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Heritage Assessment Tool Essay

575 words - 3 pages

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 _____ x 18. As an adult, do you live in a neighborhood where the neighbors are the same religion and ethnic background as yourself? x (1) Yes _____ (2) No _____ 19. Do you belong to a religious institution? (1) Yes _____ (2) No x _____ 20. Would you describe yourself as an active member? x (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 _____ x 22. Do you practice your religion at home? (1) Yes _____ (2) No _____ x (If yes, please specify) (3) Praying _____ (4) Bible reading _____ (5) Diet _____ (6) Celebrating religious holidays _____ 23. Do you prepare foods of ...view middle of the document...

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? ____________________________ Poland

Italy 2. Where was your father born? ______________________________
3. Where were your grandparents born? (1) Your mother’s mother? ______________________________ Poland Poland (2) Your mother’s father? ______________________________ Italy (3) Your father’s mother? ______________________________ Italy (4) Your father’s father? ________________________________

0 4. How many brothers _____ and sisters _____ do you have? 0

x 5. What setting did you grow up in? Urban _____ Rural _____ Suburban _____
6. What country did your parents grow up in? italy Father _____ poland Mother _____

19 7. How old were you when you came to the United States? _____
8. How old were your parents when they came to the United States? Mother _____ Father _____ 45 40 9. When you were growing up, who lived with you? _____ parents 10. Have you maintained contact with x a. Aunts, uncles, cousins? (1) Yes _____ (2) No _____ b. Brothers and sisters? (1) Yes _____ (2) No _____ x c. Parents? (1) Yes _____ (2) No _____ d. Your own children? (1) Yes _____ (2) No _____ 11. Did most of your aunts, uncles, cousins live near your home? x (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 a year or less _____ (5) Never _____ x 13. Was your original family name changed? (1) Yes _____ (2) No _____ x 14. What is your religious preference? (1) Catholic _____ (2) Jewish _____ (3) Protestant _____ x (4) Denomination (5) Other _____ (6) None _____ 15. Is your spouse the same religion as you? (1) Yes _____ (2) No _____ n/a

polish 27. What is your native language? _____
28. Do you speak this language? x (1) Prefer _____ (2) Occasionally _____ (3) Rarely _____ 29. Do you read your native language? x (1) Yes _____ (2) No _____

Source: Spector, R. E. (2000). CulturalCare: Guide to heritage assessment and health traditions (5th ed.). Pearson Education/PH College.

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