Your Wellness Roadmap Leader's Guide

This publication is intended to help educators use the "Your Wellness Roadmap" lessons with clients. It includes information on the program and goals and objectives.
Your Wellness Roadmap Leader's Guide - Articles
Your Wellness Roadmap Leader's Guide

Introduction

This lesson series grew out of the need to stem the rising incidence of type 2 diabetes in Pennsylvania as well as the nation. Although many materials are available to help those diagnosed with diabetes, fewer are available that link healthy lifestyle behaviors with reducing the risk of cardiovascular dis-ease, high blood pressure, and diabetes as a group of chronic diseases. This series, which emphasizes evaluating one’s own personal risk and then adopting two basic health-promoting principles, attempts to provide an aging population with some advice on health protection.

The two health-promoting principles are (a) being physically active, and (b) eating more plant-based foods. In addition, participants receive instructions on using the Nutrition Facts panel to help them eat less fat, saturated and trans fats, and more fiber.

These four lessons are designed to spark interest in preventative health behavior. They will not, in and of themselves, provide enough practice for firm adoption of healthful eating habits and regular exercise. They must be followed by supporting activities within the families, worksites, and the larger community. They also can be linked to other Penn State Extension programs that reintroduce and reinforce these proposed behaviors.

Target Audience

The target audience is adults age 40 and over. People in their forties are just beginning to notice the health problems surfacing among their parents and their relatives. The further over 40 we are, the more likely we are to realize that we could develop or have health problems. This is the teachable moment for health promotion.

Development and Impact

This lesson series can be delivered in a variety of settings. It is modeled after a series addressing osteoporosis, which was shown in a statewide impact study to result in improvements in knowledge and in positive changes in food behaviors when delivered in conjunction with a group motivational meeting.

Based on the impact study of the osteoporosis lessons, the leader can expect participants who receive these lessons one at a time to read at home, each in conjunction with a taste-testing and mini-motivational meeting, to make more significant changes in activity level and food choices than those who receive the lessons without the meeting. Participants who experience the motivational meeting also are more likely to:

  • consider the lessons more useful
  • try foods with which they are less familiar

Although a similar impact study has not been conducted for this lesson series, the evaluation forms provided with these lessons can provide impact data both for the county and for compilation at the state level. These evaluation forms also will guide future revisions of this lesson series.

Lesson Goals and Objectives

Educational goals

  1. Raise participants’ awareness of how personal family history, activity level, and food choices affect their risk of developing type 2 diabetes (non-insulin-dependent diabetes), as well as cardiovascular disease and high blood pressure.
  2. Encourage participants to change their activity level and food choices to lower that risk.

Educational objectives

  1. Help participants evaluate their family health history and their own risk of developing type 2 diabetes.
  2. Describe type 2 diabetes, its symptoms, and its long-term effects.
  3. Explain the role of exercise, low-fat eating, and fiber in reducing the risk of developing type 2 diabetes, as well as cardiovascular disease and high blood pressure.
  4. Introduce everyday activities as a stepping stone to regular exercise.
  5. Introduce MyPyramid and use of the Nutrition Facts panel as the basis for healthful eating.

Specific educational outcomes

Participants will:

  1. understand that the chances of developing diabetes, cardiovascular disease, and high blood pressure increase as we age.
  2. recognize that two basic principles—being physically active and eating more plant-based foods—can form the basis of a wellness plan.
  3. recognize how too little activity, too much fat, and too little fiber contribute to the risk of developing type 2 diabetes.
  4. evaluate their own family health history, their risk of developing type 2 diabetes, their target heart rate for exercise, and their fiber intake.
  5. make a change in exercise habits if appropriate.
  6. make a change in food choices and food preparation if appropriate.

Lesson Content

Each lesson packet contains:

  • a lesson with an introduction to the featured topic, recipe notes, and a basic background section
  • an information sheet, some common questions and their answers
  • a worksheet
  • a fact sheet
  • recipes (four per lesson)

Some of the lessons include additional pieces. These are:

  • Lesson 3: Activity calendar, fact sheets 2 and 3
  • Lesson 4: Fact sheet 2

Each of the worksheets provides a different assessment activity for the participant. All worksheets are designed to be scored by the participant. The work-sheets are:

  • Lesson 1: Your Family Health History
  • Lesson 2: Are You at Risk for Diabetes?
  • Lesson 3: Finding Your Target Heart Rate
  • Lesson 4: Fiber Counter

A complete list of materials to be included in each lesson is found in Appendix 1, along with notes about the worksheets and a list of the common questions.

Program Management

Location

The lessons can be delivered to adults age 40 and over in a variety of ways, including by direct mail to people’s homes. Because the lessons stress beginning a wellness plan and emphasize reducing the risk of diabetes, cardiovascular disease, and high blood pressure, they also are suitable for presentation:

  • at worksites such as blue-collar manufacturing plants, printing and publishing houses, county courthouses, banks, insurance companies, electrical utility companies, and software and hard-ware manufacturing companies.
  • through organizations such as granges, fire companies, women’s organizations, the YMCA, and business schools, as an adjunct to their other classes.
  • through community health organizations such as Area Agencies on Aging, the American Diabetes Association, and hospitals.

Based on previous experience, the lessons are unlikely to receive any attention at child care centers. Parents of young children often are too focused on their children and managing daily activities, and will not take the time to become involved in these lessons.

Contact person

Two things are critical for your success at a worksite or through any organization: the support of company or organization management and an enthusiastic contact person.

  • Contact the organization representative (in a worksite, the personnel manager is a good place to start) by phone, explain what you can offer, and make an appointment to visit him or her personally. Share lesson materials and discuss how the information can be delivered. Let the representative know that the material can sup-port the organization’s commitment to personal health or, in the case of worksites, their health benefits program.
  • Determine the person who is to be your personal contact, if interest and support are strong. Work-sites often want a nurse, a health coordinator, or a member of the personnel staff to fill that role.
  • Meet with your contact person. Determine his or her enthusiasm and desired role in the program. Contact persons can make or break your effort. If they are lukewarm, expect to have less success in recruiting people and less completion of the lessons. If they are your cheerleader, they will make your job much easier.
  • After reviewing the advantages, disadvantages, and specifics of each delivery method with your contact person, decide how the lessons will be delivered. Discuss the weekly time interval between lessons with your contact person and, if possible, talk to key informants within the organization or at the worksite. See what they think. The key informant’s opinion may be more important in determining the time interval than the contact person’s opinion.
  • Negotiate a time to begin advertising and recruitment.

Choosing a delivery method

The lessons can be provided to participants in two ways, either through pairs of group motivational meetings, or as learn-at-home lessons distributed one at a time by mail or as handouts. Each has advantages and disadvantages.

Learn at Home: You or a contact person in an organization can distribute the series as learn-at-home lessons, with an optional follow-up meeting.

Advantages:

  1. Requires least time of nutrition educator,
  2. Easy to teach a volunteer how to organize and distribute the materials,
  3. Does not require a meeting room, meetings, or preparing foods.

Disadvantages:

  1. You have no personal contact or feedback from participants,
  2. Participants will have questions that won’t be answered,
  3. Participants are much less likely to make changes in behaviors.

Group Meetings: You can distribute each lesson sequentially at a series of four pairs of motivational meetings that include taste-testing of foods featured in the lessons.

Advantages:

  1. Gives you personal contact and feedback from participants,
  2. Can be done at a workday lunch hour as well as at an evening meeting,
  3. Participants are more likely to make changes in behaviors.

Disadvantages:

  1. More preparation time required since food samples must be prepared,
  2. More work required to teach a volunteer to deliver,
  3. Requires a 30-minute time period and a meeting room twice a week for a month,
  4. Person who leads meeting must “know” the material.

Directions for both types of delivery are presented below. Please read these directions to become familiar with the work involved.

Time interval between lessons

Present the lessons so they are completed in one month. This means that you should mail, hand out, or present a lesson a week for four weeks. It is best to allow a weekend between presentation of lessons so participants have some time to try recipes and digest the material. The organization with whom you cooperate to present the series probably will prefer the lesson-a-week schedule to economize on its time commitment. Many participants will prefer the frequent contact a weekly schedule provides; however, some will feel they need more time to learn the material.

The time interval between lessons should match the participants’ ability to read and digest material and to try recipes and activities. The meetings are designed to give only highlights of the lessons. Participants still must read the lessons to get the full benefit of the series. If you choose group delivery, the time interval between meetings also should allow you sufficient time to prepare the presentations and food samples. After initially trying these with a one-week interval, you may find you need to move to a two-week interval between lessons. If you can keep participants’ interest, the longer time interval may make it easier for them to adopt the suggested behaviors.

If you choose impersonal delivery, be sure to mail each lesson individually, once a week, rather than mailing all four at once. Many participants are put off by receiving all four lessons at once, both because of the amount of material and because it sends a message that you are not interested in them personally.

Advertising and recruitment

Appendix 2 contains examples of the following advertising materials:

  • Paycheck stuffer or take-home notice*
  • Newsletter article—impersonal distribution*
  • Newsletter article—group meetings*
  • Recruitment brochure
  • In-person recruitment presentation script

The recruitment brochures are available from the Penn State College of Agricultural Sciences Publications Distribution Center, 112 Agricultural Administration Building, University Park, PA 16802, or by calling 814-865-6713. Those marked with an asterisk (*) also are available on a CD in Microsoft Word from J. Lynne Brown, 205 A Borland, University Park, PA 16802. You may want to tailor the newsletter articles for your particular site.

Here are some basic guidelines to follow when advertising:

Plan to advertise for a period of about two to four weeks. Choose a deadline for registration that precedes by one week the date you wish to hold the first meeting or distribute the first lesson.

Work with your contact person to plan advertising. Use the contact person’s suggestions and your own ideas. Not everything provided is necessary or will work with an organization or site. Use whatever works best for your situation from the ideas below.

Brochures. These may be handed out, put on display, or sent to sites to elicit interest. In some locations, a brochure can be enclosed with a personal letter inviting participation and sent to possible participants.

Newsletter article. Use in extension or organization newsletters if time and space permit.

Paycheck stuffer or take-home notice. These may be placed into any envelope that will go to a potential participant.

Personal recruitment. Extension educators consistently have found that personal recruitment is the most productive method. As one educator said, “The program will go without a recruitment presentation (by you) if the organization or company contact truly wants to see it be successful and will take the initiative to do more than just distribute brochures. Encouraging people face to face is what works.” This sometimes can be done at worksites by walking around the site and introducing yourself to people, briefly outlining the course, and giving them a brochure.

Short talks. Provide short talks (10 minutes) to advertise the course, using the outline in Appendix 2. Plan to give a minimum of one personal appearance per organization or site. You also can use this time to introduce potential participants to Penn State Extension.

Note that the brochure, paycheck stuffer, and news-letter articles all need to include the starting date, location, time, etc. Be sure to write in these details before distributing the materials.

Registration

You can arrange to have people register by mail or phone, or you may arrange a drop-off box for registration forms at the organization or worksite. Collect forms the day after the deadline, or fill in the “Return this registration form today to” space on the brochure with the name and phone number of your cooperating contact person and let that person collect the forms for you.

Make up a registration list using software available in your office. You might include columns for the following information:

  • name, sex, address, and phone number
  • Lessons 1–4 (to record distribution or attendance)
  • course questionnaires returned
  • refrigerator poster sent

When your registration list is confirmed, send each person a letter welcoming him or her to the series. In this letter, confirm the starting date and the details (distribution process or meeting room and time).

Delivery by impersonal distribution

This involves distributing the lessons one at a time for four weeks and includes the option of a concluding face-to-face meeting to answer questions and hand out refrigerator posters.

  1. Establish a lesson distribution schedule at the site so that you can deliver lessons one day of the week. Organizations may prefer different days of the week for distribution depending on their circumstances. Have the contact person announce the distribution schedule for the lessons, once a week for four weeks. Encourage contacts to complete distribution on a particular day so that participants stay on schedule. You may want to arrange to hand out the lessons personally at a particular time. Your contact person may decide to distribute them personally to participants on a particular day. If you can manage it, this personal touch helps keep participants motivated.
  2. Prepare generic sign-in sheets or copies of your registration list for the site. Ask your contact person to use these to keep track of who picks up or receives lessons.
  3. Use your registration list to keep tabs on lesson delivery, participants, and receipt of course evaluation forms.
  4. Organize the lessons so they can be distributed. The content of each lesson is listed in Appendix 1.
  • With Lesson 1, include a letter like the one provided in Appendix 3 and the pre-course questionnaire provided in Appendix 9. In the cover letter, ask the participants to return the questionnaire to you or your contact person before they receive Lesson 2. You may add a postage-paid envelope addressed to you and a deadline date for the return.
  • With Lesson 4, include the post-course questionnaire provided in Appendix 9 and a letter like that provided in Appendix 3 to encourage the completion of the questionnaire. Omit the optional paragraph in it if you do not plan to hold a concluding meeting. You may add a postage-paid envelope addressed to you and a deadline date for the return (about one week after distribution of the last lesson).
  • You might want to put the first lesson in a Penn State folder that can be used to hold all four when they have been distributed. Give the assembled lessons to your contact person if he or she will be doing the distribution. Placing a sticky note on the lesson to remind the participant when the next lesson will be handed out helps keep participants on track.
  • Arrange for a drop-off box for the pre- and post-course questionnaires, or for their collection by personnel on site.
  • Collect the pre- and post-course questionnaires returned.
  • Two weeks after the deadline for the return of the post-course questionnaires, mail those who return the questionnaires a refrigerator poster and a certificate of completion.

If you decide to hold a short concluding meeting or evening open house:

  1. Lesson 4 should contain a letter like that shown in Appendix 3 about the concluding meeting or open house date (one week after distributing the last lesson) as well as the post-course questionnaire. On the post-course questionnaire, write a deadline for its return. Set this deadline for the date of the concluding meeting. If you can-not arrange a drop-off box or collection at the site, include a business reply envelope.
  2. One week after distributing the fourth lesson, hold your concluding meeting. This can be of your own design, or it can follow the elements you choose from the Lesson 4 group meeting #2 script in Appendix 7. The meeting’s purpose is to:
    • review the keys to wellness suggested in the lesson series (see visuals, Lesson 4, meeting #2).
    • answer any questions.
    • collect post-course questionnaires and pass out refrigerator posters.
    • alert participants to other materials available from Penn State Extension.
    • taste a recipe (use any one from the group meetings).
    • pass out award of completion certificates.
    • present a certificate of appreciation to your contact person (optional).

Delivery by group meeting

This option suggests that you conduct two meetings for each lesson, one to introduce the principles of the lesson and the second two to three days later to review the worksheet, answer questions, and allow participants to taste a recipe. You would prepare food only for the second meeting. Although intense, this delivery method builds rapport with the participants, and they are more likely to follow through with behavior change. They also will be more likely to welcome you back with additional material.

If you wish, you may reduce the two meetings per lesson to one by choosing the points you want to present from the two scripts provided for each lesson in Appendices 4–7.

  1. Establish a meeting schedule at the site so you can hold the meetings and deliver lessons efficiently. Each group meeting is designed to last 30 minutes and will fit into a half-hour lunch break. Negotiate:
    • a separate meeting room (to avoid noise and distractions).
    • no smoking during the lesson (some lunch rooms allow this).
    • convenient 30-minute meeting times (you will need extra setup time).
    • a place to store your props and utensils (except food).

    You will need a table and an easel to hold the props in the meeting room. Have the contact person announce the meeting schedule for the lessons.

  2. Lay out a month-long calendar of your meetings and food preparation activities. For each lesson, you might choose to note (1) when you will food shop, (2) when you will prepare the food samples, and (3) when you will deliver the group meetings and lessons. Consider holding the weekly pairs of meetings for each lesson on Monday and Thursday, Tuesday and Thursday, or Tuesday and Friday, depending on your situation. Presentations at worksites offer an additional advantage, allowing you to conduct them during your daytime work hours. You still will need to shop and prepare the food samples, however, and whether you do this during the day or in the evening will depend on your circumstances.
  3. Prepare a generic sign-in sheet for each lesson. Have one participant at the meetings use it to keep track of who attends and who picks up lessons. Have people sign in at the beginning of the meeting. Hand out the lessons at the meeting’s end. Your volunteer can be in charge of passing out the next lesson and placing a check beside the name of each person who receives one.
  4. Assemble the lessons for distribution. The content of each lesson is listed in Appendix 1. You may put the first lesson in a Penn State folder, if you wish. Take the lessons to the meeting site with the rest of your material. The pre-course questionnaire should be completed during Lesson 1, meeting #1, and the post-course questionnaire during Lesson 4, meeting #2.
  5. Present Lesson 1 at meetings #1 and #2. Follow the group presentation script in Appendix 4. At the end of meeting #1, give each participant a copy of Lesson 1. The recipe to use for Lesson 1, meeting #2, is in Appendix 8. Prepare it between meetings #1 and #2.
  6. Provide group meetings for Lessons 2–4 at your site as outlined in Appendices 5, 6, and 7, and using the recipes in Appendix 8.
  7. Use the registration list to keep tabs of attendance at the site and receipt of pre- and post-course material.
  8. Lesson 4, meeting #2 is the concluding meeting. The script is in Appendix 7 and the recipe is in Appendix 8. The purpose of this meeting is to:
    • summarize lessons and answer any remaining questions.
    • complete and collect post-course questionnaires and pass out refrigerator posters.
    • taste a final recipe.
    • pass out award of completion certificates.
    • present certificate of appreciation to personnel contact (optional).
    • take a group picture (optional).

    Bring your registration list up to date for returned evaluation forms.

Cost and Fees

Impersonal delivery

If your contact person is willing to distribute all of the lessons and collect the pre- and post-course evaluation questionnaires, there is no reason to charge for the lessons. If you make trips to hand out the lessons and provide postage to recover the pre- and post-course questionnaires, however, charging $1.00 per lesson set is reasonable. If you mail the lessons one at a time from the county office, then it is reasonable to charge for the postage as a registration fee.

Group delivery

The costs of food samples and paper products can be recovered at $5–10 per person if the group size is 12 or more. If the group is smaller, you may have to charge more. In general, a charge of $8 per participant is not unreasonable for group delivery. You may have to adjust the cost to meet your circumstances.

Evaluation and Impact Reports

Three evaluation forms are included in Appendix 9: a pre-course questionnaire to gather baseline data, a post-course questionnaire to evaluate short-term effects of the lessons, and a delayed post-course questionnaire to evaluate behavior change. Instructions on using the pre-course and post-course questionnaires are included in the “Delivery by impersonal distribution” and “Delivery by group meeting” sections of this leader’s guide, as well as in the scripts for Lesson 1, meeting #1 (Appendix 4) and Lesson 4, meeting #2 (Appendix 7). You must mail or give the delayed post-course questionnaire to participants two months after they complete the lesson series, and then compile the data for your activity reports and for P.O.W. reporting. In addition, the specialist in charge of this program would appreciate receiving copies of the collected evaluation forms for her reports.

Pre-course questionnaire

Have participants complete and return this form to you before reading Lesson 1 or before receiving Lesson 1 instructions during meeting #1. The pre-course questionnaire is essential for evaluating behavior change and for obtaining the subjects’ initials and age, which will be used to code the forms. (To assist in evaluating individual behavior change, participants are asked to provide their initials and age in the two post-course forms as well.) The pre-course questionnaire also gathers some basic demographic data that federal extension will likely be requiring of states receiving federal support. This form provides baseline data for educational objectives on the P.O.W. Web site.

Post-course questionnaire

Have participants complete this form and return it to you immediately after reading Lesson 4 or at the end of Lesson 4, meeting #2. Participants are asked to provide their initials and age so pre-course and post-course data can be matched. This questionnaire gathers some data about the use of lesson components and about the effect of the lessons on confidence. A number of these questions provide data that can be entered for educational objectives on the P.O.W. Website.

Delayed post-course questionnaire

The Osteoporosis Impact Study indicated that it often takes some time for participants to make changes in behavior. Send this questionnaire to participants two months after they have completed the lesson series. Again, participants are asked to provide their initials and age to allow answers to be matched with pre-course data. To assess a participant’s behavior change, you can match his or her question 3 answers to the question 8 answers in the pre-course questionnaire. In addition, questions 4, 5, and 6 allow the participant to self-report any behavioral changes he or she thinks occurred.

Responses to questions 3 through 6 provide data that can be entered for educational objectives on the P.O.W. Web site.

Please send appropriately coded copies of these evaluation forms to Lynne Brown, 205A Borland, University Park, PA 16802. These are needed for yearly accomplishment reports.

List of Available Materials

The following free materials are available from the Penn State College of Agricultural Sciences Publications Distribution Center, 112 Agricultural Administration Building, University Park, PA 16802-2602. 814-865-6713

  • Lessons 1–4 (see Appendix 1 for lesson contents)
  • Advertising brochure
  • Refrigerator poster
  • Award of completion (generic)
  • Certificate of appreciation (generic)
  • Leader’s guide with scripts, visuals for group meetings, and delayed post-course questionnaires

Prepared by J. Lynne Brown, associate professor of food science, in cooperation with Frances Shacklock, and Sheila Rye.

Appendix 1

General Lesson Information

Lesson Contents

Lesson 1: Our Health Risks After Age 40 Background:

  • objectives and introduction
  • Harry’s story, Alice’s story, and three health risks

Information sheet: Some common questions and their answers

Worksheet: Your family health history

Fact sheet: Using the Nutrition Facts panel to make smart choices

Recipes:

  • banana pudding
  • butterscotch brownies
  • fluffy peach cheese cake
  • vanilla wafer crumb crust

Lesson 2: The Hidden Risk: Diabetes Background:

  • objectives and introduction
  • non-insulin-dependent, or type 2, diabetes—What is it? Who is at a greater risk?

Information sheet: Some common questions and their answers

Worksheet: Are you at risk for type 2 diabetes?

Fact sheet: Sweet nothings—are artificial sweeteners safe?

Recipes:

  • apple-strawberry crisp
  • strawberry shake
  • curried Waldorf salad
  • yogurt-cucumber vegetable dip

Lesson 3: Be Active—You Owe It to Yourself

Background:

  • objectives and introduction
  • physical activity and wellness, the first step, what about walking, making the commitment

Information sheet: Some common questions and their answers

Worksheet: Finding your target heart rate

Fact sheet 1: Start with walking

Fact sheet 2: Putting together an exercise program

Fact sheet 3: Stretching for flexibility

Recipes:

  • pizza snacks
  • energy treats
  • fruit kabobs and dip
  • pineapple honey loaf

Lesson 4: Food Sense—You Owe It to Yourself

Background:

  • objectives and introduction
  • using MyPyramid, fiber facts, set your wellness goals

Information sheet: Some common questions and their answers

Worksheet: Fiber counter

Fact sheet 1: Finding foods with less saturated and trans fats

Fact sheet 2: Finding foods with fiber

Recipes:

  • bannock bread
  • honey basil carrots
  • vegetarian sloppy joes
  • foolproof whole wheat bread

Notes on Worksheets

Lesson 1: Your Family Health History

This is a simple exercise to complete a traditional family tree in which the participant is asked to provide a bit of health and cause-of-death information for each member. This is a good exercise to conduct in one’s forties when most close family members are still alive and grandparents are available to fill in some history. Most of us will lose the opportunity to secure this information as we grow older. This is based on the idea of a family genogram, as described in M. McGoldrick and R. Gerson. 1985. Genograms in family assessment. New York: W. W. Norton & Co.

Lesson 2: Are You at Risk for Type 2 Diabetes?

This worksheet is based on one described in W. H. Herman, P. J. Smith, T. J. Thompson, M. M. Engelgau, and R. E. Aubert. 1995. “A new and simple questionnaire to identify people at increased risk for undiagnosed diabetes.” Diabetes Care 18 (3), 382–387. The authors were concerned that 40–50 percent of diabetes is undiagnosed. In addition, because the onset of type 2 diabetes can precede clinical diagnosis by 9–12 years, victims suffer circulation damage that affects the eyes, kidneys, and extremities. They used data from the Second National Health and Nutrition Examination Survey to develop this simple and inexpensive screen, which is based on risk factors identified from this database. Ideally, this questionnaire would be used in combination with blood glucose testing.

Lesson 3: Finding Your Target Heart Rate

This skill-building activity is conducted in most organized fitness classes. It is important for participants to recognize how hard they should be working when they exercise. The target heart rate provides a reliable measure of the range of heartbeat to aim for in order to obtain an aerobic workout. It changes with age and so allows anyone to find the range of heartbeat best for them. The ability to find a pulse also is a useful first aid skill.

Lesson 4: Fiber Counter

This is a simple exercise combining a 24-hour recall of foods eaten with a list of the fiber content of a variety of common foods. Although some simple arithmetic is involved, it gives the participant a quick answer to the question, “How much fiber am I eating now?”

Complete List of Some Common Questions and Their Answers

Lesson 1

  1. How do I know if I have high blood pressure?
  2. What are the symptoms of high blood pressure?
  3. Why should I get treatment if I can’t feel anything?
  4. Does eating too much sodium still put me at risk for high blood pressure?
  5. Are the risk factors for heart disease the same for men and women?
  6. If it runs in my family, what chances do I have for avoiding it?

Lesson 2

  1. Does eating sugar cause diabetes?
  2. If I am experiencing some of the symptoms of diabetes, how do I know I have diabetes?
  3. What is insulin-dependent diabetes mellitus (type 1)?
  4. Why is insulin given as an injection instead of as a pill?
  5. Can drinking cow’s milk cause type 1 diabetes?
  6. Why do people with diabetes experience so many other health problems?

Lesson 3

  1. How do I find the right exercise shoe?
  2. How do I exercise during bad weather?
  3. Does jogging burn more calories than walking?
  4. How do I lose fat in specific parts of my body? Can I “spot reduce”?
  5. How do I stay committed to regular exercise?

Lesson 4

  1. Can I increase my fiber intake with fiber supplements?
  2. Is it true that diets high in fiber cause nutrient deficiencies?
  3. Will a high-fiber diet help me lose weight?
  4. Will eating oats lower my blood cholesterol level?
  5. What does insoluble fiber do?
  6. Is it true that eating a lot of potatoes, white rice, and white bread can increase my chances of being diabetic?
  7. What is the Mediterranean diet?

Appendix 2

Advertising Pieces

Paycheck stuffer or take-home notice

Download Paycheck stuffer form page.

Newsletter article—impersonal distribution

Are you on the road to health?

Or have you had a breakdown, taken the wrong exit, or run out of gas? A new lesson series from Penn State Extension can help get you back on track. If you are over forty, you need to establish some basic health habits. This is especially important if there is a history of heart disease, high blood pressure, or diabetes in your family.

Sign up to receive the “Your Wellness Roadmap” lessons and you will be able to:

  • evaluate the health history of your family.
  • evaluate your own risk of type 2 diabetes.
  • establish how active you are now.
  • determine how much fiber you eat now.

In addition, you will learn about other people’s experiences with chronic disease in their families and what they did to lower their risk, about the levels of activity that can be protective, and about how to make food choices that protect your health. Four recipes are provided with each lesson in the series.

The four-part lesson series will be distributed to you, one lesson a week for four weeks. Each lesson will take about an hour to complete, but you will want to take additional time to try the recipes.

The lesson series begins _________.

The cost is ________ to cover postage.

Please register by _______________.

For more information , please call _______________.

We look forward to working with you.

Newsletter article—group meetings

Are you on the road to health?

Or have you had a breakdown, taken the wrong exit, or run out of gas? A new lesson series from Penn State Extension can help get you back on track. If you are over forty, you need to establish some basic health habits. This is especially important if there is a history of heart disease, high blood pressure, or diabetes in your family.

Sign up to receive the “Your Wellness Roadmap” lessons and you will be able to:

  • evaluate the health history of your family
  • evaluate your own risk of type 2 diabetes
  • establish how active you are now
  • determine how much fiber you eat now

In addition, you will learn about other people’s experiences with chronic disease in their families and what they did to lower their risk, about the levels of activity that can be protective, and about how to make food choices that protect your health. Four recipes are provided with each lesson in the series.

The four-part lesson series will be offered as a series of short meetings over a month’s time. Each week, a leader will present the main points of a lesson in two 30-minute meetings, the first on (day of week) and the second on (day of week). You will be given an activity to complete between meetings so it can be discussed at the second meeting of the week. In addition, there always will be a food to taste at the second meeting. Between the two meetings, you should review the lesson, which will take about half an hour, and you’ll want to take additional time to try the recipes on your own.

The meetings for the first lesson in the series begin ___________.

Subsequent meetings will be on (day of week) and(day of week) for three weeks. Meetings last 30 minutes.

The cost is to cover food samples provided.

Please register by _______________________.

For more information, please call _______________________.

We look forward to working with you.

Recruitment brochures

Download Recruitment Brochure sample here.

In-person recruitment presentation script

Materials needed:

  • Course brochures
  • Honey basil carrot samples in paper cups on a serving tray.
  • Recipe for honey basil carrots (see Lesson 4).

Script: Hello, my name is _________________________________________. I am an extension educator with __________________ Extension.

I am here to tell you about an opportunity for you to learn about wellness and try some more recipes. I bet most of you think that you are well or healthy—but the big question is “Will you still be healthy in five or ten years?” You can get an indication by looking at your relatives.

(Use the following example or base one on your own experiences.)

Take me, for instance. I thought I came from a family that had no health problems—until I was in my forties. Then my grandfather had several strokes and was placed in a nursing home. But of course he was in his eighties and had smoked—you can expect that. Then an uncle developed diabetes. Hmmm—I thought that maybe this was an unusual case. But when my mother developed high blood pressure when I was 45 and then died of a heart attack when I was 46, I suddenly realized that this could happen to me too.

If you have had experiences like this, we have a learning opportunity for you. It’s called “Your Wellness Road Map.” Its purpose is to provide you the opportunity to assess your own risk for three chronic diseases. Then, you will learn about two habits you can adopt to preserve your health and put you on the road to wellness.

I encourage you to register for our four-part lesson series. (Hold up brochures and sign-up sheet.) Take a brochure or, better yet, sign up right here.

(Impersonal delivery:)

As a participant, you will receive one lesson every week for four weeks. (Explain from whom and how.)

Each lesson contains:

  • background information
  • a personal assessment worksheet
  • fact sheets that teach you skills that will protect your health
  • recipes

You will need to set aside about an hour to read the lesson and fact sheets and to complete the worksheet.

(Group delivery:)

I will meet with those registered for two 30-minute meetings a week. During the first meeting, I will introduce you to the high points of the lesson and explain the worksheet. You then will review the lesson and complete the worksheet before the next meeting. At the second meeting, we will discuss the worksheets, review other parts of the lesson, and taste a recipe based on the material in the lesson. You could try the recipes over the weekend before the next pair of lessons.

Each lesson contains:

  • background information
  • a personal assessment worksheet
  • fact sheets that teach you skills that will protect your health
  • recipes

You will need to set aside about 45 minutes to read the lesson and fact sheets and to complete the worksheet.

Come up and take a sample from the tray. This is a recipe included in one of the lessons. It is a high-fiber snack that can be prepared ahead and kept in the refrigerator. Please take a brochure or sign up here for the meetings. I’d be happy to answer any questions. Thanks for your attention

Appendix 3

Letter To Include With Lesson 1 (Impersonal Delivery)

Dear participant,

Welcome to Your Wellness Roadmap.

Wellness is about keeping healthy. By age 40 you need to do things that will protect your health. This lesson series tells you about three big health risks we all face: heart disease, high blood pressure, and diabetes. Our risk of contracting these illnesses goes up significantly after we turn 45. Diabetes, high blood pressure, and heart disease run in families; if they run in yours, you are at a higher risk of developing them. Fortunately, you can do things to protect yourself against all three diseases. This lesson series discusses four things you can do to begin your wellness plan.

Each lesson in this series has:

  • a background section that provides information
  • a worksheet that helps you evaluate your risk
  • an information sheet that provides answers to some common questions
  • fact sheets that give you more information about things that can lower your risk
  • recipes for snacks, desserts, and breads

It takes about 30 minutes to read each lesson and complete the worksheet. You can try the recipes on the weekend when you have more time.

A questionnaire is included with Lesson 1. It requires only that you circle or check an answer or fill in a blank. Before you begin reading the lesson, please complete this questionnaire and return it using the postage-paid envelope provided.

We hope you complete all the lessons. Although each tells you something about risk and wellness, reading all four gives you a more complete picture.

Sincerely,

Letter To Include With Lesson 4 (Impersonal Delivery)

Dear Wellness Roadmap Participant,

I hope you have found the first three lessons you have received useful. This mailing includes Lesson 4 and a brief questionnaire.

When you have read Lesson 4 and completed the worksheet, please fill out the questionnaire. The questions require only that you check or circle an answer or fill in a blank. Your feedback will help me improve these lessons. Please send it back to me using the postage-paid envelope provided.

Optional:

(I am holding an evening open house for series participants on (date) at (time) in (location). This is an opportunity for you to get answers to your questions about the lesson, return your questionnaire, and receive a certificate of completion. I will be sharing a recipe with those attending as well.)

Thanks for your involvement with this lesson series.

Sincerely,

Appendix 4

Group Presentation Scripts: Lesson 1

Group meeting #1—30 minutes

Materials:

  • Copies of pre-course questionnaire for participants
  • Copy of Lesson 1 for your use
  • Copies of Lesson 1 for participants
  • Sign-in sheet
  • Name tags
  • Marker pen
  • Overhead projector and visuals

Visuals

  • Wellness circle
  • Person over 40 thinking
  • Three health problems
  • Three symptoms
  • Factors that put us at risk
  • Family health tree

Meeting objectives

  • Sign-in
  • Complete pre-course questionnaire
  • Overview of how lessons will work
  • Present main points with visuals
  • Pass out Lesson 1
  • Encourage participants to read lesson and complete worksheet family health history
  • Announce next meeting with food tasting

Script outline

  • Greeting: Welcome to the meeting and lessons. (Ask participants to complete name tag and sign in as you review how the lessons work.)
  • (Pass out the pre-course questionnaire and ask participants to complete it.) To demonstrate extension’s effectiveness, we have to measure the effect of this lesson series on participants. Some of the information on this form, in particular age, sex, and race groupings, is required by the federal agency providing our support. The questions about marital status, children, and income level help us determine if we are serving all the citizens of Pennsylvania. You are free to refuse to answer any of these questions, but your answers would be most appreciated. We will use your initials and age only to match what you provide here with information you will supply on later short questionnaires. Your responses will not be connected with your name or initials in any of our reports. Data from all participants will be pooled, and you will remain completely anonymous. (Answer any questions and collect the completed questionnaires.)
  • (Explain how the series will work.) There will be two half-hour meetings per lesson. These will be on (day) and (day)—three days apart. At the first meeting, I’ll explain the content briefly and pass out the lesson for you read, and then you’ll complete the worksheet on your own. At the second meeting, we’ll discuss the worksheet and review the fact sheet. I will answer questions about the lesson and we’ll have a food tasting. Then we’ll move on to the next lesson.
  • There will be a total of eight 30-minute meetings—two a week for four weeks. At the concluding meeting, I will answer any remaining questions and give you each a certificate of completion.

Each lesson contains:

  • a background section that we review
  • a worksheet that you complete
  • a sheet of common questions and their answers
  • fact sheet(s)
  • four recipes for you to try

Highlights of Lesson 1

These lessons are about wellness, which is represented by this circle. (Download Wellness Roadmap visual  s and show wellness circle to group.) Wellness is about being healthy. It’s a combination of mental or spiritual health, the mind (point to segment), and physical health, the body (point to the larger segment). All parts should be healthy to be whole or well.

These lessons focus on giving you two simple rules to guide you to physical wellness. (Point to the segment representing physical.) If you put these rules into practice, they will help protect your health. There are other rules to consider once you have these under control.

  • Ask: How many of you are over 40 years of age? (Have participants raise hands. Count those over 40 and make comment about size of group over 40.) Most of us start thinking of our health after the age of 40. About this time we start noticing changes in ourselves. We also start seeing changes in our parents. Here is an example.

(You may use this or a story of your own.) When I was 45, I had my first really serious illness. I had a sudden terrible reaction to a flu shot. I developed a sickness like flu except it didn’t get better. I ended up being bedridden, unable to sit up, and having very bad continual muscle and nerve pain that didn’t let up. It took four months for me to get back on my feet and another year to fully recover. That scared me—I wasn’t a super person anymore.

Then my mother, who was in her late sixties, started showing signs of heart disease and high blood pressure. I hadn’t seen this in my grandparents. I thought there were no health problems in my family, but suddenly they were there.

Ask: What have you experienced in your family—among your brothers, sisters, mothers, and fathers? What health problems are you seeing?

When people reach their late forties, their risk of three health problems increases.

  • Heart and blood vessel disease—disease of the heart and the circulation system. This hits men in their forties and women in their fifties (10–15 years later). Why? Estrogen protects women, and menopause removes that protection. Active heart disease has signs, including shortness of breath, chest pains. You know you have it.
  • High blood pressure—a silent disease, it involves the pressure on your blood vessels when the heart pumps and when it rests. When that pressure goes up, it damages your blood vessel system. Ultimately, it damages your eyes and your kidneys.
  • Diabetes—a silent disease, but it does have symptoms. (Show visual with three symptoms.) More and more people are showing up in doctors’ offices with the symptoms of all three of these diseases:
  • high blood cholesterol
  • elevated blood pressure
  • changes in insulin levels that affect blood glucose levels

Some common factors can put us at risk for these diseases. These are:

  • being middle-aged or older.
  • being of Hispanic, African American, or American Indian origin.
  • having a parent, brother, or sister with the disease.
  • being physically inactive.
  • being overweight, especially with the weight in the stomach.
  • eating too many calories, especially as fat.
  • eating too much sodium.
  • drinking too much alcohol.

You can’t do much about the first three factors, but you can change your habits so you don’t do the last five.

  • First, however, you have to see if the risk runs in your family. (Pass out Lesson 1, point out the family health history worksheet, and explain it. Show visual of family health tree. Ask participants to read the lesson and complete the worksheet by the next meeting, for sharing and comparison. Ask for a show of hands of who will complete the family health tree.)

I can answer questions now and also at the next session. We will taste a recipe then.

Group meeting #2—30 minutes

Materials

  • Copy of Lesson 1 for your use
  • Sign-in sheet
  • Overhead projector and visuals
  • Pineapple cake with paper plates, utensils, napkins
  • for everyone
  • Copies of recipe for pineapple cake (see Appendix 8)
  • Two bags of pretzels (different brands)
  • Can of refried beans, can of pinto beans
  • Containers of regular cream cheese, lite cream cheese

Visuals

  • Family health tree
  • Nutrition Facts panel (complete)
  • Saturated fat thermometer

Meeting objectives

  • Sign-in
  • Discuss family health history
  • Review basics of nutrition label for fat and sodium
  • Taste recipe: pineapple cake

Script outline

  • Greeting
  • Welcome to the meeting.
  • At the last meeting, you were asked to complete a family health tree. How many of you had time to do this? (Ask several of those raising hands what they found in their family tree. Let several people provide information about their families, if they wish.)
  • (Ask for and answer any questions about the lesson they read.)
  • Let’s review what the fact sheet about food labels says. (Ask participants to pull out the fact sheet “Using the Nutrition Facts panel to make smart choices.”) This fact sheet was designed to help you read nutrition labels, which are required on all packaged foods now.
  • (Download Nutrition Facts example . Show visual of Nutrition Facts panel.) To reduce your risk of heart disease, high blood pressure, and diabetes, you need to compare the fat and sodium content of foods. (Point to these numbers on the label.) For example, if you wanted to watch your sodium, you could com-pare the amount of sodium in a serving of each food.
  • (Pick up the bags of pretzels. Ask if someone will help you decide which bag of pretzels to buy.) Compare the sodium in a serving of pretzels. Does anyone know what you have to be careful of when comparing? (The serving size.) You can make a choice using the “mg of sodium” numbers.
  • You also can use the Percent Daily Value (%DV). (Refer to visual of Nutrition Facts Panel.) Medical experts recommend the great-est amount of fat we should eat daily to remain healthy. The amount is based on the number of calories we eat. The amount recommended if you eat 2,000 calories is shown here. (Point to lower part of panel.) We actually should aim to eat a little less than this.

The two fats to “watch out for” are called saturated fat and trans fat. They clog your arteries. The Nutrition Facts panel tells you the amount of saturated and trans fats provided in a serving of this food. (Point to saturated and trans fats on the panel.)

Medical experts recommend that we eat no more than 20 grams of saturated fat per day based on a 2,000-calorie intake. The %DV is the proportion or fraction of that recommended amount of saturated fat supplied by one serving of this food. You can see it this way. (Show visual of saturated fat thermometer.) A serving of this food contains 5 grams, and this is 25 percent or one-fourth of what is recommended for the day.

You can use this number in two ways. You can always choose the food with the lower %DV, or you can look for foods that supply no more than 10 per-cent of the daily value of saturated fat per serving. This rule of thumb helps you keep all of your food choices low in fat.

The amount of trans fat in a serving of this food is 2 grams. There is no Daily Value for trans fat. It is recommended that we keep our daily intake of trans fats as low as possible.

(Ask if there are questions. Repeat the explanation if necessary.)

Let’s apply this:

(Have members of the class compare olive oil and stick margarine for saturated and trans fats. Ask them to compare the Percent Daily Values for saturated fat.)

(Have class members compare regular cream cheese and lite cream cheese. What is the difference in saturated fat?)

Using the lite variety of cream cheese in recipes can provide flavor with less saturated fat. Let’s try this pineapple cake. It was made with lite cream cheese.

(Close with tasting and answering any questions. Invite participants back next week for the meetings about the next lesson.)

Group Presentation Scripts: Lesson

Group meeting #1—30 minutes

Materials

  • Copies of Lesson 2 for participants
  • Sign-in sheet
  • Overhead projector and visuals

Visuals

  • Two types of diabetes
  • Results of normal insulin action
  • Results of insulin action in diabetes
  • Symptoms of diabetes

Meeting objectives

  • Sign-in
  • Present main points with visuals
  • Pass out Lesson 2
  • Encourage to read lesson and complete personal risk assessment worksheet
  • Announce next meeting with food tasting

Script outline

Greetings

Today I will introduce you to a special disease risk—diabetes. (Show visual of two types of diabetes.) There are two types of diabetes:

  • Type 1, which occurs mainly in children and young adults. A child will completely lose the ability to make insulin. The symptoms are sudden, and to survive, the child now must take insulin. This also can happen to older adults, but it’s rarer.
  • Type 2, which occurs mainly in older adults. The ability to make insulin is reduced. Some-times type 2 diabetes can be controlled by diet and exercise; sometimes it will progress to requiring insulin.

Let’s just review a few key facts about your body. This will help you understand what insulin is and what leads to the symptoms of diabetes.

(Show visual of results of normal insulin action—two jars.)

After you eat a meal, your body breaks down the food into smaller subunits (sugar, amino acids, and fats) that are absorbed into your blood. Glucose, a sugar, is produced in greatest amounts after a meal. The first jar represents your blood immediately after a meal. The little dots represent glucose.

An organ called the pancreas makes insulin, which is released into the blood. The insulin helps your body organs (like the liver) and tissues (like muscles) take up the glucose and other food subunits. You need to absorb the glucose in the blood because it is the body’s main source of energy. (You also need to absorb the other food subunits for use by the tissues.)

The second jar represents your blood two to three hours after a meal. Most of the glucose has been absorbed. The level of glucose in the blood is low. Once most of the glucose is absorbed, no more insulin is released until you eat another meal.

(Show visual of results of insulin action in diabetes—three jars.)

When type 2 diabetes happens, the pancreas doesn’t release enough insulin, or the insulin released doesn’t work right. So the glucose level in the blood doesn’t go down the way it should.

The first jar represents your blood immediately after a meal. The little dots represent glucose. The second jar represents your blood two to three hours after a meal if you have type 2 diabetes. The third jar represents your blood two to three hours after a meal if you are healthy.

You can see that the level of glucose in the blood is higher than normal with type 2 diabetes. Your kidneys will dump this extra glucose from your blood-stream into your urine. But the level of glucose still will remain higher than normal. It is this high level of glucose in the blood that causes the damage in diabetes.

The symptoms of diabetes are shown here. (Show visual of symptoms of diabetes. Read the list.) You should be able to recognize these. Diabetes is more likely if these occur together. If these happen to you or someone in your family, go see a doctor.

Some people have a higher chance of getting type 2 diabetes. The characteristics that place you at greater risk are explained in the lesson. Those with these characteristics need to be especially watchful.

(Pass out the second lesson.) Please read the lesson and complete the worksheet. This worksheet is a fast test to see whether you are at risk for diabetes. (Ask for a show of hands of all who think they can complete the test for the next lesson.) The fact sheet provides information about artificial sweeteners. Please read this for next time. I can answer your questions on the lesson now or at that session, and we will taste another recipe then.

Group meeting #2—30 minutes

Materials

  • Copy of Lesson 2 for your use
  • Sign-in sheet
  • Overhead projector and visuals
  • Packages of Equal, Sweet-N-Low or Sugar Twin, Sunette, and Splenda
  • Chocolate whipped cream pie and paper plates, napkins, serving utensils
  • Copies of chocolate whipped cream pie recipe (see Appendix 8)

Visuals

  • Artificial sweeteners
  • Acceptable daily intakes
  • Saccharin
  • Aspartame
  • Acesulfame-K
  • Sucralose

Meeting objectives

  • Sign-in
  • Answer questions about diabetes and risk factors
  • Review risk assessment
  • Review and answer questions about artificial sweeteners
  • Taste recipe: chocolate whipped cream pie

Script outline

Greetings

How many of you completed that simple risk assessment worksheet? What did you find?

I will be reviewing briefly the information about artificial sweeteners, but first, what questions do you have about diabetes? I can’t help with treatment questions right now, but I can answer questions about the types of diabetes and the symptoms.

Lets just look briefly at artificial sweeteners. (Put packages of sweeteners out on table, saying their names.) These have been introduced by the food industry as a way to control calories, but a lot of people with diabetes use them as well. Their use is approved by the American Diabetes Association. Thinking about what diabetics can eat, however, has changed a lot in the last few years. Now diabetes professionals think that diabetics can eat sweets made with regular sugar as long as it is part of a meal. They do not recommend sweets as a snack.

The use of artificial sweeteners is a personal choice. Four are on the market, and several more are in the wings.

(Option 1: Show summary visual listing all four of the sweeteners. Explain the differences between them using just a few facts from the material that follows. Ask if participants have questions about these sweeteners and try to answer most of these. Then, show the last visual on acceptable daily intakes.)

(Option 2: Show a visual for each sweetener and provide more information about each. This leaves less time for questions, but may be better for audiences with few questions. Then, present the information on acceptable daily intakes.)

Saccharin has been around the longest. (Show visual of saccharin.) The tabletop sweeteners that contain it are Sweet-N-Low, Sugar Twin, and Sweetmate. It is calorie free and heat stable. A liquid form can be used in cooking.

This sweetener carries a warning statement on it because of a suggested link to bladder cancer in rats. In November 1997, a review board of the FDA voted to retain saccharin on a list as “reasonably anticipated to be a human carcinogen.” Saccharin does cross the placenta during pregnancy, so it is not recommended for use by pregnant women.

Saccharin is widely used in soft drinks and other processed foods. It will be listed in the ingredients.

Aspartame was introduced about 15 years ago and is sold under the brand name Equal. The major distributor is Monsanto, which operates a web site about Equal Zero Calorie Sweetener. (Show visual of Aspartame.)

Aspartame is used as a tabletop sweetener, but it is not calorie free. It is digested as a protein, so it provides 4 cal/gram just like sugar. Because it is so sweet, however, a very small amount (0.5 g/teaspoon) is packaged with lactose as a carrier in each packet. This provides about one-ninth the calories of an equal amount of sugar, or two calories per teaspoon. A teaspoon of sucrose would provide about 15 calories. It is not heat stable, so it cannot be used in baking; Monsanto, however, has published volumes of recipes that use it creatively in foods after they are cooked. It is not recommended for those with phenylketonuria. People with this disease cannot metabolize phenylalanine, one of the amino acids in aspartame.

Acesulfame-K is sold as a tabletop sweetener under the name of Sunett. (Show visual of Acesulfame-K.) This product contains no calories and is heat stable, so it can be used in cooking.

Sucralose is the most recent addition to the sweetener choices. (Show visual of sucralose.) It is found in the Splenda brand tabletop sweetener. Sucralose is good to use in cooking and baking because it is heat stable and does not produce a bitter aftertaste. It provides no calories and is found in thousands of processed foods and beverages. Everyone can safely consume this product, including pregnant and nursing women.

Acceptable Daily Intake: The FDA reviews the safety information provided by food companies developing sweeteners and, based on these studies, establishes an acceptable daily intake (ADI). FDA data suggest that the sweetener would cause you no problems if you consumed less than this amount daily over a lifetime. The acceptable daily intake also has a 100-fold safety factor. This means that scientists established the level at which a sweetener is toxic in test animals, and then they set the upper limit of what you might consume at 1/100 of that level. This chart shows you the levels just as they are presented in the lesson.

Except for saccharin, the ADIs are based on kilo-grams. One kilogram is 2.2 pounds. So to find your personal level, you would need to divide your weight by 2.2.

If you want to use any of these sweeteners in cooking, you just have to try them. Some people notice an aftertaste with saccharin or acesulfame-K. Don’t assume that you can just add these sweeteners and leave out the sugar. With many sweeteners, you have to replace the bulk that the sugar provides with something else, so recipes may call for cutting the sugar rather than complete substitution.

The recipe we will taste today uses sugar-free (and fat-free) chocolate instant pudding mix sweetened with both aspartame and acesulfame-K. See how you like it.

(Close: Answer any remaining questions. Invite participants back next week for the meetings about the next lesson.)

Group Presentation Scripts: Lesson 3

Group meeting #1—30 minutes

Materials

  • Copy of Lesson 3 for your use
  • Copies of Lesson 3 for participants
  • Sign-in sheet
  • Overhead projector and visuals
  • Flip chart or chalkboard

Visuals

  • Benefits of physical activity…
  • You get health benefits from…
  • If you have been inactive…
  • What are you doing already?

Meeting objectives

  • Sign-in
  • Present main points with visuals
  • Pass out Lesson 3
  • Encourage to read lesson and find target heart rate
  • Announce next meeting with food tasting

Script outline

Greetings

Today I want to introduce you (or reintroduce you) to the first key to physical wellness: daily physical activity (or exercise).

The benefits of daily activity recently were reviewed by a team of experts for the surgeon general of the United States. What do you think these benefits were? (Ask participants to tell you some of these benefits. Show benefits of physical activity visual. Compare what they suggested to the list on the visual.)

These experts also made a general exercise recommendation. What do you think that recommendation was? (Wait for responses.) The old recommendation for people was 20 minutes of vigorous exercise three or more times a week. Most people think of exercise as very structured—you go to a gym or class and suffer.

(Show you get health benefits from... visual.) Now the experts stress that you can get health benefits from participating in moderate physical activity most days of the week. These can be routine activities. Here are some examples of moderate exercise:

  • 30 minutes of brisk walking
  • 30–45 minutes of gardening
  • pushing a stroller for 1.5 miles in 30 minutes
  • 45 minutes of volleyball

The more you do, the greater the benefit.

Each of these activities uses about 150 calories. Doing them every day uses 1,000 calories in a week. (Show if you have been inactive... visual.) If you have been inactive, the experts recommend that you

  • focus on accumulating 30 minutes of activity per day.
  • combine several short periods of activity.

This means that you can count 15 minutes of walking, 5 minutes of stair climbing, and another 10 minutes of walking. Or you can combine time spent washing windows and raking leaves. But you should work up to setting aside a 30-minute period daily for some sort of activity.

  • Work on walking until you have a sufficient pace to make this aerobic. (Aerobic activities are activities that strengthen your cardiovascular system—the blood vessels and heart.) This might take a year.
  • Eventually combine three days of aerobic activity with two sessions of strength-building activities. Strength-building activities are similar to weight lifting. We need both cardiovascular strength and muscle strength, especially as we age. This will allow us to continue doing the activities of daily living longer.
  • But most of us are not completely inactive. (Show visual—what are you doing already?) We clean house, walk all over the grocery store, rake leaves, mow the lawn, shovel the snow. But we don’t do these every day.

Tell me about the physical activities you do now. (Go to the flip chart and record items provided by participants. Encourage them to explain what they do—daily and sporadically. Make a list.) Help me identify what you do every day. Which of these activities can be done every day? (Place a star next to that activity on the flip chart.)

Think about what you do now and see if you can identify which activities you do each day that can count toward the 30 minutes recommended. Or think about what you can do to get your 30 minutes of activity.

(Pass out the third lesson.) Please read the lesson and complete the worksheet, which is designed to help you find your target heart rate. You get the most benefit from activities if they are done at a certain heart rate. It’s easy to fill out this worksheet. We’ll talk about it next time. (Ask for a show of hands of who will complete the form.)

I can answer questions now and also at the next session. We will taste a recipe then.

Group meeting #2—30 minutes

Materials

  • Copy of Lesson 3 for your use
  • Sign-in sheet
  • Overhead projector and visuals
  • Stopwatch or wristwatch that indicates seconds
  • Banana delight plus small drinking cups and napkins
  • Copies of banana delight recipe (see Appendix 8)

Visuals

  • Finding your pulse (two options)
  • Walking feet
  • Television watcher (optional)

Meeting objectives

  • Sign-in
  • Present main points with visuals
  • Teach how to find pulse and record resting pulse
  • Encourage to walk
  • Taste recipe: banana delight
  • Remind of next meeting—final week

Script outline

Greetings

(Ask how many calculated their target heart rate. Ask a few to share their range. If necessary, go through a calculation with them. Encourage them to keep the target in mind.) One doesn’t get any cardiovascular benefit from activity unless it is done in a certain heartbeat range. You need to establish a number of beats per 10 seconds in your target heart range during your walk, for instance. Then you can check periodically (by taking your pulse) to see if you are in the range.

First, you need to know how to take your resting pulse. (Ask how many have ever taken their pulse.) Let’s review how to do this. (Show finding your pulse visuals.) You can take your pulse at two points—your wrist or your carotid artery.(First, lead participants through finding their pulse at their wrist. Make sure everyone finds it. Then, have them find their pulse in their neck. Make sure everyone can find it.)

Let’s test how you would do this. Find your pulse, and when I say “go,” start counting, saying 0 first. (Take a 10-second count. Ask for values. These should be within 10 to 15 beats if a person is normotensive. Thank participants for sharing their values.)

Walking is one of the easiest ways to get regular exercise. (Show walking feet visual. Ask: How many of you do this? Ask one who does this how she got started. Let her share her story with the group.)

What are the barriers you experience to starting walking regularly? (Close with a discussion of barriers. Ask participants how to get around some of the barriers mentioned.)

Optional: (Show television watcher visual.) TV can be a barrier if you don’t restrict the time when it is watched. Parents can restrict watching TV to certain hours of the day. You also can use the VCR to tape shows, and use these tapes as rewards. For instance, you can decide to watch TV only after 10 PM, as a sort of reward for getting the day’s work done. Or you can make a particular TV program that you watch on Wednesday evening into the reward for taking a walk on Monday, Tuesday, and Wednesday. This incentive system, or bargain with yourself, can help you get started.

If you exercise, you might get hungry. The recipes in this week’s lesson are snacks. This is an example of a snack that you can have in the refrigerator to satisfy your hunger after walking. (Pass out banana delight.)

(Close, answering any remaining questions.) During next week’s meetings about Lesson 4, we will review the second key to physical wellness.

Appendix 7

Group Presentation Scripts: Lesson 4

Group meeting #1—30 minutes Materials

  • Copy of Lesson 4 for your use
  • Copies of Lesson 4 for participants
  • Sign-in sheet
  • Overhead projector and visuals

Visuals

  • MyPyramid
  • Saturated and trans fats facts and goal
  • Saturated fat in a sandwich
  • Fiber facts and goal
  • Fiber in a day

Meeting objectives

  • Sign-in
  • Present main points with visuals
  • Pass out Lesson 4
  • Encourage to read lesson and complete the fiber counter
  • Announce next meeting with food tasting

Script outline

Greetings

Today I want to introduce or reintroduce you to the second key to physical wellness: eating more plant-based foods.

MyPyramid shows the foods we should eat each day as well as the proportion in which we should eat them. (Show the MyPyramid visual.) It’s really a new way to present the idea of food groups. If we follow the advice of MyPyramid, we are following the principals of healthful eating.

Let’s review MyPyramid briefly. (Ask the participants to help you.)

What food groups are represented in MyPyramid?

  • The three bands on the left represent grains, vegetables, and fruits—the plant-based foods. Foods from these three groups should provide more of our daily calories. We all need to eat more from these groups each day.
  • The skinny band in the middle represents oils. Examples are oil used in cooking, mayonnaise, salad dressings, soft margarine, and foods that are naturally high in oil such as oily fish, nuts, olives, and avocados. We only need to eat a small amount of these each day.
  • The two bands on the right represent the milk and meat and bean groups. These groups contain mainly foods from animals. The meat and bean group also includes nuts and beans. We only need to eat foods from these two groups a few times a day.

To ensure wellness, we all need to eat more foods from the grains, vegetables, and fruits groups. This will help us alter the amounts of saturated and trans fats and fiber. These nutrients have different effects on our health.

First, eating more plant-based foods helps us reduce our intake of saturated and trans fats.(Show saturated and trans fats facts and goals visual.) By raising the level of bad blood cholesterol (LDL), saturated and trans fats contribute directly to an increased risk of heart disease. Trans fat can also directly increase risk by lowering the level of good blood cholesterol (HDL). Since they narrow your arteries and make them less flexible, saturated and trans fats also can contribute to the development of high blood pressure.

Optional: Saturated fat is found in many animal and animal-derived foods. You can lower your saturated fat intake by choosing to eat lower-fat versions of these foods. Trans fat is found in many processed foods, solid margarines, and vegetable shortening. You can lower your trans fat intake by reading the Nutrition Facts panel to help you choose foods lower in trans fat and by using unsaturated vegetable oils and soft margarines.

The Daily Value for saturated fat is the recommend-ed amount of saturated fat to include each day in a healthful diet. If you eat 2,000 calories, for example, this would be 20 grams of saturated fat. If you ate 20 grams of saturated fat in a day, you would get 100 percent of the Daily Value. The goal is to actually eat less than 100 percent of the Daily Value. The Nutrition Facts panel can help you monitor this.

(Show saturated fat in a sandwich visual.) For in-stance, the ingredients in this sandwich provide you with the following percentages of the recommended daily amount of saturated fat:

  • Lebanon bologna—13 percent
  • processed cheese—20 percent
  • bread—0 percent
  • mayonnaise—9 percent

Eating this sandwich will give you 42 percent of the Daily Value for saturated fat. This means that you have 58 percent left before you hit 100 percent. On average, in a day, you want to have less than 100 percent DV of saturated fat. You want to come in under the goal.

Rule: Compare the amounts of saturated fat in foods and choose those in which the %DV in a serving is less than 10 percent. There is no Daily Value for trans fats. Health experts recommend that we keep our intake of trans fats as low as possible. Compare the Nutrition Facts panel of products to choose those with low amounts of trans fat.

Second, if you eat more plant-based foods, you are likely to eat more fiber. (Show fiber facts and goal visual.) Fiber helps us lower our risk of all three diseases—heart disease, high blood pressure, and diabetes.

Your goal is to eat at least 100 percent of the Daily Value for fiber, perhaps even 110 percent.

(Show fiber in a day visual.) This person ate cereal, bean soup, and prunes, which provided a total of 70 percent of the Daily Value. To get to 100 percent or over, he or she needs to eat several more food items that have fiber.

(Pass out Lesson 4.) Please read the lesson and complete the worksheet, which is a fiber counter. This will help you identify good sources of fiber and give you an indication of how much you eat in a day. Raise your hand if you will try to complete the fiber counter for our last meeting.

I can answer questions now and also at the next session. We will taste a high-fiber dish then.

Group meeting #2—30 minutes

Materials

  • Copy of Lesson 4 for your use
  • Copies of post-course questionnaire for participants
  • Sign-in sheet
  • Overhead projector and visuals
  • Your completed “fiber counter”
  • Three-bean and barley salad, serving dishes, and utensils
  • Copies of recipe for three-bean and barley salad (see Appendix 8)
  • Four types of canned soup that vary in saturated fat, trans fats, and fiber

Visuals

  • Good sources of fiber
  • Keys to wellness

Meeting objectives

  • Sign-in
  • Review fiber finder results
  • Conduct label reading exercise
  • Taste recipe: three-bean and barley salad
  • Complete post-course questionnaire
  • Pass out awards of completion and refrigerator posters

Script outline

Greetings

(Ask how many completed the fiber counter. If some did, ask them to describe what they found. If no one did this, pull out the one you completed and go through the exercise with them. Read off your foods and have participants find the amount of fiber. Total the amount and ask participants if this is enough. Ask for suggestions of what you could have eaten to get closer to 100 percent of the Daily Value.)

(Optional: Review good food sources of fiber, if participants don’t seem to know them. Show the good sources of fiber visual.) Fiber is found in:

  • fruit, especially if you eat the skin or tiny seeds.
  • vegetables, especially if you eat the stems, leaves, or flower buds (broccoli).
  • whole wheat bread or bread made with added bran or oatmeal (whole wheat must be the first ingredient).
  • certain hot cereals like oatmeal or processed cereals like All-Bran.
  • grains like rice, millet, kasha, barley, and beans.

Develop the habit of looking at the Daily Value for fiber on the labels of foods you choose.

(Set out the four types of canned soup.)

The worksheet in this lesson suggests that you concentrate on watching what nutrients on the Nutrition Facts panel of the foods you buy (saturated fat, trans fat, and fiber). Let’s do an exercise together. We need to compare these four soups and decide which is the best choice if we want to keep our saturated and trans fats down and our fiber intake up.

(Have a volunteer come forward and place the cans in order of increasing Percent Daily Value for saturated fat. Have another volunteer pick the soup that has the lowest amount of trans fat. Have someone else then decide which soup has the highest Percent Daily Value for fiber. Discuss which soup would be the best choice.)

Several things can contribute to the fiber in soup. Vegetables are one, and beans are another. Beans also can be used to make a salad. Many of you are familiar with three-bean salad. Let’s taste another version of this. (Pass out salad samples.) This salad contains three types of beans, as well as barley.

This is the end of Your Wellness Roadmap. I hope this has helped you focus on a few basic things you can do to improve your chances of good health. Let’s review what those basic things were.

(Show keys to wellness visual.) This lesson set emphasized four things for you to do:

  • Find out your family health history.
  • Evaluate your own personal risk of diabetes.

Then be proactive—start or work harder to protect your health by:

  • being physically active.
  • eating more plant-based foods.

Are there any more questions about the lessons?

I would appreciate your completing this simple evaluation. It will help us plan any revisions. (Pass out and then collect evaluations.)

Close: Thank you for attending our sessions. I enjoyed meeting with you. As a final gift to you, here is an award of completion and a refrigerator poster to remind you to be active.

Appendix 8

Recipes for Group Presentations

  • Lesson 1: Pineapple Cake
  • Lesson 2: Chocolate Whipped Cream Pie
  • Lesson 3: Banana Delight
  • Lesson 4: Three-Bean and Barley Salad

Pineapple Cake

  • 2 cups flour
  • 1 1/2 cups sugar
  • 2 tsp baking soda
  • 1 cup walnuts, chopped
  • 2 med. eggs
  • 1 (20 oz) can crushed pineapple, in own juice

Icing:

  • 2 oz light cream cheese
  • 1/2 cup confectioners sugar
  • 1/2 tsp vanilla
  • Yield: 24 servings

Beat eggs and sugar. Add flour, baking soda, and pineapple and juice. Mix until moist. Add walnuts. Place in a 9-by-13-inch pan prepared with vegetable spray. Bake at 350 degrees for 20 to 30 minutes. Let cool. Prepare icing. Mix softened cream cheese with vanilla and sugar until smooth. Spread evenly over top of cake. Store leftovers in refrigerator.

Nutrient content per serving:

  • 151 calories
  • 4 g fat
  • 27 g carbohydrates
  • 3 g protein
  • 87 mg sodium
  • 17 mg cholesterol
  • 1 g dietary fiber

Chocolate Whipped Cream Pie

  • 1 vanilla wafer crumb crust (recipe follows)
  • 1 1/5 oz package sugar-free chocolate instant pudding mix
  • 2 cups skim milk
  • 1 1/2 cups frozen whipped topping

Yield: 6 servings

Prepare vanilla wafer crumb crust (reserve 2 Tbsp crumb mixture). Pack into a 9-inch pie shell and chill in refrigerator at least 2 hours before making filling. Prepare pudding according to package directions using the 2 cups skim milk. Allow to cool for one-half hour. Spoon pudding carefully into chilled pie shell and chill until pudding is firm. Spread whipped topping gently across top of the pie with a small spatula. Scatter the reserved crumb mixture on top as a garnish. Store leftovers in refrigerator.

Nutrient content per serving:

  • 242 calories
  • 14 g fat
  • 26 g carbohydrates
  • 5 g protein
  • 350 mg sodium
  • 9 mg cholesterol
  • 1 g dietary fiber

Vanilla Wafer Crumb Crust

  • 2 Tbsp margarine, melted
  • 30 vanilla wafers*
  • 1/4 tsp pure vanilla extract

Yield: One 9-inch pie shell

Prepare a 9-inch pie plate by rubbing inside, bottom, and sides with 1 tsp of the margarine; set aside. Crush vanilla wafers to make very fine crumbs (1 1/4 cups). Place crumbs in a large bowl; combine vanilla and melted margarine and drizzle all over crumbs. Mix thoroughly with a blending fork to make sure all is well blended. Remove about 2 Tbsp of crumb mixture and set aside to use as a garnish on top of pie. With back of a large spoon, press remaining crumbs evenly all over bottom and sides of prepared pie pan. Chill in refrigerator 2 hours or longer before filling.

*Some brands of vanilla wafers contain trans fats. Nabisco Nilla Wafers do not.

Banana Delight

  • 1 tsp cinnamon
  • 1 cup strawberry lowfat yogurt
  • 1 large banana, sliced

Yield: 4 servings

Mix cinnamon and yogurt. Fold in banana slices. Chill.

Optional: Blend all ingredients in a blender until smooth. Serve as a beverage.

Nutrient content per serving:

  • 94 calories
  • 1 g fat
  • 20 g carbohydrates
  • 3 g protein
  • 36 mg sodium
  • 3 mg cholesterol
  • 1 g dietary fiber

Adapted from Sunshine Meals, State of Florida, Department of Health and Rehabilitative Services, 1987.

Three-Bean and Barley Salad

  • 2 cups pinto beans, canned or cooked
  • 2 cups garbanzo beans, canned or cooked
  • 2 cups black beans, canned or cooked
  • 4 cups cooked barley
  • 6 Tbsp onions, chopped fine
  • 4 tsp garlic paste
  • 1 cup tomato, diced
  • 3 Tbsp fennel, fresh chopped
  • 3 Tbsp basil, fresh chopped
  • 3 Tbsp oregano, fresh chopped
  • 1 Tbsp dry mustard
  • 1 Tbsp salt (or less)
  • 1 Tbsp black pepper
  • 1 cup balsamic vinegar
  • 1/4 cup olive oil

Yield: 12 servings (1/2 cup)

Rinse canned beans. Cook barley according to directions. Combine beans and barley in a bowl; set aside. In hot pan, add olive oil, then add onions and garlic and cook until onions are transparent. Mix all spices with tomatoes and add remaining ingredients. Heat until warmed through. Pour over beans and barley and mix well. Serve. Refrigerate leftovers.

Nutrient content per serving:

  • 243 calories
  • 6 g fat
  • 40 g carbohydrates
  • 10 g protein
  • 556 mg sodium
  • 0 mg cholesterol
  • 8 g dietary fiber

Appendix 9

Evaluation Forms

Download the evaluation forms .

Authors

More by J. Lynne Brown, Ph.D., R.D.