1. FDNS4660 Curriculum Project Emilie Koetter April 12, 2013

2. Target Audience O Women between the ages of 46 and 64 with Type II Diabetes O Why this audience?  12.6 million women have diabetes (13.7% of women age 46–64)  Diabetes is the leading cause of death for women in this age range  Women with diabetes are at higher risk for CVD

3. Health and Nutrition Issues O There are many complications associated with type II diabetes:  Cardiovascular disease  Stroke  Diabetic kidney disease (nephropathy)  Retinopathy and cataracts  Neuropathy and amputation  Depression  Periodontal disease O The presence of diabetes lowers life expectancy by 5-10 years.

5. Needs Assessment O Women ages 46 - 64 with type II diabetes O Lack of knowledge and understanding about diabetes and diabetes self- management O Family knowledge and understanding of diabetes O Lack of knowledge about proper dietary and overall lifestyle habits relative to diabetes

7. Program Goal O To provide women with type II diabetes the knowledge and skills necessary to confidently and successfully manage their disease.

8. Objectives o Foundational knowledge The client will:  Understand the necessary lifestyle changes for health improvement. o Application:  Be able to create a healthy meal plan with carbohydrates distributed throughout the day.  Use carbohydrate counting to design and eat regular meals, control portion sizes, and make healthy food choices to help manage their diabetes.

9. Objectives o Integration:  Understand the relationship between lifestyle factors such as diet and physical activity, and the level of control they have over their diabetes. o Human dimension:  Come to see themselves as knowledgeable, capable, and in control of their diabetes. o Caring: o Be more interested in living an overall healthy lifestyle to better manage their health and happiness. o Learning How to Learn:  Identify important sources of information about nutritional guidelines and glycemic control.

10. Teaching Plan- Module #1 Objective : Clients will understand what carbohydrates are and how they affect their blood sugar levels. Be able to create a healthy meal plan with carbohydrates distributed throughout the day. O Pre-Assessment: Assessment of knowledge “pre- quiz” to determine what the clients already know about nutrition and diabetes as well as relating nutrition to their disease O Learning Activities: Cooking Demonstration Group discussion of material Q & A O Post-Assessment: Quiz to determine what the client has learned during the lesson and if they have additional questions or concerns

11. Teaching Plan- Module #2 Objectives: The patient will come to view themselves as knowledgeable, capable, and in control of their diabetes; Will understand the relationship between lifestyle factors such as diet and physical activity, and the level of control they have over their diabetes. O Pre-Assessment Questionnaire regarding current perceptions and beliefs about methods and ease of diabetes management (Pre- and Post-) O Learning Activities Target lab value handout Handouts for tracking exercise, dietary intake, blood glucose, medications Meditation and stress relief session Yoga session with introductory poses O Post-Assessment Current lifestyle habits as well as a post- assessment of changes they plan to implement

12. Teaching Plan- Module #3 O Objectives: The client will understand the relationship between lifestyle factors such as diet and physical activity, and the level of control they have over their diabetes. O Pre-Assessment Evaluation of current physical activity (what, where, when, how often, duration) O Learning Activities CDC podcasts Common household items which can be used during exercise to make it more fun and interesting; can be done at home Use of entertainment (xbox, wii, etc.) for exercise and how they can be used for the whole family O Post-Assessment 1-2 weeks after program send an email survey to see if participants have implemented any activities and what their thoughts, perceptions and barriers to implementation are

13. Teaching Plan- Module #4 O Objective: The client will be able to manage their diabetes medications and take them as prescribed. Family members will be ready to help loved ones manage their diabetes. O Learning Activities CDC podcasts on diabetes management with family involvement Handouts on diabetes care guidelines One-on-one sessions with patient, diabetes educator, and family to help lead discussion and moderate the session O Pre- and Post- Assessment Survey for family members and patients before and after lesson to assess knowledge and understanding of subjects discussed; help determine whether session is helpful and to make changes or adjustments in future sessions

14. Logic Model Outcomes InputsActivitiesOutputsInitialIntermediateLonger term Program developers Training staff Teachers and instructors Food demo equipment and ingredients Writing utensils, handouts, & presentation materials etc. for class Lesson plans Location to hold program Electronics used in class activities (computer, etc.) Food demonstration Yoga demonstration and class sessions Stress relief exercise Observational learning Knowledge about diabetes including dietary and exercise related knowledge Resources and information for diabetes self- management, healthful diet planning, and exercise performance. Participants will… become more aware of the changes necessary to live a healthy lifestyle and be in control of their diabetes; Be introduced to the basics of meal planning, label reading, portion control, & insulin and carbohydrate ratios; Have a general understanding of how lifestyle and dietary choices affect blood glucose levels; Be aware of the complications associated with unmanaged diabetes Participants will… be able to create healthy meal plans with even distribution of CHO; Be able to control portion sizes and identify healthy food options; Be more interested in living an overall healthy lifestyle Participants will be more in control of their diabetes and will make the changes necessary to control their blood glucose levels. Participants will adapt a healthier lifestyle including regular exercise and healthful dietary patterns.

15. Budget ItemCost Adult Education Instructor$192 ($16/hr x 3 hr/wk x 4 wks) Ingredients & supplies for cooking demo$100 Displays & handouts for classes$100 Informational packet$300 ($15 each x 20 people) Podcasts$0 (from CDC) Website$8 Computer software$200 Location$200 Insurance$300 TOTAL~ $1,400

16. References O Centers for Disease Control and Prevention. Interim Report: Preposed Recommendations for Action A National Public Health Initiative on Diabetes and Women’s Health. Version current 8 January 2013. Internet: http://www.cdc.gov/diabetes/pubs/pdf/interim.pdf (accessed 23 January 2013).http://www.cdc.gov/diabetes/pubs/pdf/interim.pdf (accessed 23 January 2013). O Fowler, MJ. Diagnosis, Classification, and Lifestyle Treatment of Diabetes. Clinical Diabetes 2010;28:79-86. doi: 10.2337/diaclin.28.2.79. Internet: http://clinical.diabetesjournals.org/content/28/2/79.full.pdf (accessed 23 January 2013). http://clinical.diabetesjournals.org/content/28/2/79.full.pdf (accessed 23 January 2013). O Franz MJ, Bantle JP, Beebe CA, Brunzell JD, Chaisson JL, Garg A,,Holzmeister LA, Hoogwerf B, Mayer-Davis E, Mooradia AD, et al. Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications. Diabetes Care 2002;25:148-198. doi: 10.2337/diacare.25.1.148. Internet: http://care.diabetesjournals.org/content/25/1/148.full.pdf (accessed 24 January 2013). http://care.diabetesjournals.org/content/25/1/148.full.pdf (accessed 24 January 2013). O Narayan, KM. The Steno Diabetes Study. Clinical Diabetes 2004;22:34-35. doi: 10.2337/diaclin.22.1.34. Internet: http://clinical.diabetesjournals.org/content/22/1/34.full.pdf (accessed 22 January 2013). http://clinical.diabetesjournals.org/content/22/1/34.full.pdf (accessed 22 January 2013). O Redmond, B. Self-Efficacy and Social Cognitive Theories. Penn State University. Version current: 13 February 2010. Internet: https://wikispaces.psu.edu/display/PSYCH484/7.+Self- Efficacy+and+Social+Cognitive+Theories (accessed 17 February 2013).https://wikispaces.psu.edu/display/PSYCH484/7.+Self- Efficacy+and+Social+Cognitive+Theories O Social Cognitive Theory. University of Twente. 12 December 2012. Internet: http://www.utwente.nl/cw/theorieenoverzicht/Theory%20Clusters/Health%20Communicati on/Social_cognitive_theory.doc/ (accessed 19 February 2013). http://www.utwente.nl/cw/theorieenoverzicht/Theory%20Clusters/Health%20Communicati on/Social_cognitive_theory.doc/

17. Questions?