Power to Prevent - National Diabetes Education Program - National ...

More documents

Recommendations

Info

Please answer the following. Circle only one number for each question. (Check “Don’t know or refused” if you do not know or do not want to answer.) 1. How often do you skip a meal and then snack or overeat? 2. How often do you eat foods high in fat, such as fried foods or lots of butter, cheese, or lard? 3. How often do you eat more than you think you should? General Health Daily or more often More often than weekly but less than daily Weekly Sure I can Think I can More often than monthly but less often than weekly Not sure I can Don’t think I can 7. Lose weight if overweight 4 3 2 1 8. Get support from family/friends 4 3 2 1 9. Get blood pressure under control 4 3 2 1 10. Handle stress better 4 3 2 1 No more often than once a month 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 How confdent are you that you can make changes now? Please circle one number to indicate how confdent you are that you can make the following changes. (Check “Don’t know or refused” if you do not know or do not want to answer.) Physical Activity Sure I can Think I can Not sure I can Don’t think I can 1. Get physical activity more often 4 3 2 1 2. Be physically active for longer time 4 3 2 1 Eating Sure I can Think I can Not sure I can Don’t think I can 3. Eat more healthful food 4 3 2 1 4. Overeat less often 4 3 2 1 Taking Medication (if Applicable) Sure I can Think I can Not sure I can Don’t think I can 5. Miss fewer medications 4 3 2 1 6. Take medications on time 4 3 2 1 Please put your name (or your initials with day and month of birth) at the top of this questionnaire and give it to your program leader. Don’t know or refused Don’t know or refused Don’t know or refused Don’t know, refused or not taking medications Don’t know or refused NDEP Power to Prevent Appendices 39
The next questionnaire is an optional choice for organizations that work with people with diabetes and want to evaluate the impact of their Power to Prevent program. The National Diabetes Education Program and its partner organizations have not obtained OMB (Offce of Management and Budget) nor IRB (Institutional Review Board) clearance or other approval for gathering data from program participants. These questionnaires are provided for your convenience only. Please check with your organization before administering this or any other questionnaire regarding your organization’s guidelines concerning data collection. Your organization or its funding agencies may require clearance of this data collection and have special processes for approval. NDEP Power to Prevent Appendices 40
Page 1 and 2:
Power to Prevent A Family Lifestyle
Page 3 and 4:
Credits and Acknowledgments NDEP Af
Page 5 and 6:
Table of Contents Foreword. . . . .
Page 7 and 8:
Appendix Materials and Resources Th
Page 9 and 10:
Additional Resources for Program Le
Page 11 and 12:
Organizations Black Women’s Healt
Page 13 and 14:
in the Forward/Introduction section
Page 15 and 16:
NDEP GAME PLAN Food and Activity Tr
Page 17 and 18:
Session No. and Title Session 10 Pa
Page 19 and 20:
Session Duration Each session is de
Page 21 and 22:
Session Preparation As program lead
Page 23 and 24:
Refreshments and healthful snacks,
Page 25 and 26:
Conducting the Session NOTE: Times
Page 27 and 28:
Say: “Let’s fll in our Individu
Page 29 and 30:
The program leader ends the session
Page 31 and 32:
NOTE: You could choose other sticke
Page 33 and 34:
NDEP Power to Prevent Program Leade
Page 35 and 36:
Getting Started Getting started wit
Page 37 and 38:
NDEP Power to Prevent Program Leade
Page 39 and 40:
Key to Icons Used in Power To Preve
Page 41 and 42:
At least two helpers to assist peop
Page 43 and 44:
Say: “The objectives for today’
Page 45 and 46:
What are some of the Complications
Page 47 and 48:
Pledge Possible Improvements I’ll
Page 49 and 50:
NDEP Power to Prevent Session 0
Page 51 and 52:
Purchase stickers (stars, smiling f
Page 53 and 54:
Discussion Points Say: “Small Ste
Page 55 and 56:
Preparation and Reminders for the N
Page 57 and 58:
Advance Preparation NOTE: The NDEP
Page 59 and 60:
Discussion Points Say: “Healthy e
Page 61 and 62:
Activity Take a 5- to 0-minute brea
Page 63 and 64:
Tips for Inviting a Registered Diet
Page 65 and 66:
NDEP Power to Prevent Session 3 0
Page 67 and 68:
Appendix U: Why Physical Activity I
Page 69 and 70:
in silence. Suggest that if partici
Page 71 and 72:
Ask participants to name ways that
Page 73 and 74:
Optional Activities 4.1 Visit an At
Page 75 and 76:
also be downloaded from the NDEP We
Page 77 and 78:
Say: “Cooking can be a fun activi
Page 79 and 80:
Page 81 and 82:
Brochure 7 Principles for Controlli
Page 83 and 84:
Conducting the Session Welcome Welc
Page 85 and 86:
List answers on a fipchart, and mak
Page 87 and 88:
Page 89 and 90:
Conducting the Session Welcome Welc
Page 91 and 92:
Activity Take a 5- to 0-minute brea
Page 93 and 94:
Advance Preparation In addition to
Page 95 and 96:
Further Information on Diabetes Pre
Page 97 and 98:
Page 99 and 100:
Obtain copies of Appendix Q: Energi
Page 101 and 102:
Review of Discussion Points Say:
Page 103 and 104:
Page 105 and 106:
Advance Preparation In addition to
Page 107 and 108:
My Pyramid Some people in your grou
Page 109 and 110:
Page 111 and 112:
Bring copies of menus from several
Page 113 and 114:
Example of better “I statement”
Page 115 and 116:
Page 117 and 118:
If you plan do to the Optional Acti
Page 119 and 120:
It is recommended that people with
Page 121 and 122:
Optional Activities 1.1 Review the
Page 123 and 124: Advance Preparation In addition to
Page 125 and 126: Discussion Points Say: “Making ch
Page 127 and 128: Pledge Have participants make an in
Page 129 and 130: Advance Preparation for Session 12
Page 131 and 132: Make photocopies of the Post-progra
Page 133 and 134: Review of Discussion Points Say:
Page 135 and 136: NDEP Power to Prevent Session 2 6
Page 137 and 138: NDEP Power to Prevent Appendices 2
Page 139 and 140: Sample Letter to Potential Partners
Page 147 and 148: Black Women’s Health Imperative w
Page 151 and 152: Community newspaper organizations S
Page 153 and 154: Selecting and Securing a Regular Me
Page 155 and 156: Reward participants for fnishing th
Page 157 and 158: People bring their children to the
Page 161 and 162: “I can accept failure. Everyone f
Page 171 and 172: Session Questionnaire Intent 1 Pre-
Page 173: Where Am I Right Now? Thinking abou
Page 177 and 178: Feelings About Having Diabetes Plea
Page 179 and 180: Pre-Session 3 Questionnaire (Fill o
Page 181 and 182: Post-Session 3 Questionnaire (Fill
Page 183 and 184: Pre-Session 4 Questionnaire (Fill o
Page 187 and 188: Please answer the following. (Check
Page 189 and 190: Check Ups Please check “Yes” or
Page 191 and 192: How confdent are you now? Please ci
Page 195 and 196: Where Am I Right Now? Thinking abou
Page 199 and 200: 1 Start Here 2 Check Calories 3 Lim
Page 213 and 214: The Plate Method The Plate Method c
Page 223 and 224: Spotting Denial Denial has a few ca
Page 225 and 226:
If you have three or more of these
Page 227 and 228:
Let Anger Be Your Ally The goal is
Page 229 and 230:
Learning to Relax There are many wa
Page 231 and 232:
NDEP Power to Prevent Appendices 96
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Si Usted Tiene Diabetes, ¡Sepa los
Page 239 and 240:
Small Steps. Big Rewards. Prevent T
Page 241 and 242:
Publications and Resources for Chil
Page 243 and 244:
Team Care: Comprehensive Lifetime M
Page 245 and 246:
Team Care: Comprehensive Lifetime M
Page 247 and 248:
Page 249 and 250:
New Beginnings: A Discussion Guide
Page 251 and 252:
Page 253:
show all

Power to Prevent - National Diabetes Education Program - National ...

Create successful ePaper yourself

Delete template?

Save as template?