you participate in ethnic activities? (1) Yes_(2) NO (If yes, please verify) (3) Singing (4) Holiday celebrations (5) Dancing (6) Festivals (7) Costumes (8) Other 25. Are your friends from the same religious background as you? (1) Yes (2) No 26. Are your friends from the same ethnic background as you? < (1) Yes (2) No 27. What is your native language? n 28. Do you speak this language? (1) Prefer (2) Occasionally (3) Rarely 29. Do you read your native language? (1) Yes (2) No a year or less (1) Yes Source: Spector, R. E. (2000). CulturalCare: Guide to heritage assessment and health traditions (5th ed.). Pearson Education/PH College. BOX 6 – 1 Heritage Assessment Tool cobs Cuba Clubs ceba Note: The greater the number of positive responses, the greater the 16. Is your spouse the same ethnic background as you? person’s identification with a traditional heritage. The one exception to positive answers is the question about family name change. This (1) Yes(2) No question may be answered negatively. 17. What kind of school did you go to? (1) Public (2) Private 1. Where was your mother born? Cuba (3) Parochial 2. Where was your father born? 18. As an adult, do you live in a neighborhood where the neighbors cuba are the same religion and ethnic background as yourself? 3. Where were your grandparents born? (1) Yes 7 (2) NO (1) Your mother’s mother? 19. Do you belong to a religious institution? (2) Your mother’s father? (1) Yes (2) No (3) Your father’s mother? (4) Your father’s father? 20. Would you describe yourself as an active member? 4. How many brothers 1 and sisters P do you have? (1) Yes (2) No 21. How often do you attend your religious institution? 5. What setting did you grow up in? Urban Rural (1) More than once a week (2) Weekly Suburban (3) Monthly (4) Special holidays only 6. What country did your parents grow up in? (5) Never Father 22. Do you practice your religion at home? Mother (1) Yes (2) No 7. How old were you when you came to the United States? 15 (If yes, please specify) 8. How old were your parents when they came to the United (3) Praying (4) Bible reading States? Mother 42 Father 51 (5) Diet (6) Celebrating religious holidays 9. When you were growing up, who lived with you? moal dad 23. Do you prepare foods of your ethnic background? ? brother (1) Yes 2 (2) No 10. Have you maintained contact with a. Aunts, uncles, cousins? (1) Yes < (2) No 24. Do you participate in ethnic activities? b. Brothers and sisters? (1) Yes (1) Yes < (2) No (2) No c. Parents? (1) Yes 7 (2) No (If yes, please verify) d. Your own children? (1) Yes (2) No (4) Holiday celebrations 11. Did most of your aunts, uncles, cousins live near your home? (5) Dancing (6) Festivals (1) Yes < (2) No (7) Costumes (8) Other 12. Approximately how often did you visit your family members who 25. Are your friends from the same religious background as you? lived outside your home? (1) Yes O (2) No (1) Daily – (2) Weekly 2 (3) Monthly (4) Once 26. Are your friends from the same ethnic background as you? a year or less (5) Never (1) Yes (2) No 13. Was your original family name changed? 27. What is (1) Yes _ (2) No 28. Do you speak this language? 14. What is your religious preference? (1) Prefer (2) Occasionally_(3) Rarely (1) Catholic (2) Jewish (3) Protestant 29. Do you read your native language? (4) Denomination (5) Other (6) None (1) Yes (2) No 15. Is your spouse the same religion as you? (1) Yes (2) No too no children (3) Singing Source: Spector, R. E. (2000). CulturalCare: Guide to heritage assessment and health traditions (5th ed.). Pearson Education/PH College. BOX 6 – 1 Heritage Assessment Tool Note: The greater the number of positive responses, the greater the person’s identification with a traditional heritage. The one exception to positive answers is the question about family name change. This question may be answered negatively, o spouse 16. Is your spouse the same ethnic background as you? (1) Yes (2) No 17. What kind of school did you go to? (1) Public (2) Private (3) Parochial / 18. As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself? (1) Yes (2) No 1. Where was your mother born? 2. Where was your father born? Nicaragua , Nicaragua Nicariona Alicaraana coach 3. Where were your grandparents born? (1) Your mother’s mother? (2) Your mother’s father? (3) Your father’s mother? (4) Your father’s father? 4. How many brothers L and sisters I do you have? 5. What setting did you grow up in? Urban Rural Suburban di carabia 6. What country did your parents grow up in? Father ficaragua Mother thurada 7. How old were you when you came to the United States? 10 / Z (2) No aunt 4724 24 (2) No 19. Do you belong to a religious institution? (1) Yes (2) No / / 20. Would you describe yourself as an active member? (1) Yes (2) No / 21. How often do you attend your religious institution? (1) More than once a week (2) Weekly (3) Monthly , (4) Special holidays only (5) Never 22. Do you practice your religion at home? (1) Yes (2) No (If yes, please specify) (3) Praying (4) Bible reading (5) Diet (6) Celebrating religious holidays / 23. Do you prepare foods of your ethnic background? (1) Yes 7 (2) NO (2) No 8 24. Do you participate in ethnic activities? (1) Yes (2) No (If yes, please verify) (3) Singing (4) Holiday celebrations (5) Dancing (6) Festivals (7) Costumes (8) Other 25. Are your friends from the same religious background as you? (1) Yes (2) No / 26. Are your friends from the same ethnic background as you? (1) Yes (2) No . 27. What is your native language? 28. Do you speak this language? (1) Prefer (2) Occasionally (3) Rarely 29. Do you read your native language? (1) Yes (2) NO (2) No < ? 8. How old were your parents when they came to the United States? Mother 23 Father_19 9. When you were growing up, who lived with you? 10. Have you maintained contact with a. Aunts, uncles, cousins? (1) Yes b. Brothers and sisters? (1) Yes C. Parents? (1) Yes . (2) No d. Your own children? (1) Yes 11. Did most of your aunts, uncles, cousins live near your home? (1) Yes 12. Approximately how often did you visit your family members who lived outside your home? (1) Daily (2) Weekly (4) Once a year or less (5) Never 13. Was your original family name changed? (1) Yes 14. What is your religious preference? (1) Catholic 7 (2) Jewish (3) Protestant (4) Denomination (5) Other (6) None 15. Is your spouse the same religion as you? (1) Yes z (2) No Z(3) Monthly Spanish (2) No 1 (3) Rarely (2) No _ o ho spouse Source: Spector, R. E. (2000). CulturalCare: Guide to heritage assessment and health traditions (5th ed.). Pearson Education/PH College. 1
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