Section of Supportive Hospice and Palliative Medicine

Department of Family and Community Medicine

University of the Philippines Philippine General Hospital
Manila

SHPM PROGRAM DOCUMENT (CFAT 012011-2)

COMPENDIUM OF FILIPINO ASSESSMENT TOOLS FOR CLINICAL PRACTICE & RESEARCH

THE COMPREHENSIVE FAMILY APGAR (CAPGAR)

AUTHOR/S: Manuel Medina Jr. and the Section of Supportive Hospice and Palliative Medicine (SHPM)
FILIPINO VERSION: The Filipino and English Versions were developed simultaneously.
PURPOSE: To assess general family function.
DESCRIPTION: The CAPGAR was developed by M. Medina, Jr. M.D. and the Section of Supportive Hospice and Palliative Medicine,
University of the Philippines Philippine General Hospital (SHPM, UP-PGH). The goal was to develop a valid and reliable Filipino measure
of family function. It is primarily intended for family medicine and palliative medicine physicians. The items used in the construction of the
CAPGAR were directly based on a review of relevant international tools and research, and the opinion and experience of the Section of
SHPM in the assessment of family function. In particular, the review and evaluation of available materials focused on materials related to the
original Family APGAR developed by Smilkstein (1978), and materials related to family adaptation in times of crisis. The brief 15 item
CAPGAR provides a measure of general family function. It also includes 3 subscales representing 3 domains: Flexibility (6 items), Cohesion
(6 items), and Communication (6 items). It also has 5 items which are similar to the 5 items of the original Family APGAR.
SCORING: Scoring retained the original 3-point scoring system of the original Family APGAR. Each item is scored on a 0 to 2 basis using
the following key: almost always = 2, some of the time = 1, hardly ever = 0. This allowed for the direct computation of the original Family
APGAR Score, using the items derived from the original APGAR. The scores for the all the items in the CAPGAR and its subscales are
summed resulting in scores for the CAPGAR subscales (Flexibility, Cohesion and Communication) and a total score for the entire CAPGAR.
Higher scores reflect a higher degree of satisfaction with family function in general or based on the 3 dimensions measured by the
subscales; while lower scores reflect lower degree of satisfaction with family function. The scores range from 0 to 30 for the entire CAPGAR
(general family function) and from 0 to 12 for the Flexibility, Cohesion and Communication subscales. The scores of 5 items which are
derived from the original Family APGAR ranges between 0 and 10. Scores for the 5 original APGAR domains (Adaptation, Partnership,
Growth, Affection, and Resolve), can also be obtained by summing the 3 items in each domain; and scores will range from 0 to 6.
Simplified Classification System: The original Family APGAR and its original classification system is one of the most familiar family
assessment tools used by many family medicine and palliative medicine clinicians. To address the requests for a simplified classification
system by many clinicians, the following system is proposed. This proposed scoring system is developed in the same manner as the scoring
system of original Family APGAR as proposed by Smilkstein- the scale is divided evenly into classes and the classification system is based
solely on what appears to be most appropriate and conceptually correct; as opposed to an empirically based division of the scale. The author/s
recommends that for intensive clinical assessment and/or research, the actual scale should be used instead of the classification system.
For the entire CAPGAR (0-6, highly dysfunctional; 7-12: moderately dysfunctional; 13-18: functionally at risk; 19-24: moderately
functional; and 25-30: highly functional). For the Flexibility, Cohesion and Communication subscales (0-4: inadequate; 5-8: at risk or
potentially inadequate; 9-12: adequate). In this system, at risk categories means that the quality measured may be inadequate when the
family is faced with a severe stressor or multiple stressors. The author/s believe that a major limiting factor in the original Family APGAR
was the simplified category system. The CAPGAR was developed to address the limitations of the original Family APGAR that has been
noted in several recent studies. For this reason, the author/s advice against oversimplification of the CAPGARs scale using very limited
classification systems which will also adversely affect the CAPGARs discriminatory power and sensitivity.
RELIABILITY: The CAPGAR (Filipino Version) has excellent internal consistency. The coefficient alpha for the full CAPGAR scale was
0.95, which indicates good internal consistency reliability. Alpha for each of the subscales are also good: Flexibility (0.90), Cohesion (0.89)
and Communication (0.88). Exploratory factor analysis showed that items in the flexibility and cohesion domains tended to load separately
into to two latent factors. For each of the original Family APGAR, the values for alpha are: Adaptation (0.88), Partnership (0.81), Growth
(0.83), Affection (0.83), and Resolve (0.83). For the study, the computed Cronbachs alpha for the Family APGAR was 0.86, which also
indicates good internal consistency.

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VALIDITY: Results also show good correlation between satisfaction with family function based on the original Family APGAR, and the
perception of adequacy of family function, flexibility, cohesion and communication based on the CAPGAR. Items and subscales of the
CAPGAR, which inquires about satisfaction with family function, also correlate well with equivalent items and subscales which inquire
about perception of adequacy of family function. Validity is also supported by the process of tool development and item selection based on
expert opinion and the review of relevant internationally recognized tools and research. Further validation studies are ongoing and planned by
the author/s.
PRIMARY REFERENCE: 1) M. Medina and the Section of Supportive Hospice and Palliative Medicine (SHPM). The Comprehensive
Family APGAR Questionnaire. SHPM Program Document (FAM 012010-1b). SHPM, DFCM, UP-PGH. 2010. 2) M. Medina, MJ Umali,
and MJ Guerzon-Joson. The Development and Evaluation of the Comprehensive Family APGAR (CAPGAR). SHPM Program & Research
Document (FAM 012011-1). SHPM, DFCM, UP-PGH. 2011.
In addition to the primary reference, this document can be cited as follows: M. Medina and the Section of Supportive Hospice and Palliative
Medicine (SHPM). The Comprehensive Family APGAR (CAPGAR). SHPM Program Document. Compendium of Filipino Assessment
Tools for Clinical Practice & Research (CFAT 012011-2). SHPM, DFCM, UP-PGH. 2011.
AVAILABILITY: Permission to use the CAPGAR should be obtained from the author/s. The CAPGAR is in an early stage of development.
In order to maintain an organized program for further development and ensure appropriate use, use of the CAPGAR is mainly restricted to
programmed studies within the SHPM. However, the authors also recognize the severe lack of easily available Filipino tools to assess family
function aside from the Filipino version of the original Family APGAR. Therefore, the author/s are amenable to the use of the CAPGAR in
studies outside of SHPM as long as permission is obtained. Requirements include: submission of program / project / research plan or
proposal to the author/s, changes or modifications to the plan or proposal as required by the author/s; regular updates; citation of the role of
the author/s in the program / project / research, and as co-author; and submission of the final draft of report or paper for suggestions prior to
final approval. No fees apply to non-funded clinical and research programs. No changes or modifications to the content, format, scoring and
interpretation of scores of this assessment tool are allowed by the author/s.

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COMPREHENSIVE FAMILY APGAR SCALE (CAPGAR) FILIPINO / TAGALOG

TUNGKOL SA AKING PAMILYA,
AKO AY NASISIYAHAN
A
Dahil nakakaasa ako ng tulong sa aking pamilya sa oras ng
problema.(*)
Dahil nakakaasa ako na handa ang aking pamilya na tumanggap ng
karagdagang responsibilidad at gawain upang matulungan ako kung
mayroon akong mga problema.
Dahil nakakaasa ako na handa ang aking pamilya na magbigayan at
mag-kasundo upang matulungan ako kung mayroon akong mga
problema.
P
Sa paraan ng pakikipagtalakayan sa akin ng aking pamilya tungkol sa
aking problema. (*)
Sa paraan ng pag-unawa, pagtanggap at paggalang ng aking pamilya
sa aking mga opinyon at pahayag
Sa paraan ng pagsasama sa akin ng aking pamilya sa pag-dedesisyon
tungkol sa mga bagay na may kinalaman sa buong pamilya.
G
Na tinatanggap at sinusuportahan ng aking pamilya ang aking mga
nais na gawin patungo sa mga bagong landas para sa aking ikauunlad.
(*)
Na ang aking pamilya ay tinutulungan ako upang makamit ko ang
aking mga kagustuhan sa buhay.
Na tunay na ninanais ng aking pamilya na ako ay maging maligaya sa
buhay.
A
Sa paraang ipinadadama ng aking pamilya ang kanilang pagmamahal
at pag-uunawa sa aking damdamin katulad ng galit, lungkot at pagibig. (*)
Sa paraan ng pagtanggap at paggalang ng aking pamilya sa aking mga
damdamin.
Sa tunay na pagmamahal at pagmamalasakit sa akin ng aking
pamilya.
R
Na ang aking pamilya at ako ay nagkakaroon ng panahon sa isat isa.
(*)
Sa paraan ng pagpapahalaga namin sa isat isa at sa buong pamilya.

HALOS
HINDI

PAMINSAN
-MINSAN

PALAGI

Na ang aking pamilya at ako ay nagsusumikap na panatilihing buo

ang aming pamilya, lalo na kung may mga problema
PARA SA DOKTOR
A
P
G
A
R

FLEX = (A + P)
COH = (A + R)
COMM = (P + A)
GEN FUNC = (A + P + G + A + R)
APGAR = Sum (* Items)

Manuel Medina Jr. MD and the Section of Supportive Hospice & Palliative Medicine, University of the Philippines-Philippine General Hospital, Manila. 2010.

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COMPREHENSIVE FAMILY APGAR SCALE (CAPGAR) - ENGLISH

HARDLY
EVER

ABOUT MY FAMILY I AM SATISFIED

SOME OF
THE TIME

ALMOST
ALWAYS

A
That I can turn to my family for help when something is troubling me
(*)
That my family is willing to take additional responsibilities and tasks
to help me when I have problems
That my family is willing to negotiate and compromise to help me
when I have problems
P
With the way my family talks on things with me, and shares problems
with me (*)
With the way my family accepts and respects my statements and
opinions
With the way my family involves me in a process of shared decision
making about matters that concern the family
G
That my family accepts and supports my wishes to take on new
activities or directions (*)
That my family helps and supports me to achieve what I prefer and
want in life
That my family truly wants me to be happy in my life
A
With the way my family expresses affection and responds to my
emotions such as anger, sorrow and love (*)
With the way my family accepts and respects my feelings
With the way my family truly and sincerely loves and cares for me
R
With the way my family and I share time together (*)
With the way my family values each other and the whole family
That my family and I makes an effort to keep the family intact,
especially when faced with problems

FOR THE DOCTOR

A
P
G
A
R

FLEX = (A + P)
COH = (A + R)
COMM = (P + A)
GEN FUNC = (A + P + G + A + R)
APGAR = Sum (* Items)

Manuel Medina Jr. MD and the Section of Supportive Hospice & Palliative Medicine, University of the Philippines-Philippine General Hospital, Manila. 2010.

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