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

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Post-Session 4 Questionnaire (Fill out this questionnaire at the end of session 4) Name or other identifer (such as initials with day and month of birth): _________________________ Physical Activity-Related Lessons 1. 2. 3. Don’t know or refused Three health benefts of physical activity are: (Check “Don’t know or refused” if you do not know or do not want to answer.) Physical Activity-Related Lessons Please circle one number to indicate how strongly you agree or disagree with each of the following statements. (Check “Don’t know or refused” if you do not know or do not want to answer.) 1. I understand the connection between physical activity and diabetes prevention. 2. I understand why properly ftting shoes are important for a person with diabetes. Strongly agree Agree Neither agree nor disagree Disagree 5 4 3 2 5 4 3 2 3. I can think of small steps I can take to increase my physical activity. 5 4 3 2 4. I am confdent I can be more physically active. 5 4 3 2 5. I can name physical activities I can do to reduce stress. 5 4 3 2 Strongly disagree Don’t know or refused Please put your name (or your initials with day and month of birth) on this questionnaire and give it to your program leader. NDEP Power to Prevent Appendices 49
Post-Session 5 Questionnaire (Fill out this mid-program questionnaire at the end of session 5) Name or other identifer (such as initials with day and month of birth): ______________________ Thanks for participating in our program! This questionnaire was given to you to fll out at the beginning of the program. Now we would like you to fll it out again. Then you can compare your answers from the frst session with these answers to see how far you have come. Goals and Expectations My goals are to: (Please check all that apply, or write in your own.) Lose weight Feel better about myself Physical activity more Learn to eat and/or cook more healthily Learn more about how to control diabetes in general Take control over my diabetes Prevent diabetes in myself Other:_________________________________________________________________________ Where Am I Right Now? Please answer the following questions thinking about your physical activity and eating over the past fve weeks. Please circle one number to indicate how strongly you agree or disagree with the following statements. (Check “Don’t Know or Refused” if you do not know or do not want to answer.) In this program I: Strongly agree Agree Not sure Disagree Strongly disagree 1. Understand more about diabetes control. 5 4 3 2 1 2. Understand more about diabetes prevention. 3. Gained support from other members of the group. 4. Became able to teach my family about diabetes prevention. 5. Became able to make changes in my eating. 6. Became able to make changes in my physical activity. 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 5 4 3 2 1 Don’t know or refused NDEP Power to Prevent Appendices 50
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Power to Prevent A Family Lifestyle
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Credits and Acknowledgments NDEP Af
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Table of Contents Foreword. . . . .
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Appendix Materials and Resources Th
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Additional Resources for Program Le
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Organizations Black Women’s Healt
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in the Forward/Introduction section
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NDEP GAME PLAN Food and Activity Tr
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Session No. and Title Session 10 Pa
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Session Duration Each session is de
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Session Preparation As program lead
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Refreshments and healthful snacks,
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Conducting the Session NOTE: Times
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Say: “Let’s fll in our Individu
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The program leader ends the session
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NOTE: You could choose other sticke
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NDEP Power to Prevent Program Leade
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Getting Started Getting started wit
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NDEP Power to Prevent Program Leade
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Key to Icons Used in Power To Preve
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At least two helpers to assist peop
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Say: “The objectives for today’
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What are some of the Complications
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Pledge Possible Improvements I’ll
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NDEP Power to Prevent Session 0
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Purchase stickers (stars, smiling f
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Discussion Points Say: “Small Ste
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Preparation and Reminders for the N
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Advance Preparation NOTE: The NDEP
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Discussion Points Say: “Healthy e
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Activity Take a 5- to 0-minute brea
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Tips for Inviting a Registered Diet
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NDEP Power to Prevent Session 3 0
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Appendix U: Why Physical Activity I
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in silence. Suggest that if partici
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Ask participants to name ways that
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Optional Activities 4.1 Visit an At
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also be downloaded from the NDEP We
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Say: “Cooking can be a fun activi
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Brochure 7 Principles for Controlli
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Conducting the Session Welcome Welc
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List answers on a fipchart, and mak
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Conducting the Session Welcome Welc
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Activity Take a 5- to 0-minute brea
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Advance Preparation In addition to
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Further Information on Diabetes Pre
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Obtain copies of Appendix Q: Energi
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Review of Discussion Points Say:
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My Pyramid Some people in your grou
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Bring copies of menus from several
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Example of better “I statement”
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If you plan do to the Optional Acti
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It is recommended that people with
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Optional Activities 1.1 Review the
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Discussion Points Say: “Making ch
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Pledge Have participants make an in
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Advance Preparation for Session 12
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Make photocopies of the Post-progra
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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
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Page 161 and 162: “I can accept failure. Everyone f
Page 171 and 172: Session Questionnaire Intent 1 Pre-
Page 173 and 174: Where Am I Right Now? Thinking abou
Page 175 and 176: The next questionnaire is an option
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: 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 193 and 194: Post-Session 11 Questionnaire (Fill
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
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NDEP Power to Prevent Appendices 00
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Si Usted Tiene Diabetes, ¡Sepa los
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Small Steps. Big Rewards. Prevent T
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Publications and Resources for Chil
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Team Care: Comprehensive Lifetime M
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Team Care: Comprehensive Lifetime M
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New Beginnings: A Discussion Guide
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