Republic of the Philippines

Province of Negros Occidental

Northern Negros State College of Science and Technology
College of Nursing and Allied Health Sciences
Brgy. Rizal, Sagay City
(034) 722-4120/ www.nonescost.edu.ph ISO 9001:2015
Certified

A Family Health Case Study

Presented to the
College of Nursing and Allied Health Sciences
In Partial Fulfillment of the Requirements
in
HENCM 104
FAMILY HEALTH CASE STUDY

Submitted by:
Shaira Pamplona
Maria Angela Viovicente

Submitted to:
Jireh May Gesulgon RN, MN, LPT
Alberto Mahinay RN, MN
Clinical Instructors
 CHAPTER I
FAMILY STRUCTURE, CHARACTERISTICS AND DYNAMICS

Table 1. Demographic Data of Family Sapa

FAMILY RELATION AGE SEX CIVIL PLACE OF
MEMBERS TO HEAD STATUS RESIDENC
E
Joseph Lagunaya Husband 44 M Married Purok Paho,
Sapa Brgy. Rizal
Elizabeth Robleco Wife 41 F Married Purok Paho,
Sapa Brgy. Rizal
Jessica Robleco Sapa Eldest Daughter 18 F Single Purok Paho,
Brgy. Rizal
Joseph Robleco Elder Son 15 M Single Purok Paho,
Sapa, jr. Brgy. Rizal
Arian Mark Robleco Younger Son 12 M Single Purok Paho,
Sapa Brgy. Rizal
Melissa Robleco Niece 15 F Single Purok Paho,
Brgy. Rizal
Daniel Dela Peña Boyfriend of M Single Purok Paho,
Jessica Brgy. Rizal

The Family Sapa is an extended family. Elizabeth Robleco Sapa was only in grade four
while Mr. Joseph Lagunaya Sapa completed his primary education. Their children and niece
are currently students at the Farm School, which is close to their house. Arian Mark, Jessica,
and their niece Melissa were juniors in high school, while Joseph Jr. was a senior. Daniel
Dela Peña, Jessica's boyfriend, is just an eighth-grader. Iglesia ni Cristo is their religion, and
Elizabeth and Joseph are the ones who make choices, particularly on health issues. As of
right now, there are no clearly visible conflicts within the Sapa family.
 CHAPTER II
SOCIO- ECONOMIC
Table 2. Occupational data of Family Sapa
FAMILY OCCUPATION PLACE OF INCOME
MEMBER WORK
Joseph Lagunaya Tricycle Driver Prk. Paho, Brgy. Php 1,000.0
Sapa Rizal per week
Elizabeth Robleco Hacienda Laborer Prk. Paho, Brgy. Php 1,000.00
Sapa Rizal per week
Jessica Robleco Student Farm School N/A
Sapa
Joseph Robleco Student Farm School N/A
Sapa, jr.
Arian Mark Student Farm School N/A
Robleco Sapa
Melissa Robleco Student Farm School N/A
Daniel Dela Peña Hacienda Laborer Prk. Paho, Brgy. Php 1,000.00
Rizal per week

Mrs. Elizabeth Robleco Sapa and Daniel Dela Peña work as hacienda laborers, while Mr.
Joseph Lagunaya Sapa drives a tricycle. They all make the same amount each week—1,000
pesos. Sometimes, their budgets don't allow for the purchase of their daily necessities.
Budgets for hygiene goods have less priority due to the limited resources available to families.
However, financial decisions are made jointly by the two parents.
 CHAPTER III
HOME AND ENVIROMENT

Housing
The Family Sapa’s living space is somehow adequate. There are two rooms in their
house. The first room is where the 4 children sleep and the second is where the parents sleep
while Daniel is outside their dining area. A dumpster behind their house may contain
breeding sites, and their house is slanted as a result of being impacted by a typhoon. Their
food storage and cooking facilities are somehow inadequate. The family’s sink was not
properly cleaned, and the water from the well was used for cleaning the dishes and washing
their hands, which might contain pathogens since the water source is also stocked with
goldfish. A water pump is their water supply, and they buy their drinking water from their
neighborhood. They now have a temporary toilet room and under that is their drainage
system, which is somehow adequate.

Kind of Neighborhood
The family’s neighborhood is not congested. There is adequate space between each
household. Their area is somehow clean because there is only minimal garbage scattered. In
their barangay, the "rural ambiance" can be felt because of the tall trees, fresh air, and wide
expanses of vacant land.

Social and Health Facilities

Near the family’s house is a makeshift basketball court, which serves as a recreational
facility in their area. Their barangay also has a covered court wherein community programs
are usually held and a health center that offers various healthcare services like immunization
programs for infants, prenatal check-ups for pregnant mothers, and feeding programs for
malnourished children.

Communication and Transportation

Though there are social and health facilities available, the family still needs to ride a
motorcycle because it’s far. The only communication and transportation facilities that are
available are cell phones and motorcycles.
 CHAPTER IV
HEALTH STATUS OF EACH MEMBER OF THE FAMILY

Medical History
The family's previous illnesses have included fevers, colds, and coughs. According to
them, these illnesses do not usually last for more than 2–3 days. Furthermore, Jessica also
reported that she had experienced syncope before due to fatigue and skipping meals.

Health Beliefs and Practices

When the family experiences illnesses like fever, for example, their first option is
"pahilot." Parents admit that they would bring their children to someone who knew how to
perform the practice of "hilot" and after the said procedure, the children’s fever would
gradually subside. If it is ineffective, they would then go to the health center, especially if the
fever lasts more than 3 days. However, there are also instances when they resort to
self-medication. Furthermore, they prefer to perform household chores rather than rest
whenever they feel sick.

Nutritional Assessment
Table 3. Nutritional Status of the Children
NAME OF WEIGHT HEIGHT BMI INTERPRETATION
CHILDREN (kg) (m) (kg/m²)
Jessica R. Sapa 30.45 1.43 14.89 Underweight
Joseph R. Sapa, jr. 31.32 1.51 13.74 Underweight
Arian Mark R. Sapa 23.34 1.30 13.81 Underweight

The children’s nutritional status is reflective of malnutrition, as they are all underweight.
For their dietary history, the family’s meals are composed of rice, vegetable soups, and dried
fish. They also drink instant coffee early in the morning. The family also cooks vegetable
soups, utilizing those available in their backyard like camote leaves, kangkong, and papaya
fruit. They also rarely eat meat. However, there are also times when Jessica skips a meal due
to other school work.
Developmental Assessment
In terms of psychosocial development, the student nurses have observed that Jessica and
Arian Mark are in the 5th stage. Jessica is experiencing role consumption because she is
having doubts about whether she will pursue college or not, while her brother shows lowered
self-esteem, as evidenced by his only shyly nodding whenever we talk to him. As for
cognitive development, Joseph Jr., Melisa, and Arian Mark are supposed to be in the formal
operations period, where they are already able to solve abstract problems, but due to their
poor physical development, their cognitive ability was also altered. In terms of psychosexual
development, Arian Mark is in the latency stage as he focuses more on his hobbies, like
drawing and cycling. Jessica, Joseph Jr., Melisa, and Daniel, on the other hand, are already in
the genital stage as they focus more on social interactions and relationships. Lastly, in terms
of moral development, all of them are under the third stage, which is maintaining social
relations by following the good boy/good girl orientation.

Risk factor assessment

The risk factors that the student nurses have observed in the family are the following: an
inability to buy healthy foods, to properly utilize healthcare services, and to recognize the
importance of hygiene and sanitation. Their inability to buy healthy foods can impede their
capability to achieve optimal nutrition, which might also alter their physical, physiological,
and cognitive well-being. Also, their inability to utilize free healthcare services from the
Health Center can contribute to their improper disease management and poor health practices.
Lastly, their inability to recognize the importance of hygiene and sanitation can impact how
they take care of themselves (e.g., bathing and tooth brushing) and how they maintain the
cleanliness and organization of their home environment.

Physical Assessment
As mentioned, the children are malnourished. This is supported by their low BMI
(below 18.5kg/m²) and mid-arm circumference (less than 12.5 cm). Furthermore, Jessica also
displays pallor, aside from her low blood pressure, which is 80/60.
The student nurses have also observed that the mother’s hair is unkempt and dry, as is
her skin. There are also evident plaques in the mother’s teeth. Their household also reflects
their poor sanitary practices, with plates remaining uncovered near the sink, bedrooms not
properly organized, clothes not neatly folded on the corner, family members sleeping on their
makeshift table, dogs sleeping anywhere in the house, and water used to wash the dishes
coming from the well, which a goldfish is also inhabiting.

Results of Laboratory/Diagnostic and other Screening Procedures

Because the family does not go to clinics whenever they get sick, the student nurses were
not able to collect any laboratory, diagnostic, or screening procedures that could support the
children’s possible malnutrition and Jessica’s anemia.

Immunization Status
All of the family members were fully immunized at birth and had been vaccinated with
the COVID-19 vaccine. The following are their vaccines: Daniel and Jessica received
Sinovac; Mr. and Mrs. Sapa received Moderna; Melisa, Joseph Jr., and Arian Mark received
Pfizer.

Healthy Lifestyle Practices

As mentioned, the family strives to practice a healthy lifestyle by incorporating
vegetables into their meals. They also engage in physical activity by doing household chores
and performing labor work. The family usually goes to bed at 8 or 9 p.m. and wakes up at 5
a.m., thus sleeping for 8 or 9 hours. Mrs. Sapa can only take a break from household chores
when her children are around. Her children can only stay at home during weekends, vacation
breaks, and holidays. Mrs. Sapa was ligated after the birth of her third child, Arian Mark. In
terms of stress management, the parents relieve their stress by resting, while the children do
so by focusing on their hobbies, using their phones, or hanging out with their peers.

Use of Promotive-Preventive Health Services

The family fails to appropriately utilize the services offered in the health center because
of their beliefs regarding hilot and self-medication, as well as their trust in their body’s
capacity to heal itself.

PROBLEMS AND HEALTH TEACHINGS AND INTERVENTIONS
Actual or Potential Health Problems
Table 4. family Health Problems Identified in Family Sapa
CUES OR DATA
Objective data:
Jessica's BMI is 14.89, Joseph
Jr.'s is 13.74, and Arian Mark's
is 13.81, all of which are
considered underweight. Their
mid-arm circumference is also
less than 12.5 cm.
Subjective data:
Jessica verbalized that, “Kis-a
uga lang amon ginasud-an kay
wala na kami kwarta.”
Objective data:
Jessica’s BP is only 80/60. She
is also pale.
Subjective data:
Jessica verbalized that, “Ligad
nalipongan ko. Siguro sa sobra
man ka-kapoy.”
Objective data:
The Sapa family’s home is made
of light materials. Their house is
also slanting backwards.
Subjective data:
Mrs. Sapa verbalized that,
“Tungod sang bagyo,
nagpahilay na ni ang amon nga
balay. Amo na subong,
ginatiguman ko gid nga
CHAPTER V
FAMILY NURSING PROBLEMS
I. Malnutrition as a health deficit
A. Inability to recognize the existence of health
condition/problem due to:
a. Lack of knowledge
b. Denial about its existence as a result of fear of
consequences of diagnosis of problem, specifically,
social stigma and cost implications.
B. Inability to make decisions with respect to taking
appropriate health action due to:
a. Failure to comprehend the nature/magnitude of
the problem/condition
b. Low salience of the problem/condition
c. Negative attitude towards the health
condition/problem
II. Hypotension as a health deficit
A. Inability to recognize the existence of health
condition/problem due to:
a. Inadequate knowledge
b. Denial about its existence as a result of
fear of consequences of diagnosis of problem,
specifically, cost implications.
B. Inability to make decisions with respect to taking
appropriate health action due to:
a. Failure to comprehend the nature/magnitude of
the problem/condition
b. Low salience of the problem/condition
c. Negative attitude towards the health
condition/problem
III. Accidental hazard as a health threat
A. Inability to provide a home environment conducive
to health maintenance and personal development due to:
a. Inadequate family resources, specifically
financial constraints/limited financial resources
makapatukod kami bag-o nga
balay kay kadelikado nga bisan
san-o pwede siya malumpag.”
Objective data:
Mrs. Sapa has plaque on her
teeth and has unkempt and dry
hair.
Subjective data:
Mrs. Sapa verbalized that,
“ Udto na pero wala pa ko
subong kapaligo.”
Objective data:
The family’s sink was not
properly cleaned, and the water
from the well was used to clean
the dishes and wash their hands,
which might contain pathogens
since the water source was
inhabited by goldfish.
Subjective data:
Mrs. Sapa verbalized that, “Sa
bubon man lang kami gakwa
sang amon gigamit panghugas.
Gali may ginbuhi man sila na
gold fish sa bubon.”
Objective data:
Jessica’s boyfriend and Mrs.
Sapa’s niece are living together
with the family.
Subjective data:
Mrs. Sapa verbalized that, “Ang
nobyo ni Jessica, kay daari na
lang pod gaistar sa amoa. Mayu
na lang gabulig man siya sa
panimalay. Ang akon nga
pag-umangkon, daari ko man
giapaistar kay mas lapit ang
skwelahan diri.”
IV. Unhealthful lifestyle and personal habits as a
health threat
A. Inability to recognize the presence of the condition
or problem due to:
a. Lack of or inadequate knowledge
b. Denial about its existence or severity as a result
of fear of consequences of diagnosis of problem,
specifically cost implications
c. Attitude/philosophy in life which hinders
recognition/acceptance of a problem
B. Inability to make decisions with respect to taking
appropriate health action due to:
a. Low salience of the problem
b. Failure to comprehend the nature/magnitude of
the problem/condition
V. Poor Home Condition as a health threat
A. Inability to make decisions with respect to taking
appropriate health action due to:
a. Low salience of the problem
b. Negative attitude towards the health
condition/problem
c. Inaccessibility of appropriate resources,
specifically financial constraints
VI. Additional members as a foreseeable crisis
A. Inability to provide a home environment conducive
to health maintenance and personal development due to:
a. Inadequate family resources, specifically
financial constraints/limited financial resources
Table 5. Scoring and Justification of Family Problems
HEALTH CRITERIA SCORE JUSTIFICATION
PROBLEM
Malnutrition Nature: It is a health deficit because the children’s
of Jessica, Health deficit (3/3) x 1= 1 health was not maintained.
Joseph Jr.,
and Arian Modifiability: It is partially modifiable because their low
Mark Partially (1/2) x 2= 1 income prevents them from affording
modifiable nutritious food.

Preventive It is moderately preventable because they

potential: (2/3) x 1=2/3 can keep malnutrition from becoming
Moderate severe if they eat the right amount of food.

Salience: The family perceived that the problem did

A condition (1/2) x 1=1/2 not need immediate attention because they
not needing thought it was natural to be thin because
immediate they were poor.
attention

Total: 3 1/6
Hypotension Nature: It is a health deficit because Jessica was
of Jessica Health deficit (3/3) x 1= 1 not able to maintain her health.

Modifiability: It is partially modifiable because, even

Partially (1/2) x 2= 1 though she can go to the health center for a
modifiable consultation, she still refuses to go there.

Preventive It is moderately preventable because her

potential: (2/3) x 1=2/3 condition can only be prevented if she
Moderate consults the health center.

Salience: The family perceived it as not needing

A condition (1/2) x 1=1/2 immediate attention because they think
not needing that it is normal when someone is fatigued.
immediate
attention

Total: 3 1/6
Accidental Nature: It is a health threat because it can
hazard Health threat (2/3)x1 = 2/3 contribute to the occurrence of accidents
specifically and injuries in the household, especially if
their slanting the house suddenly collapses.
house Modifiability:
Partially It is partially modifiable because the house
modifiable (1/2) x 2 = 1 could collapse anytime soon and really
requires an immediate repair, which could
be difficult for the family's limited
 resources.

Preventive It has moderate preventive potential

potential: (2/3)x 1= 2/3 because if an earthquake or a typhoon
Moderate occurred, their house would probably
collapse, causing future casualties,
Salience: damages, and injuries.
Condition
needing (2/2) x 1=1 This condition needed immediate attention
immediate because the family thinks that their house
attention needs to be repaired immediately because
it is not already safe for them to live here.

Total: 3 1/3
Unhealthy Nature: It is a health threat because poor hygiene
lifestyle and Health threat (2/3)x 1= 2/3 practices can be detrimental to the health
personal of family members.
habits
specifically Modifiability: It is easily modifiable because the family’s
poor Easily (2/2) x 2= 2 unhealthful personal habits can be
personal modifiable corrected by teaching them about the
hygiene different proper hygiene practices and their
importance to the maintenance of their
health.

Preventive It has high preventive potential because

potential: (3/3) x 1= 1 diseases can be prevented from developing
High within the family if they practice proper
hygiene.

Salience: It is not perceived as a condition needing

Condition not change by the family. It is because they
needing (1/2) x 1=1/2 think that their current personal habits are
immediate acceptable as long as they have not caused
attention them any serious diseases in the meantime.

Total: 4 1/6
Poor home Nature: It is a health threat because a polluted
condition Health threat (2/3)x 1= 2/3 water supply can be detrimental to the
specifically health of family members.
polluted
water supply Modifiability: It is easily modifiable because it can be
Easily (2/2) x 2= 2 corrected by teaching them about the
modifiable importance of a safe water supply in the
maintenance of their health.
Preventive (3/3) x 1= 1
potential: It has high preventive potential because, if
High the family has a safe water supply, certain
diseases can be prevented from developing
 within the family.
Salience:
Not perceived It is not perceived as a condition needing
as a condition (0/2) x 1= 0 change because the family perceives that
needing their current home condition is acceptable
change and has not caused them any serious
disease in the meantime.

Total: 3 2/3
Additional Nature: It is a foreseeable crisis because having
members Foreseeable (1/3)x 1= 1/3 additional family members live together
crisis would require an unusual demand for
family resources.

Modifiability: It is not modifiable because we cannot

Not (0/2) x 2= 0 simply shove the additional member away
modifiable from the household in order to make the
current family resources adequate for the
needs of all the individuals living within
that family.

Preventive It has low preventive potential because

potential: (1/3)x1 = 1/3 unusual demands on resources would
Low inevitably occur since there are additional
members present.

Salience: This condition is not perceived by the

Not perceived family as a problem needing change
as a condition (0/2) x 1 = 0 because they believe that the more
needing members a family has, the merrier the
change household is.

Total: 2/3

The actual and potential health problems that the student nurses have identified are those
that fall under the health deficit (malnutrition of the three children and hypotension in
Jessica), health threats (accidental hazards and unhealthy personal habits), and foreseeable
crisis (an additional member) categories. These problems are supported by the cues and data
that we have gathered during our community visit and are ranked accordingly.
Table 6. ranking of Family Health Problems
Priority Problem Score
1 Unhealthy lifestyle and personal habits, specifically 4 1/6
poor personal hygiene as a health threat
2 Poor home condition, specifically polluted water 3 2/3
supply as a health threat
3 Accidental hazard, specifically slanting house as a 3 1/3
health threat
4 Malnutrition of Jessica, Joseph Jr., and Arian Mark as a 3 1/6
health deficit
5 Hypotension of Jessica as a health deficit 3 1/6
6 Additional members as a foreseeable crisis 2/3

Interventions
With regards to the priority ranking presented above, the student nurses have formulated
a nursing care plan below:
Table 7. Family Nursing Care Plan
Health Family Goal of Objectives Nursing Method Resources Evaluation
Problem Nursing Care of Care Interventions of Required Criteria
Problem Family and
-Nurse Standard
Contact
Unhealthy Inability to After After nursing 1. Discuss Home Transportation Criteria:
lifestyle and recognize the nursing intervention, with the family visit expenses Knowledge
personal presence of the intervention, the following the importance about
habits, condition or the family should be of personal Time and personal
specifically problem due will take achieved: hygiene to effort of the hygiene
poor to: necessary their health. nurse and the practices
personal a. Lack of or action to 1. The family
hygiene as a inadequate improve family 2. Utilize Standard:
health threat knowledge their should know health After 1 day
b. Denial personal the measures of
about its habits. importance involving the community
existence or of proper elimination of exposure,
severity as a hygiene. physical the above
result of fear of threats by criteria will
consequences 2. The improving on be met by
of diagnosis of family the facilities in the family.
problem, should their home,
specifically practice either by
cost proper constructing
implications hygiene needed ones or
c. Attitude/ practices. modifying
philosophy in those already
life which existing.
hinders
recognition/ 3. Explore
acceptance of a with the family
problem the ways of
improving
Inability to personal
make decisions hygiene
with respect to considering
 taking their limited
appropriate resources.
health action
due to:
a. Low
salience of the
problem
b. Failure to
comprehend
the
nature/magnitu
de of the
problem/
condition

This care plan was implemented on December 14, 2022. The interventions that the
student nurses have performed are as follows: health education about proper hygiene and
sanitation, the importance of maintaining cleanliness in the house and having safe drinking
water, the relationship between environment and health, and the prevention of cholera and
diarrhea.

Health Teachings
The health teachings that the student nurses shared with the family included the ways of
practicing personal hygiene and sanitation, wherein they taught them the importance of hand
washing in preventing diseases like cholera and diarrhea. They also discussed the
significance of maintaining the house’s cleanliness, that is, by helping them avoid the spread
of microorganisms inside their home, preventing them from acquiring disease-causing
microorganisms, and providing them with a home environment conducive to the promotion
and maintenance of their health. Also, the student nurses taught the importance of practicing
a healthy lifestyle like eating a nutritious meal despite their limited resources by planting a
variety of vegetables, root crops, and even fruit trees in their backyard. They also reminded
them that it is unsafe to use the water in the well where there is a goldfish because the said
organism can carry germs that contaminate the water and could make them sick. The student
nurses also reminded the family that they should not allow their pet dogs to sleep anywhere in
the house because these dogs’ hairs can remain in the areas and there is a great possibility
that they might inhale these hairs as well as these dogs’ dander, which could be very alarming
because these can clog inside the lungs and lead to the development of respiratory problems.
Furthermore, the student nurses also explained to them the importance of properly storing
their kitchen utensils and maintaining the cleanliness of their sinks.
 CHAPTER VI
LEARNING FACILITATION/CONCLUSION/RECOMMENDATION

Learning Facilitation
The student nurses facilitated the Sapa family in their journey towards the improvement
of their lifestyle and personal habits by conducting health education with them about the
ways in which they can improve their health. Furthermore, the student nurses have seen
improvements from them in our recent community exposure because they noticed that the
family tried to build a makeshift toilet facility in order to improve their sanitation.

Conclusion
The Sapa family, from Prk. Paho, Brgy. Rizal was the family chosen for the family
health assessment. The evaluation was carried out using the set of questions that were
provided. The student nurses interviewed the family's head member to collect the information
required to complete the assessment. The Sapa family includes Mr. Joseph Sapa, 44, Mrs.
Elizabeth Sapa, 41, and their children Jessica, 18, Joseph Jr., 15, Arian Mark, 12, Melissa
(Elizabeth's niece), 15, and Daniel Dela Peña, Jessica's boyfriend. Certainly, both parents are
the heads of their households. This is because both Mr. and Mrs. Sapa believed that they were
equally qualified to manage their family; thus, they did not designate the head of the family
by gender norms.
During the assessment, it was observable that their house wasn't in great condition. It was
also not comfortable and lacked all the amenities. The children are all sleeping in the same
room. The family's sink wasn't adequately cleaned, and they utilized well water to wash their
hands and clean their dishes, which could have contained pathogens given that the water
supply is also stocked with goldfish. Furthermore, Mrs. Sapa works as a hacienda laborer,
and Mr. Sapa earns most of the family's living as a tricycle driver. Their income is
inconsistent and not substantial. Joseph, Jessica, and Arian Mark are all students at a farm
school that is close to where they are currently living. While their necessities are met by their
parents’ income, they also help cover their housing costs. Because the family's resources
were typically low, the budget for hygiene received lower priority. Following this, the
researchers have created a specific nursing care plan using their understanding of the nursing
process, the data they have gathered, and the established diagnoses. The following are the
goals of nursing care: After the nursing intervention, the family will take the necessary steps
to improve their habits by discussing the significance of personal hygiene to their health,
utilizing health measures involving the manipulation or elimination of physical threats
through the improvement of facilities in the home (building necessary ones and modifying
those already existing), as well as exploring with the family the ways of improving personal
hygiene. Following the nursing intervention, the family will make the necessary changes to
their routines. In addition, the family will also understand the value of cleanliness, practice
good hygiene habits, and ensure that all family members can effectively complete their
developmental activities.
Upon the implementation of the interventions, the student nurses noticed the family's
determination to correct their unhealthy lifestyle and personal habits. The student nurses also
observed the family's willingness to listen to their health teachings about proper hygiene and
sanitation.

Recommendations
The student nurses have identified and prioritized problems and needs with the family.
The student nurse has also created a care plan on how to deliver the best nursing care for the
family to address their needs. The following recommendations are recognized by both the
student nurses and the family:

 The family Sapa should help each other motivate, help, and stop the unhealthy lifestyles
of family members, specifically their poor hygiene practices.
 The family should practice proper hygiene and sanitation (e.g., bathing and brushing
their teeth regularly, trimming their nails, changing clean clothes, and performing hand
washing as frequently as the situation calls).
 The family should maintain a sanitary environment conducive to health maintenance and
disease prevention.
 The family should ensure safe drinking water and a sanitary water supply to prevent
them from acquiring water-borne diseases.
 The family should recognize the importance of going to the health center.