PERT Program

Tip of the Month: December


Cultural Assessment

I want to provide culturally appropriate care to my patients and their families. But there are so many areas to assess, there’s rarely time to do a complete “cultural” assessment. Do you know of a BRIEF, clinically useful way to assess cultural influences?

A brief cultural assessment tool that we find useful for practice is Fong’s CONFHER model (Fong, 1985).1 It’s easy to remember and you can select specific areas that are most appropriate for your individual residents and families. CONFHER is described as:

C = Communication. Does the resident speak English? Understand common health terms such as pain or fever? What nonverbal communication is used?
O = Orientation. What are the resident’s ethnic identity, values, orientation, and acculturation? Do they identify with a specific group? Where were they born? How long have they lived here?
N = Nutrition. This includes food, food preferences, and taboos. Food has meaning for most people and can be a source of comfort. There may be some foods the person must avoid eating because they are unacceptable in their cultural group.
F = Family relationships. Family structure is important. How is family defined and who is in the family? Who is the head of the household? Who makes decisions in the family? What is the role of women and children? Is it important to have family present when someone is sick? Who should be present when the person is dying?
H = Health and health beliefs. What does the person do to stay healthy? Who do they consult for health problems? How do they explain illness? Not all cultural groups believe in the germ theory of disease. Illness may be seen as the result of evil spirits or something being out of balance. Are there folk remedies or herbal preparations that are commonly used to restore health?
E = Education. What is the person’s learning style and educational level? How much formal education did the person complete? What was their occupation?
R = Religion. What is the person’s preference? Does the client have any religious beliefs or restrictions that have an impact on health care and illness? For example, Jehovah’s Witnesses do not believe in blood transfusions. Some religions would prohibit organ donation.



1 Fong, C. M. (1985). Ethnicity and nursing practice. Topics in Clinical Nursing, 7(3), 1-10.

The above information is adapted from Wilson SA, Ersek M, Kraybill BM. (in press). Cultural issues in palliative care. (In) Coyne P & Panke J (Eds.). Conversations in Palliative Care, New York: Pohl Publishing