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

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Post-Program Questionnaire (Fill out this post-program questionnaire at the beginning of session 12) 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 at the beginning of the program. Now we would like you to fll it out again. Please make sure that your group leader has your home address so that a copy of this questionnaire can be sent to you. 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 in this program were to: (Please check all that apply, or write in your own.) Lose weight Feel better about myself Become more physically active 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 and/or my family Other:_________________________________________________________________________ In this program I did the following: (Please check all that apply, or write in your own.) Learned more about diabetes control Learned more about diabetes prevention Gained support from other members of the group Became able to teach my family about diabetes prevention Became able to make changes in my eating Became able to make changes in my physical activity Other:_________________________________________________________________________ NDEP Power to Prevent Appendices 59
Where Am I Right Now? Thinking about your physical activity and eating over the past three months, please answer the following questions: 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.) Right now: Strongly agree Agree 1. I eat healthily. 5 4 3 Not sure Disagree 2 Strongly disagree 2. I get enough physical activity. 5 4 3 2 1 3. I want to eat more healthily. 5 4 3 2 1 4. I want to be more physically active. 5 4 3 2 1 Physical Activity During the past week, what was the highest level of physical activity you got? (Check the best answer below.) 1 Don’t know or refused No specifc physical activity routine (just activities of daily living such as walking in the house or at work) Light intensity physical activity (for example, slowly walking the dog, breathing and heart beat are not faster) Moderate intensity physical activity (brisk walking, light yard work e.g. raking leaves or mowing lawn, biking at a casual pace) Vigorous physical activity (jogging/running, swimming laps, playing basketball or soccer) During the last week, how many days were you physically active at the level you checked above for at least 30 minutes per day? None to 2 days 3 to 5 days 6 to 7 days Eating How do you usually decide what to eat? (Please check all that apply.) Count calories Count carbohydrates Avoid sweets and sugars Limit amount of fat Eat anything I want or whatever is convenient Other:_________________________________________________________________________ NDEP Power to Prevent Appendices 60
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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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Review of Discussion Points Say:
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NDEP Power to Prevent Appendices 2
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Sample Letter to Potential Partners
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Page 143 and 144: NDEP Power to Prevent Appendices 8
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 and 184: Pre-Session 4 Questionnaire (Fill o
Page 185 and 186: Post-Session 5 Questionnaire (Fill
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: Post-Session 11 Questionnaire (Fill
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 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
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Team Care: Comprehensive Lifetime M
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New Beginnings: A Discussion Guide
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