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Presence of Wellness Condition
A. Potential / Readiness for Enhanced Capability

How many times do you eat in a day?

What are the usual foods that you eat in every meal?
Do you do exercise daily?
What do you usually do in your past time?
Do you know that you have a health center nearby your place?
How frequently do you visit your health center?
What are the resources/ programs/ services available in your health
8. What are the programs or services offered in your health center?
9. Whenever you dont feel well, do you always seek medical attention? If no,
10. What do you usually do when a member/s of the family get sick? Do you
take over the counter drugs or herbal medications?
11. Did you have annual medical or dental check up?
12. How do you discipline your children?
13. Did your children receive a complete immunization?
14. Did you practice breastfeeding before? For how long? How frequent?
15. What is your religion?
16. How frequently do you go to church with your family?
17. Will you allow your children to eat junk foods or drink carbonated drinks?
18. Do you and the rest of the family members take vitamin supplements?


Presence of Health Threats

1. Is there any member of the family who smokes?

2. Where do you get your drinking water or water for bathing or laundry?
3. Do always make sure that all your cooking and eating equipments are
4. Do you wash hands before and after preparing the food, cooking, eating,
and toilet use?
5. Is there anyone in this baranggay who has been diagnosed with pneumonia
or tuberculosis? Are they living nearby?

6. Does the income of your family can adequately sustain your needs?
7. Do you have stairs at home? Do you always make sure its safe to use?
8. Where do you keep pointed/sharp objects, insecticides, pesticides,
chemical fertilizers and medicines? Is it out of childrens reach?
9. Where do you keep fire-producing materials at home? (Match/lighter, gas,
10. In case of damages at home, do you always make time to repair it?
11. How many times do you eat in a day?
12. Are you fond of eating salty, fatty, oily foods and sweets?
13. How often do you eat fruits and vegetables?
14. How do breastfeed your baby? Is your baby showing a good suck?
15. How frequently do you breastfeed your baby in a day?
16. When did you stop breastfeeding your baby and when did you start bottle
17. Did he/she able to tolerate the bottle feeding?
18. How is your relationship with your husband / wife?
19. How is your relationship with your parents and siblings?
20. Do you have any conflict between any of your family members / relatives?
21. Is there any member of the family / relatives whos sick and needs special
care and attention?
22. How many members are there in the family? Are you all living under the
same roof?
23. Where do you keep you food? Do you have containers for storage?
24. Are there stagnant nearby? What do you usually do?
25. Where do you throw your wastes? Are there compost pits or containers for
garbage disposal?
26. Do you practice waste segregation? If yes, how did you do it?
27. Are there canals or drainage in your place or nearby?
28. Is the noise of the vehicles becomes a problem to your family?
29. Does your neighbor burn garbage/s that makes a problem?
30. Do you drink alcohol beverages? If yes, how often? How long?
31. Do you smoke? If yes, how often? How long?
32. Do you always use slippers when walking?
33. Are you fond of eating raw meat or fish or other raw or uncooked foods?
34. Do you self medicate even if not sick?
35. Do you engaged in drag racing or any other dangerous sports?
36. What time do you sleep and wake up? How many hours is your sleep? Do
you have any problems when sleeping? (e.g. insomnia)
37. Do have regular exercises at least 30mins a day?
38. Do you practice bed nets or mosquito nets for malaria and filariasis?
39. Do have health history of any kind of diseases? (e.g. difficult of labor)
40. Do you have any children works enable sustain/provide the needs for the


Presence of Health Deficits


1. Do you have any member in the family who is experiencing signs of

illness whether it is diagnosed or not?
2. Do have any family member who is mentally incapacitated?
3. Do you have a sick/disable family member?
Presence of Stress Points/Foreseeable crisis situations
1. Are you experiencing crisis or anticipated events like getting
married, entering school and/or hospitalization of family member?

1. How do you perceived a problem?
2. What factors do you consider in solving a problem?
3. What are the things that you do in order to provide a home environment
conducive to health maintenance?
4. How did you utilize community resources for health care?